The Clinical Applications And Research Of The Influence Of Chitosan On Fiber Flap Of The Envelope After The Expansion

Purpose: This issue on the basis of the success of all animal experiments will be used in clinical, to further explore the application of chitosan fibrous capsule around the thickness of the number of capillaries, collagen content and fibroblasts Fine changes in the structure of the law, to set out the expansion of chitosan-coated fibers after implantation in the course of forming the fibroblast cells into muscle cells and collagen fibers into the synthesis and secretion by the impact of further revealed chitinase Sugar intervention fibrous capsule formation mechanism .It will be better applied to clinical chitosan to resolve the skin and soft tissue expansion of the application of capsular contracture due to a result of reduced utilization of expansion after the flap, and become an important issue in plastic surgery.Methods1. Clinical data:since 2006, each of two patients at the same time with expansion to repair a total of 24 cases of various diseases. 12 males, 12 females, aged 22 years old to 33 years old.2 groups For each peripheral lesions in patients with the peeling of superficial skin fascia some lacunars deep enough, one soft tissue expander of 100 ml is implanted in each side of skin and. And one side is the experimental group and the other side as a control group.3 expander implant and injection methodAfter the stripping of lacunars place, the experimental group observe the inactive bleeding, there will be injection of 2ml of -Chitosan (2% )lacunar, coating them evenly, then implant1 one skin and soft tissue expander of 100ml , implant one skin and soft tissue expander of 100ml according to conventional control group. On the third day after surgery, injection expansion began, in the conventional method: injection with anesthesia, inject once every other day depending on the circumstances expansion, according to tension size of the flap, in the reaction to the pressure under flap in 4-5 seconds limited; the quantity of injection of the experimental side is the same as the control side. Per skin and soft tissue expander of 100 ml 200 ml stop injection after 200ml.4 basedAfter completion or the second phase expansion of operations, under local anesthesia, surgical expansion from the same surface fibrous capsule location sized 4 cm×4cm fiber coated specimens are tiled in sterile gauze, 1.40 fixed with 4% neutral E The aldehyde, paraffin sections, which were for conventional paraffin sections HE staining, Masson CD34 staining and staining. Cut fibrous capsule specimens sized 0.1 cm×0.1cm×0.3cm with neutral formalin-fixed, with TEM observation. Cut the fibrous capsule with samples flap placed a drop of liquid paraffin slide surface, take photos within 5 min of its natural shrinkage with image analysis method to calculate the shrinking rate of tissue.5 observation indicators(1) rate of contraction: After the remove of expander, on the expansion of surplus flap, cut fiber (4 cm×4cm) coated with the flap retraction in its natural process of the first 5 min and photographed, by using analysis system, measurement Paper flap around the contraction of the area of the tissue shrinkage rate [1]. Comparison of the experimental group and the control group after the expansion of capsular flap with the shrinkage rate changes. (2) Conventional optical microscopy HE staining of histological sections change, and application of fiber yardstick measuring the thickness of specimens coated fibers; Masson staining was observed under light microscope sections compared with the experimental group and the control group specimens collagen fiber content changes, Application of pathology and image analysis system for the average gray stained quantitative analysis to quantify the two groups of collagen fiber content contrast optical microscopy CD34 staining biopsy, compared experimental group and control group the number of capillaries in the fibrous capsule change. (3) Under the TEM, observe the experimental group and the control group within the fibroblast cell and swift changes in order to contrast the two groups in the fibroblast collagen secretion myofibroblastic conversion degree of difference.6 statisticallyApplication of SPASS11.5 statistical processing software, the experimental results are for statistical analysis.ResultsA contraction rateContraction rate of the experimental group (43.371±7.312%), the contraction rate for the control group (45.637±6.613%) between the two groups is statistically significant (p <0.05).Light microscopy of 22.1 HE staining and the thickness of coated fibersOptical microscope: (1) the experimental group: that a large number of fibroblasts, and the new thin-walled capillaries in the Vision is casual, and there are a large number of naive view of the fibroblast cells, naive view of the fibroblast cell body than, often ends processes, and basophilic cytoplasm slightly due to a little blue, and seen in the control group with a large number of fibroblasts, a large number of maturing fibroblasts that fibroblasts, maturing into fibroblast collagen synthesis and secretion by protein in the cells surrounding collagen fibers spindle elongated shape, gradually less cytoplasmic and nuclear staining deeper than the experimental group. Comparison of the experimental group with control for the foreseeable: the number of fibroblasts in the experimental group in the naive view significantly more than the control group, while the maturing fibroblasts in the control group is significantly more than the number of fibroblasts in the experimental group . Randomly selecting 100 times optical microscope HE staining biopsy in experimental group and 15 vision in control group using microscopic measurement yardstick HE staining sections of the fiber coating thickness. Results: The thickness of capsular: 516.000±128.491μm, fiber coating thickness of control group: 833.000±227.379μm, a significant difference between the two groups (P <0.05).2.2 Masson staining and image analysisMasson staining was observed under light microscope sections, the experimental group: 4/6-5/6 thickness of the fiber coated with gray, which scattered in the foreseeable fibroblast nuclear Chenghui black, oval, Pai osteoporosis remaining 2 / 6 - 1 / 6 was green, which was fine fibroblast cell spindle, black ash, are loose, and the ability of the two groups to fibroblasts, endothelial cells of the kind that lined a control group: fiber layer coated Green, fibroblast cells elongated fusiform loose distribution of endothelial cells scattered in the spindle-like cells. Quantitative image analysis of the experimental group average gray 170.383±14.313, and the control group average gray 159.762±10.623, a significant difference between the two groups (P <0.05).2.3 CD34 staining and the number of capillaries observed CD34 staining light microscope sections of capillary endothelial cells that are marked as yellow, casual lies in the vision, light microscopy were randomly selected CD34 staining sections 100 times the experimental group and control group 15 vision, artificial capillary count the number of results: experimental group capillary volume averaged 8.200±2.150 vision, and the control group averaged vision 7.900±1.729, respectively, the experimental group and control group had no significant difference (P> 0.05).3 TEM observationExperimental group: fibroblasts, rough endoplasmic reticulum expand into pool-like, the number dropped markedly, deregulation of phenomenon obviously, some or most of mitochondrial aristae integrates or disappears, occasionally normal Gorky's body, or occasionally no microfilament structure, free ribosomes decrease in the number of the control group: fibroblast expansion is seen in the rough endoplasmic reticulum, deregulations of rare phenomenon, in the basic integrity of mitochondrial ridge, we can see that many obvious microfilament structure, the number of ribosomal is with no obvious reduction. Fibroblast spindle long, long oval nuclei, cytoplasm of a large number of rough endoplasmic reticulum, there are many mitochondria. Rough endoplasmic reticulum pool is with a high degree of expansion. Not typical high-complexes. Microfilaments within the cytoplasm, there are many free ribosomes. Long chromates are rich, easily stained are less, there are many mature cells around the collagen fibers.ConclusionOn the basis of successful animal experiments, It is implicated on clinical cases. It is further confirmed that chitosan can inhibit fibroblast collagen synthesis and secretion, inhibit fibroblast cells to transform into muscle fibers, making fibrous capsule thinning and collagen fiber content reduced shrinkage decreased, thereby reducing out-of-band fiber - Film flap after the expansion of the shrinkage rate, and will not affect the expansion of capsular flap after the nutritional role. Therefore, the study has high clinical value and good promotion prospects.