Johnson J B, Ichinose H, Obagi Z E, Laub D R
Louisiana State University Medical Center, New Orleans, USA.
Ann Plast Surg. 1996 Mar;36(3):225-37. doi: 10.1097/00000637-199603000-00001.
Currently, no documentation correlates histological changes with clinical signs of depth of the trichloroacetic acid peel. Obagi identified clinical signs of depth of injury following topical trichloroacetic acid application, employing prepeel conditioning and a method for slowing trichloroacetic acid action. A three-part study of 20 patients was undertaken to determine whether Obagi's visual and palpatory signs of depth correlated histologically with depth of peel. Also analyzed were physiological mechanisms associated with these signs. Patients were pretreated and biopsy specimens were harvested before and after modified trichloroacetic acid peeling. The results largely confirmed the validity of Obagi's observations regarding the method of trichloroacetic acid peel described. These clinical signs are verified by histology and correlated with some findings by electron microscopy. Differentiation of papillary from upper reticular dermal penetration is particularly useful. Physiological explanations for the phenomena observed are proposed. The specificity and safety of peels may be improved with these criteria.
目前，尚无文献将三氯乙酸化学剥脱的组织学变化与剥脱深度的临床体征相关联。欧邦琪（Obagi）通过术前预处理和一种减缓三氯乙酸作用的方法，确定了局部应用三氯乙酸后损伤深度的临床体征。开展了一项针对20名患者的三部分研究，以确定欧邦琪的视觉和触诊深度体征在组织学上是否与剥脱深度相关。还分析了与这些体征相关的生理机制。对患者进行预处理，并在改良三氯乙酸剥脱前后采集活检标本。结果在很大程度上证实了欧邦琪关于所述三氯乙酸剥脱方法观察结果的有效性。这些临床体征通过组织学得到验证，并与电子显微镜下的一些发现相关。区分乳头层与真皮上层网状层的穿透情况特别有用。对观察到的现象提出了生理学解释。采用这些标准可能会提高化学剥脱的特异性和安全性。
