SPECIES-RELATED DIFFERENCES IN PERCUTANEOUS WOUND-HEALING
SPECIES-RELATED DIFFERENCES IN PERCUTANEOUS WOUND-HEALING
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DOI：
10.1007/bf02407772
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发表时间：
1985-01-01
影响因子：
3.8
通讯作者：
VONRECUM, AF
中科院分区：
文献类型：
--
作者：
GANGJEE, T;COLAIZZO, R;VONRECUM, AF
经皮穿透装置通过手术在皮肤上造成的缺陷永久突出。通常，它们为体外植入物或器官与外部设备提供了连接。皮肤穿透区呈现出独特的医疗问题。界面组织通常不会愈合和密封到植入物上，但仍然是持续的急性或慢性炎症的焦点，并最终因感染而分解。这种病理生理现象以前已经用定性光学显微镜方法研究过了。大量的实验研究试图通过不同的植入材料和设计来改善种植体-表皮的密封性。为了能够系统地研究生物材料对种植体-表皮界面现象的影响，对定量的组织学参数进行了评估。测试植入物由涤纶天鹅绒制成，放置在狗、山羊和兔子身上不同的预先选择的时间段，以确定与时间和物种相关的组织病理学变化。结果表明，种植体孔内结缔组织的成熟程度似乎与巨细胞和多形核粒细胞的浓度(组织相容性)有关。在不同的条件下，多孔经皮植入物周围的表皮增殖过程似乎遵循一定的固定模式，并伴随着排斥力，导致植入物向外运动，直到完全挤出。植入期出现的微小血肿表明，机械力破坏了界面组织桥。在所研究的三种动物中，基本的组织学过程是相同的。然而，种植体孔内的表皮移行率和结缔组织成熟度存在数量上的差异，这可能解释了不同物种之间观察到的不同的失败模式和时间。研究表明，经皮愈合可能与植入材料的组织相容性、机械界面作用力和表皮增殖模式直接相关。前两种可能最终通过选择最佳的植入材料和装置配置来控制。然而，控制表皮的迁移将是延长经皮植入寿命的关键。
Percutanous devices permanently protrude through a surgically created defect in the skin. Usually they provide a connection for intracorporeal implants or organs with external devices. The skin penetration area presents unique medical problems. The interfacing tissue usually does not heal and seal to the implant but remains a focus of constant acute or chronic inflammation and eventually breaks down because of infection. This pathophysiological phenomenon has been studied previously with qualitative light microscopical methods. A large number of empirical studies have attempted to improve the implant-epidermal seal with various implant materials and designs. To allow systematic studies of the effect of biomaterials on implant-epidermal interface phenomena, quantitative histological parameters were evaluated. Test implants were made from Dacron velour and placed in dogs, goats, and rabbits for various preselected periods to determine time- and species-related histopathological variations. Results showed that the degree of connective tissue "maturity" within the pores of the implant appears to be related to the concentration of giant cells and polymorphonuclear granulocytes (histocompatibility). The process of epidermal proliferation around porous percutaneous implants appears to follow certian fixed patterns under different conditions that are accompanied by expelling forces, resulting in an outward movement of the implant until it is completely extruded. The presence of microhematomas throughout the implantation period indicates that mechanical forces disrupt interfacial tissue bridges. The basic histological processes are qualitatively the same in the three animal species studied. However, there are quantitative differences with regard to epidermal migration rate and connective tissue maturation within the implant pores, which may explain the different failure modes and times observed among species. The study indicated that percutaneous healing may be directly related to histocompatibility of the implant material, mechanical interfacial forces, and epidermal proliferative patterns. The first two may eventually be controlled by selection of optimal implant materials and device configurations. The control of epidermal migration, however, will be the key to prolonging percutaneous implant life.