【作者】 郭树忠；

【导师】 陆裕朴； 鲁开化；

【作者基本信息】 第四军医大学 ， 整形外科学， 1994， 博士

【摘要】 皮肤撕脱伤是常见的创伤之一，目前尚缺乏理想的治疗方法。研究皮肤撕脱伤组织坏死的机理，探索在判断撕脱组织血液循环和活力的基础上最大限度的保留有活力的组织，减少继发坏死的发生，对于提高治疗效果具有十分重要的意义。 本研究模拟交通事故伤研制了皮肤撕脱伤模型机，在速度为23.68km／h，压强为2.8kg／cm~2时形成猪后肢潜行撕脱伤模型，在潜行撕脱区切取4×10cm大小的皮瓣后使组织缺血程度保持基本一致的情况下进行了下述研究。 于猪后肢皮肤撕脱伤后即刻、12h、24h、48h、72h和7天取撕脱组织，用光镜、透射电镜和扫描电镜观察，并与常规皮瓣进行比较。发现伤后受伤区域有散在的表皮细胞部分或全层脱落，真皮胶原纤维部分溶解，血管充血、破裂出血、血管内皮细胞受损伤。皮瓣近端损伤伤后逐渐得到修复，皮瓣远端逐渐发生变性坏死。撕脱皮瓣伤后24小时远端发生灶性坏死，伤后48小时形成以大量炎细胞浸润和血栓形成为特征的成活与坏死交界区。与常规皮瓣比，撕脱皮瓣充血、水肿、炎细胞浸润和变性坏死均发生早而且严重。在对伤后不同时间猪血清和撕脱皮瓣远端组织中丙二醛的含量测定发现，伤后24小时内血液和受伤组织中的丙二醛显著升高，推测自由基引发的脂质过氧化反应在撕脱组织坏死中发挥了重要的作用。在对撕脱皮瓣近、远端组织不同时间钙含量的测定发现，伤后钙含量显著升高，其中皮瓣近端伤后12小时达高峰，以后逐渐下降，而远端伤后24小时以后钙含量仍保持较高的水平，推测钙离子超负荷也是撕脱组织发生坏死的原因之一。 在一侧猪后肢形成撕脱皮瓣，另一侧形成相同大小的常规皮瓣进更多还原

【Abstract】 Skin avulsion injury is one of the common traumas. There is not ideal method in the treatment. It is very important to study the mechanism of avulsed tissue necrosis and search ideal circulation and viability prediction technique for keeping viable tissue maximaly while reducing the secondary necrosis minimally.In this study, We mimiced traffic accident, and have developed a machine with which we have created an avulsion injury pattern in hind leg of pig. The velocity of the mechine is 23.68km/h, intensity of pressure is 2.8kg/cn~2 . A 4×10cm random avulsed flap was created in the avulsed area for keeping ischemia Level of the avulsed tissue equally.Samples were took from the avulsed tissue immediately、 12、 24、 48、 72、 hours and 7 days posttrauma, and were observed under light and electron microscope. It was found that the epidermides were partially or totally scaled in some avulsion areas, callagenous fibers of dermis were dissolved. Congestion and hemorrhage could be found in the dermis and subcutaneous. Endothelial cells were damaged in some vessels. The injury of proximal part of the avulsed skin flaps gradually renovated, while the distal part degenerated and became necrobiosis after injury. Focal necrosis happened in distal part 24 hours posttrauma. Junction Zone of survival and necrosis, which was caracterized by many inflammatory cells infiltration and thrombosis, could be found 48 hours after injury in the avulsed skin flaps. As compared with normal skin flap, avulsed skin flap’s congestion, edema, inflammatory cells infiltration, degeneration and necrosis happaned early, seriously and developed quickly.The malanyldialehyde ( MDA) in serum and avulsed tissue was measured 1、 2、 4、 8、 12、 24 hours after trauma. The results showed the MDA increased constantly after trauma. It means that the free radicals may play a very important role in the necrosis of avulsed tissue. The amount of calcium in avulsed tissue also increased greatly. This results suggested that there was calcium over-load happened in avulsed tissue.We adopted thermometer, laser Doppler blood flowmeter and fluorescein to predict the viability of avulsed skin flap. The results showed that when surface temperature of the avulsed skin flap descended 2. 4℃, Doppler index was lower更多还原