Schmidt B L, Pogrel M A, Regezi J A, Smith R, Necoechea M, Kearns G, Azaz B
Department of Oral and Maxillofacial Surgery, University of California, San Francisco, USA.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997 Feb;83(2):206-14. doi: 10.1016/s1079-2104(97)90007-x.
SPECIFIC AIM. To evaluate the take of skin grafts on conventionally prepared beds and on beds prepared by a carbon dioxide laser, with and without abrasion of the bed. SIGNIFICANCE. Graft take is dependent on hemostasis, immobility, and nutrition of the graft. Scalpel excision of the skin graft can be associated with hemostatic difficulties and laser treatment of the skin graft bed can provide hemostasis. Abrasion of the bed after laser treatment may then be a means of opening small lymphatic and blood vessels to maintain the graft. Laser treatment followed by abrasion of the bed may provide an ideal graft base before suturing of the skin graft. MATERIAL AND METHODS. Full-thickness skin grafts were taken with a scalpel at three sites on the dorsal skin of 24 guinea pigs. The three beds were prepared with pressure alone to provide hemostasis, laser vaporization followed by abrasion with gauze to produce pinpoint bleeding, and laser vaporization alone. The original skin from each of the sites was then sutured back in place. At postoperative days 1, 3, 5, 10, 21, and 35 the graft sites were assessed clinically for "take." Laser Doppler measurements were also made to evaluate blood flow. Histologic sections of the three sites were prepared. Immunohistochemical analysis was performed to evaluate cell proliferation and angiogenesis. RESULTS. For the animals sacrificed through day 10 the rate of take for the sites that were not lased was 100%. For the sites that were lased alone and lased and abraded the rate of take was 71% with no difference between the two techniques. The lased sites demonstrated increased inflammatory response and graft necrosis. Immunohistochemical analysis showed increased cellular proliferation and angiogenesis in the bed. DISCUSSION. Grafts take best on a scalpel-prepared bed. Laser preparation of the bed, with or without abrasion, demonstrates decreased "take." Therefore the carbon dioxide laser is not a recommended means to take a graft or prepare the graft bed.
具体目标。评估在传统制备的创面以及经二氧化碳激光制备的创面上进行皮肤移植的情况，创面有无进行磨削处理。意义。移植皮片的存活取决于止血、固定以及皮片的营养状况。用手术刀切除皮肤移植供区可能会伴有止血困难，而对皮肤移植创面进行激光治疗可实现止血。激光治疗后对创面进行磨削可能是一种开放小淋巴管和血管以维持移植皮片存活的方法。在缝合皮肤移植片之前，先进行激光治疗然后对创面进行磨削可能会提供理想的移植床。材料与方法。在24只豚鼠背部皮肤的三个部位用手术刀切取全厚皮片。三个创面分别采用单纯压迫止血、激光汽化后用纱布磨削以产生点状出血、单纯激光汽化的方法进行制备。然后将每个部位的原皮肤缝合回原位。在术后第1、3、5、10、21和35天，对移植部位进行临床评估以确定“存活情况”。还进行激光多普勒测量以评估血流情况。制备三个部位的组织学切片。进行免疫组织化学分析以评估细胞增殖和血管生成情况。结果。对于在第10天前处死的动物，未进行激光处理的部位移植皮片存活成功率为100%。对于仅进行激光处理和既进行激光处理又进行磨削处理的部位，移植皮片存活成功率为71%，两种技术之间无差异。激光处理的部位显示炎症反应增加和移植皮片坏死。免疫组织化学分析显示创面细胞增殖和血管生成增加。讨论。移植皮片在手术刀制备的创面上存活情况最佳。无论有无磨削处理，激光制备创面的移植皮片存活成功率均降低。因此，二氧化碳激光不是推荐的用于获取移植皮片或制备移植创面的方法。
