Gangjee T, Colaizzo R, von Recum A F
Ann Biomed Eng. 1985;13(5):451-67. doi: 10.1007/BF02407772.
Percutaneous devices permanently protrude through a surgically created defect in the skin. Usually they provide a connection for intracorporeal implants or organs with external devices. The skin penetration area presents unique medical problems. The interfacing tissue usually does not heal and seal to the implant but remains a focus of constant acute or chronic inflammation and eventually breaks down because of infection. This pathophysiological phenomenon has been studied previously with qualitative light microscopical methods. A large number of empirical studies have attempted to improve the implant-epidermal seal with various implant materials and designs. To allow systematic studies of the effect of biomaterials on implant-epidermal interface phenomena, quantitative histological parameters were evaluated. Test implants were made from Dacron velour and placed in dogs, goats, and rabbits for various preselected periods to determine time- and species-related histopathological variations. Results showed that the degree of connective tissue "maturity" within the pores of the implant appears to be related to the concentration of giant cells and polymorphonuclear granulocytes (histocompatibility). The process of epidermal proliferation around porous percutaneous implants appears to follow certain fixed patterns under different conditions that are accompanied by expelling forces, resulting in an outward movement of the implant until it is completely extruded. The presence of microhematomas throughout the implantation period indicates that mechanical forces disrupt interfacial tissue bridges. The basic histological processes are qualitatively the same in the three animal species studied. However, there are quantitative differences with regard to epidermal migration rate and connective tissue maturation within the implant pores, which may explain the different failure modes and times observed among species. The study indicated that percutaneous healing may be directly related to histocompatibility of the implant material, mechanical interfacial forces, and epidermal proliferative patterns. The first two may eventually be controlled by selection of optimal implant materials and device configurations. The control of epidermal migration, however, will be the key to prolonging percutaneous implant life.
经皮装置永久性地穿过皮肤外科手术造成的缺损处。通常，它们为体内植入物或器官与外部装置提供连接。皮肤穿透区域存在独特的医学问题。界面组织通常不会愈合并与植入物密封，而是始终是急性或慢性炎症的焦点，最终因感染而破裂。此前已采用定性光学显微镜方法研究了这种病理生理现象。大量实证研究试图用各种植入材料和设计来改善植入物与表皮的密封。为了系统研究生物材料对植入物与表皮界面现象的影响，评估了定量组织学参数。测试植入物由涤纶绒制成，并在狗、山羊和兔子体内放置不同的预选时间段，以确定与时间和物种相关的组织病理学变化。结果表明，植入物孔隙内结缔组织的“成熟度”似乎与巨细胞和多形核粒细胞的浓度（组织相容性）有关。多孔经皮植入物周围的表皮增殖过程在不同条件下似乎遵循某些固定模式，同时伴有排出力，导致植入物向外移动，直至完全挤出。在整个植入期都存在微血肿，这表明机械力会破坏界面组织桥。在所研究的三种动物物种中，基本的组织学过程在性质上是相同的。然而，在表皮迁移率和植入物孔隙内结缔组织成熟度方面存在定量差异，这可能解释了不同物种间观察到的不同失败模式和时间。该研究表明，经皮愈合可能与植入材料的组织相容性、机械界面力和表皮增殖模式直接相关。前两者最终可能通过选择最佳的植入材料和装置配置来控制。然而，控制表皮迁移将是延长经皮植入物使用寿命的关键。
