Elshal E E, Inokuchi T, Yoshida S, Sekine J, Sano K, Ninomiya H, Ikeda H
Second Department of Oral and Maxillofacial Surgery, Nagasaki University School of Dentistry, Japan.
Int J Oral Maxillofac Surg. 1998 Apr;27(2):141-8. doi: 10.1016/s0901-5027(98)80314-7.
Epithelialization of subcutaneous fascial flaps and muscle-only flaps used for reconstruction of the oral mucosa were studied in a rabbit model. Angiography was performed to help to design a subcutaneous cervical fascial flap and a cleidomastoid muscle-only flap. These flaps were transferred into a mucoperiosteal defect on the mandibular alveolus. The flaps were gradually infiltrated by acute inflammatory cells from the periphery and then replaced by granulation tissue originating from the oral mucosa. The epithelialization was by secondary intention. An epithelial tongue from the surrounding epithelium migrated onto the granulating flaps with eventual coverage after three weeks. After two months, the muscle-only flap was covered by a poorly organized epithelium, different from the highly uniform epithelium in the fascial flap. The granulation tissue which replaced the muscle-only flap matured to fibrous tissue, associated with severe contraction. This was characterized by dense regular collagen fibers, no elastic fibers, and few capillaries, while the fibrous tissue which replaced the fascial flap was characterized by random collagen and elastic fiber morphology and numerous dilated blood vessels, and was associated with mild contraction. This experiment supports the view that the different extracellular matrices of these flaps may play a role in epithelial configuration and contraction.
在兔模型中研究了用于口腔黏膜重建的皮下筋膜瓣和单纯肌肉瓣的上皮化过程。进行血管造影以辅助设计皮下颈筋膜瓣和单纯胸锁乳突肌瓣。将这些皮瓣转移至下颌牙槽黏膜骨膜缺损处。皮瓣逐渐被外周的急性炎症细胞浸润，随后被源自口腔黏膜的肉芽组织替代。上皮化通过二期愈合完成。来自周围上皮的上皮舌迁移至肉芽皮瓣上，三周后最终实现覆盖。两个月后，单纯肌肉瓣被组织不良的上皮覆盖，这与筋膜瓣中高度均匀的上皮不同。替代单纯肌肉瓣的肉芽组织成熟为纤维组织，伴有严重收缩。其特征为密集规则的胶原纤维、无弹性纤维且毛细血管稀少，而替代筋膜瓣的纤维组织的特征是胶原和弹性纤维形态不规则且有大量扩张血管，伴有轻度收缩。该实验支持以下观点，即这些皮瓣不同的细胞外基质可能在上皮形成和收缩中发挥作用。
