游离皮片骨面埋置后骨-皮重附着的实验研究

Experiment of new attchment between bone and skin after free skin flap on the bone

目的:通过游离皮片骨面埋置植皮的实验研究,探索骨面埋置植皮的可行性;使移植皮肤和骨面间形成较为牢固的连接,满足种植床的软组织要求。方法:选择30只健康6月龄新西兰白兔(雌雄不限),随机分成A、B、C共3组,每组10只。分别在双侧下颌角处骨面埋置全厚、中厚皮片及滑行皮瓣覆盖双侧下颌角处骨面。实验组术后4周二期手术将移植皮片暴露,6周后处死所有动物,切取标本。进行大体标本观察,组织学观察(脱钙HE染色、MASSON染色)、透射电镜检查,进行统计学分析。结果:A组成活9例,B组成活17例,C组成活19例,χ2检验分AB、AC、BC三组两两比较成功率,AB两组及AC两组有统计学意义,BC两组无统计学意义。大体标本观察见成活皮肤色泽、质地好,与骨面结合紧密,成活皮肤无明显活动度;HE染色及MASSON三色法染色见皮肤层次分明,与骨面无间隙,皮肤内血管丰富;透射电镜下观察见真皮层与骨皮质结合紧密,未见间隙,真皮内胶原纤维部分穿入骨面,形成类似于骨膜附着的沙比纤维,提示皮肤-骨面连接紧密,且连接强度较高。结论:中厚皮片骨面埋置植皮是一种可行的方法。

Objective By means of experimental study of free skin graft on the bone surface buried in the soft tissue,the feasibility of the method mentioned above is explored.Fairly firm connection between transplanted skin and bone surface is formed so that soft tissue meets the requirements of the implant site.Methods 30 healthy 6-month-old New Zealand white rabbits regardless of gender difference have been divided into 3 groups（A,B and C） randomly with 10 in each group.Full-thickness skin graft,split-thickness skin graft and skin flap have been transplanted on the bilateral mandibular angle respectively.4 weeks after the first surgery,the skin grafts of the rabbits in the experimental groups（Group A and B） were exposed by the second operation.All rabbits were executed 6 weeks after the first surgery to obtain the specimens.General specimen observation,histological observation（HE and MASSON） and transmission electron microscope observation were carried out,followed by statistical analysis.Results There were 9,17 and 19 successful cases in Group A,B and C respectively.Success rate was analyzed using χ2 test between the group pairs of AB,AC and BC.Both group pairs of AB and AC showed significant difference while the group pair of BC showed did not.In the general specimen observation,the survived skin was found to have good color and texture and connect closely to the surface of the bone.No obvious mobility was observed either.In the HE and MASSON methods observation,the survived skin showed distinctive layers and have a close connection with the bone surface.There were abundant blood vessels within the skin.In the transmission electron microscope observation,the dermis layer and bone cortex appeared to have close connection.Collagen fiber in the dermis layer ripped into the surface of bone,forming the structure resembling the Sharpey fiber in general periosteum.This indicated a close connection between the skin and bone surface with relatively high connection strength.Conclusion Split-thickness skin graft on the bone with soft tissue cover is a feasible method.