CAJ | 학술논문

目的观察扩张皮肤移植后的变化,探讨扩张皮肤远期回缩的机制.方法选用8条普通成年犬,在每条犬背部设计4个解剖部位相对应的皮瓣下置入扩张器,注水8周后行扩张器取出术,随机将8条犬分为4组,每组2只,在犬皮肤扩张移植时和移植后3、6周及3、6个月检测其组织学、电镜变化及α-平滑肌肌动蛋白(αt-SMA) mRNA和蛋白的表达.结果表皮层和真皮层移植后6个月基本恢复正常;电镜下可见扩张后表皮细胞排列紧密,真皮层于扩张后成纤维细胞数量较多,功能活跃,真皮深层有肌成纤维细胞存在,其胞质内微丝明显.移植后3个月成纤维细胞功能恢复正常,胶原排列趋于整齐,肌成纤维细胞消失,组织学在3～6个月时恢复到对照组水平.α-SMA mRNA和蛋白水平的表达在3周后达到最高,分别为1.204 ±0.011和1.533 ±0.012,3个月时明显降低为0.910±0.008和0.519±0.007,差异有统计学意义(P＜0.05),α-SMA mRNA和蛋白水平变化趋势一致.结论扩张皮肤的组织学变化在移植后6个月逐渐恢复正常,扩张皮肤远期回缩的机制可能与扩张皮肤内的肌成纤维细胞数量和功能状态有关.
목적 관찰확장피부이식후적변화,탐토확장피부원기회축적궤제.방법 선용8조보통성년견,재매조견배부설계4개해부부위상대응적피판하치입확장기,주수8주후행확장기취출술,수궤장8조견분위4조,매조2지,재견피부확장이식시화이식후3、6주급3、6개월검측기조직학、전경변화급α-평활기기동단백(αt-SMA) mRNA화단백적표체.결과 표피층화진피층이식후6개월기본회복정상;전경하가견확장후표피세포배렬긴밀,진피층우확장후성섬유세포수량교다,공능활약,진피심층유기성섬유세포존재,기포질내미사명현.이식후3개월성섬유세포공능회복정상,효원배렬추우정제,기성섬유세포소실,조직학재3～6개월시회복도대조조수평.α-SMA mRNA화단백수평적표체재3주후체도최고,분별위1.204 ±0.011화1.533 ±0.012,3개월시명현강저위0.910±0.008화0.519±0.007,차이유통계학의의(P＜0.05),α-SMA mRNA화단백수평변화추세일치.결론 확장피부적조직학변화재이식후6개월축점회복정상,확장피부원기회축적궤제가능여확장피부내적기성섬유세포수량화공능상태유관.
Objective To investigate the biological changes after transplantation of expanded skin and discuss the mechanism of skin retraction for further improving the clinical efficacy.Methods Eight adult dogs were used.On the back of each animal,4 rectangular expanders were implanted beneath the skin and panniculus carnosus bilaterally.Final injection was terminated through weekly injection over an 8-week period.Dogs were divided into 4 groups (n =2 each).At 3rd week,6th week,3rd month and 6th month after inset of the flaps respectively,the skin-flap area was measured with histological examination stained with hematoxylin and eosin (HE),ultrastructural observation under transmission electron microscope,and the expression level of α-smooth muscle actin (α-SMA) mRNA and protein.Results The epidermis and dermis of expanded flap returned to normal 6 months after the flap inset.The ultrastructural study revealed the following changes.In the epidermis,the intracellular spaces in all layers of expanded epidermis were significantly reduced.The expanded dermis contained large bundles of compacted collagen fibers which lined in disordering fibroblasts.A few myofibroblasts were seen in deeper part of the dermis.Three months post-inset,the fibroblasts functioned normally.Collagens lined themselves regularly and myofibroblasts disappeared.The α-SMA mRNA expression in skin expansion was significant between high expression (1.204 ± 0.011) at 3rd week and low expression (0.910 ± 0.008) at 3rd month.The expression of protein was same between (1.533 ±0.012) at 3rd week and (0.519 ±0.007) at 3rd month.The change trend of α-SMA mRNA and protein was consistent (P ＜ 0.05).Conclusion The changes after skin expansion returned to normal after 6 months,expanded skin had certain degree of contraction after transplantation,which may be related to the appearance and persistence of myofibroblasts in dermis.