Skin Stretching Device를 이용한 피부결손의 일차봉합: 신장된 돼지피부의 형태학적 연구 및 임상경험

Abstract

A common goal of plastic surgeons facing skin defects those are difficult to close primarily is providing proper tissue replacement for the defects with minimal scars. To permit closure of problematic areas of skin shortage that might otherwise have required grafts or flaps, harnessing adjacent extra skin using skin expansion, presuturing or skin stretching is best choice. A skin stretching device is designed to exploit the viscoelastic properties (creep and stress relaxation) of skin using increasing stretching force on the skin margins. It is easy and simple in application on an outpatient basis or at bedside. Preoperative stretching can save operation time and delayed stretching is indicated following severe trauma. We experienced 11 cases of difficult skin defects on the face, scalp, elbow, chin, lower leg and heel. All were closed directly 2 to 7 days after stretching without complications. To elucidate the morphologic changes of the stretched porcine skin, a 7×10cm skin defect was created on the back of pig followed by direct closure of that defect 5 days after stretching. Histologic studies were performed with light and electron microscopes 1, 3, 7 and 14 days after stretching respectively. The results were as follows: 1) One day after stretching, collagen bundles realigned along the direction of stretching force and collagen fibrils became slender with increased diameter discrepancies. Microfragmentation of elastic fibers appeared 2) Three days after stretching, elastic fibers were mostly fragmented and some activated fibroflasts with mild collagen production were noted. 3) More rough endoplasmic reitculum (RER) appeared within the activated fibroblasts 7 days after stretching. Collagen fibers were synthesized by activated fibroblasts and collagen fibrils became thicker with decreased diameter discrepancies. Regeneration of elastic fiber increased. 4) Fourteen days postoperatively, collagen fibers began to show normal findings of control group and elastic fibers were completely regnerated and all findings were same as control group. Key Words: Skin stretching ,Viscoelastic property