Staging Delay, And The Preoperative Clinical Applications To Reduce Tension In The Expansion Flap Surgery

Skin expansion technique has been used for tens of years sincethe final phase of 70 era of the twenty century. It has provided uswith a new satisfactied method for reconstruction of burn scar,tumour and skin defect since its development for many yeas. As aresult, it has become an epoch-making achievement in plasticsurgery. But any new technique is not very perfect and has itsdisadvantage, it need uninterrupted research, improvement, andeventually become more and more perfect. The thesis sum upcorrelated histology and haemodynamics of skin expansiontechnique and how to improve microcirculation of expanded skinflap.Summarize of the newest literature reviewed interrelatedbiologic change, which include resource of skin, morphologicchange of skin, morphology turnover and change ofmicrocirculation, hemodynamic change, analysis and preventivestrategy of disturbance microcirculation. Skin resource of skinexpansion technique is derived from three parts: living beingdevelopment, elasticity expansion and machine creeping. Livingbeing development is the main source of skin expansion technique inroutine tissue expansion method, but the main skin source in rapidtissue expansion method is elastic expansion and machine creeping, on the other hand cello-caryocinesis rarely happened.Histomorphology of skin expansion technique shows significantlychange, histomorphologic change of routine tissue expansion ismuch different from which of rapid tissue expansion. All of clinicalresearch report that quantity of blood capillary and the volume ofblood flow of microcirculation inexpanded skin flap increase in bothroutine tissue expansion and rapid tissue expansion, the survival areaof the expanded flap obviously extends. So the clinical applicationof skin expansion technique has recently become more and morepopular. Potential necrosis of expanded skin flap caused by themicrocirculation disturbance hinders application of skin expansiontechnique. The reason is that firstly incentive of expansion causescomplex physiological change of microcirculation of expanded flap;Secondly mechanism of ischemia-reperfusion injury occurs when theexpanded flap is transferred for the preventive treatment of themechanism of microcirculation disturbance, some pertinent literaturereported a lot of precautionary strategy, which include ischemiapreconditioning and some medicine. As a result these methods canincrease microcirculation and extend the survival area of theexpanded flap. in order to prevent microcirculation disturbance ofexpanded flap, we applied for an improved technique that combinesthe modified operation of flap delaying with the preoperative decreased tension so that can improves microcirculation and extendsthe survival area of the expanded flap.From May, 2000 to May, 2005, this technique was used in 22patients (male 13 , female 9). The flaps were completely survivedafter the procedure, follow-up of all patients were about 1 to 3 years.Satisfactory results were achieved in all patients without anycomplication.By analyzing clinical data, we can draw the followingconclusions. Firstly, the blood flow of microcirculation of skin flapincreases and survival rate of skin flap also increases by the skinexpanding technique. Secondly, the chief complication of Skinexpansion technique is the skin flap necrosis, it will affecttherapeutic efficacy. Thirdly, the microcirculation changing by theexpanding skin flap is a complicated physiological process, and alsois an important cause of microcirculation disturbance, anotherimportant cause of the skin flap necrosis is ischemia-reperfusioninjury. Fourthly, in order to prevent and improve microcirculation ofexpanded skin flap, some methods are so that survival rate ofexpanded skin flap is improved. Lastly, The technique by combiningmodified operation of the delaying with decreased tension canimproves microcirculation and extends the survival area of theexpanded flap.