| BackgroundThe repair of a various large wounds of skin and soft tissue, especially for deepblood vessels, nerves and bone exposed or abdominal wall defect in war and naturaldisaster conditions is a difficult problem to solve.ObjectivesThe combine use of autologous skin transplantation and artificial dermis techniqueprovides a new prefabricated flap to repair bone exposed deep wounds or complextraumatic war defects.MethodSelect105healthy SD rats, male rats aged6to8weeks, weighing150-200g. Taking25were randomly divided into A, B, C, D, E five groups (group A for artificialprefabricated flap, group B for traditional prefabricated flap, group C for artificial dermisunder skin directly repair, group D for artificial dermis under subcutaneous directlyrepair, group E for skin graft). The right ankle joint in the rat on each side cut1cmincision, remove the skin, subcutaneous, fascia and other soft tissue to form a tendon,bone exposed complex wound model. Midline of the penis from the top3cm,1cm to theright leg wound size take rat skin to get wet gauze wrap and set aside. Group A use thefascia tissue and the same size artificial dermis covering the wound and the thin skingraft repair after replantation in artificial dermis surfaces suture fixation. After4weeks,the complete artificial prefabricated flap taking off from the surrounding fascial flapformation superficial inferior epigastric artery and vein as fascial pedicle flap. Through1.5cm wide subcutaneous tunnel and sutured, abdominal wound sutured directly. GroupB without artificial dermis, and the rest step are identical with Group A. Group C useabdominal fascial flap and formation superficial inferior epigastric vessel as fascialpedicle flap. Through subcutaneous tunnel width of1.5cm sutured above it into samesize artificial dermis, suture skin to repair the wound, abdominal wounds sutured directly.Group D use the same size artificial dermis, use abdominal fascial flap and formationsuperficial inferior epigastric vessel as fascial pedicle flap. Through subcutaneous tunnelwidth of1.5cm sutured, suture skin to repair the wound, abdominal wounds sutureddirectly. Group E remove the skin of the abdominal wall transplanted directly on thewound and sutured. After the completion of each group, sterile gauze was used to thewound. Adhesive bandage fix the leg wound in functional position and use the rat protection cover. The first28days after each group last surgery were performed bygeneral observation. Artificial flap observation healed in each group and chose thecompletely healed groups, then made40in the same way and then test the legs activityobservation, swelling observation, histological observation, radiological methods ofmeasurement and observation.Results1. General observation: The28days after surgery, wounds of group A and group Bwere healing but wounds of group C, D, E were not healing. Then group A and group Bwere measured contrast.2. Legs activity observation: The28days after the result of the ankle joint range ofmotion using the t-test. A set of results is shown that the left and right ROM of group A,the left and right ROM of group B,the left ROM of group A and group B, the right ROMof group A and group B comparisons showed no significant difference (P>0.05).3. Legs swelling observation: After measure around the perimeter of the rats, thestatistical results ankle joints using t-test. Group A pre-operation and7days afteroperation,7days after operation and14days after operation,14days after operation and21days after operation,21days after after operation and28days after operation werestatistically significant (P<0.05). Pre-operation and28days after operation were notstatistically significant (P>0.05). Group B pre-operation and7days after operation,7days after operation and14days after operation,14days after operation and21days afteroperation,21days after after operation and28days after operation were statisticallysignificant (P<0.05).Pre-operation and28days after operation were not statisticallysignificant (P>0.05). Between group A and group B, pre-operation,7days after operation,14days after operation,21days after after operation and28days after operation were nostatistical significance (P>0.05).4. Histological observation: Measuring CD31+immunohistochemical positivecumulative integrated optical density (IOD), IOD values between the groups werecompared using t-test.7days after operation and14days after operation,14days afteroperation and21days after operation were statistically significant (P<0.05).21days afterafter operation and28days after operation were no statistical significance (P>0.05).Masson staining to measure the thickness between the groups were compared using t-test.The difference28days after operation in group A and group B slice thickness flapstatistical results were statistically significant (P<0.05). 5. Radiological observation:28days after operation in group A and group B,prefabricated flap microvascular was contrast by contrast agent filling vessel and X-rayradiography. Abdominal blood vessels and its branches on both sides of the legs pale arevisible, group A and group B are no significant differences, indicating that the bloodsupply of leg after28days is very similar to normal legs. The surgical intervention flapsin group A compared to group B are brighter and thicker, indicating that the group A flaphas more tiny blood vessel formation and better vascular perfusion.Conclusion1. The method of artificial dermis directly repair and skin graft repair the woundmodel can not be completely healed in28days after operation; the method of artificialprefabricated flap and traditional prefabricated flap to repair the wound model can becompletely healed in28days after operation.2. Artificial prefabricated flap is not significantly different from the traditionalprefabricated flap in general observation, legs activity observation, swelling observation.Artificial prefabricated flap is superior to the traditional prefabricated flap in bloodperfusion and statistical is statistically significant to the traditional prefabricated flap inflap thickness. |
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