Berry D P, Harding K G, Stanton M R, Jasani B, Ehrlich H P
Department of Pathology at the University of Wales College of Medicine, Cardiff, United Kingdom.
Plast Reconstr Surg. 1998 Jul;102(1):124-31; discussion 132-4. doi: 10.1097/00006534-199807000-00019.
The closure of ungrafted sacrococcygeal pilonidal sinus excisional wounds was studied in 15 patients. Wound punch biopsies were taken on a regular basis, and histologic sections were made. To document changes, computer-assisted morphometric image analysis was employed. Initial average wound depth was 37.8 +/- 4.6 mm, and complete closure (0 wound depth) was reached by 68 days. Wound contraction contributed 88 percent to wound closure, whereas the deposition of scar only contributed 12 percent. Maximum cells density within granulation tissue was reached by day 18. Myofibroblasts, identified by alpha-smooth muscle actin immunostaining, first appeared on day 11. Unlike those observed in laboratory animals, myofibroblasts were a minor cell population of granulation tissue, never exceeding 10 percent of the cells. The pattern of collagen fiber organization was documented by polarized light microscopy of Sirius red-stained sections. Early granulation tissue collagen fibers demonstrated a fine greenish birefringence, whereas more mature granulation tissue collagen fibers were thicker, displaying orange-yellowish birefringence. Myofibroblasts were associated exclusively with thicker collagen fibers, whereas fibroblasts were associated with both fine and thick collagen fibers. It is proposed that human wound contraction involves a volume change whereby normal dermal and adipose tissues are pulled into the defect by forces generated within fibroblasts.
对15例患者未移植的骶尾部藏毛窦切除伤口的愈合情况进行了研究。定期进行伤口穿刺活检并制作组织学切片。为记录变化情况，采用了计算机辅助形态计量图像分析。伤口初始平均深度为37.8±4.6毫米，68天时实现完全愈合（伤口深度为0）。伤口收缩对伤口愈合的贡献为88%，而瘢痕形成仅占12%。肉芽组织内细胞密度在第18天达到最大值。通过α-平滑肌肌动蛋白免疫染色鉴定的肌成纤维细胞在第11天首次出现。与在实验动物中观察到的情况不同，肌成纤维细胞是肉芽组织中的少数细胞群体，从未超过细胞总数的10%。通过天狼星红染色切片的偏振光显微镜观察记录胶原纤维的组织模式。早期肉芽组织胶原纤维呈现出细微的绿色双折射，而更成熟的肉芽组织胶原纤维更粗，呈现橙黄色双折射。肌成纤维细胞仅与较粗的胶原纤维相关，而成纤维细胞与细的和粗的胶原纤维均相关。有人提出，人类伤口收缩涉及体积变化，即正常的真皮和脂肪组织被成纤维细胞产生的力量拉入缺损处。
