MEDPOR材料片薄筋膜覆盖的实验研究

Super-thin coverage of MEDPOR ear framework:an animal study

目的 试以极薄的颞深筋膜替代较厚的颞浅筋膜覆盖MEDPOR耳廓支架 ,以求能更清晰地显露支架的仿真外观。但颞深筋膜不包含轴型血管 ,成岛状瓣后其血运不足以支持移植皮片成活。该实验观察能否通过MEDPOR相互交通的细密孔隙 ,以毛细血管长入的方式 ,与支架背面的颞浅筋膜建立血运联系 ,以支持移植皮片成活。方法 在兔背部深、浅两层筋膜之间插入 30mm× 15mm× 2mm的MEDPOR片。对照组即时于深筋膜深面掀起 ,上植皮片 ;实验组原位缝回 ,3周后再于深筋膜深面掀起 ,切断深筋膜蒂部后 ,于深筋膜深面植皮 ,观察两组植皮成活情况。结果 对照组兔 6只 ,4只皮片全部坏死 ,2只植皮 80 %以上坏死 ;实验组兔 6只 ,皮片全部成活。结论 不含轴型血管的深筋膜成瓣后 ,其血运不足以支持皮片成活 ;深、浅两层筋膜之间 3周内可通过一定厚度的MEDPOR材料的孔隙建立血运联系 ,且仅依靠此新建立的跨MEDPOR的血运联系 ,即能支持深筋膜上所植皮片的成活。

Objective It would make a reconstructed ear more naturally when deep temporal fascia, which is much thinner, cover the MEDPOR ear framework instead of superficial temporal fascia. However, without an axial vascular supply, should skingraft be taken on the islanded deep temporal fascia flap? Perhaps this fascia flap could get a new blood supply from the underlying superficial temporal fascia through the porous framework after a period of time. This study was to test its possibility. Methods A piece of 30×15×2mm MEDPOR material was inserted between superficial and deep fascia on the back of a rabbit. In control group, skin graft on the deep surface of deep fascia was operated at once; in experiment group, the incision was sutured and the skin graft was operated 3 weeks later in the same incision. Results Skin grafts were taken in all the 6 rabbits in the experiment group. 80%～100% of necrosis occurred in all the 6 rabbits of control group. Conclusion Without an axial vascular supply, skin graft can not survive on the islanded deep fascia flap. This fascia flap can get a new blood supply from the underlying superficial fascia through the porous MEDPOR material, through which small vessels grow between the two fascia after 3 weeks.