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首页> 外文期刊>Urology >Skin flap closure by dermal laser soldering: a wound healing model for sutureless hypospadias repair.
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Skin flap closure by dermal laser soldering: a wound healing model for sutureless hypospadias repair.

机译：通过真皮激光焊接闭合皮瓣：无缝合尿道下裂修复的伤口愈合模型。

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OBJECTIVES: Laser tissue soldering (LTS) with the diode laser and human albumin-hyaluronate-indocyanine green solder is a safe and effective method of providing an immediate leak-free closure during hypospadias repair. In this report, we compare the physiology, histology, and immunohistochemistry of wound healing following LTS and suturing in a rat skin flap model. METHODS: A 4 x 5-cm skin flap was raised and bisected (4 cm) on the dorsum of 48 Sprague-Dawley rats. The central wound was either closed from a dermal approach by suturing or LTS or left open, and studied at 0, 3, 5, 7, 10, 14, and 21 days postoperatively. An intraoperative comparison was made between suturing and LTS with respect to operative time. Postoperatively, flaps were excised for tensiometric analysis, and sections were stained with hematoxylin-eosin to define wound architecture. Resting skin temperature, laser exposed temperature without solder, and maximum temperature with solder (one drop) were measured at the level of the deep dermis, superficial striated muscle layer, and within the solder. Mean peak temperatures were recorded during a 1-minute laser activation time. RESULTS: Mean continuous suturing time (4.9 +/- 1.1 minutes) was significantly (P < 0.001) faster than either LTS (7.7 +/- 0.77 minutes) or discontinuous suturing (8.2 +/- 0.62 minutes). Two seromas (sutured) and two instances of partial wound dehiscence (1 sutured, 1 LTS) were noted. Tensile strength was increased significantly (P < 0.001) for up to 5 days in the LTS group, but was equal to suturing at 7 and 10 days. Immediate tensile strength after LTS was equivalent to a 7-day healed wound. At 14 days, wounds initially left open and those closed by LTS were stronger than sutured wounds (P < 0.05). There was no evidence of thermal injury or foreign body reaction in the LTS group. Solder was incorporated within the dermis in all wounds at 21 days. Laser activation of solder resulted in significant increases in temperature at all three tissue levels: 65.0 +/- 5.2 and 69.9 +/- 6.8 degrees C in the deep and superficial skin (no significant difference between the two), and 101 +/- 15.6 degrees C within the solder (P < 0.001 versus superficial and deep skin). CONCLUSIONS: Our results indicate that sutureless dermal LTS of skin flaps provides increased tensile strength for up to 7 days, with relatively greater tensile strength provided within the first 3 days. Our laser technique does not appear to alter the normal wound healing process. Rather, solder-tissue interaction initially, and extracellular matrix infiltration of solder later, provide the basis for improved wound strength. For hypospadias repair using skin flaps, these wound attributes may permit sutureless surgery.
机译：目的：用二极管激光器和人白蛋白-透明质酸-吲哚菁绿色焊料进行激光组织焊接（LTS）是一种安全有效的方法，可在尿道下裂修复期间提供立即无泄漏的闭合。在此报告中，我们比较了大鼠皮瓣模型中LTS和缝合后伤口愈合的生理学，组织学和免疫组织化学。方法：在48只Sprague-Dawley大鼠的背部上举一个4 x 5 cm的皮瓣并一分为二（4 cm）。中心伤口通过缝合或LTS从皮肤入路闭合，或保持开放状态，并在术后0、3、5、7、10、14和21天进行研究。术中比较了缝合和LTS的手术时间。术后，切除皮瓣进行张力分析，并用苏木精-伊红对切片染色以定义伤口结构。在真皮深层，横纹肌层和焊料内部测量静息皮肤温度，不使用焊料的激光暴露温度以及使用焊料的最高温度（一滴）。在1分钟的激光激活时间内记录了平均峰值温度。结果：平均连续缝合时间（4.9 +/- 1.1分钟）比LTS（7.7 +/- 0.77分钟）或不连续缝合（8.2 +/- 0.62分钟）明显快（P <0.001）。注意到两个血清肿（缝合）和两个局部伤口裂开（两个缝合，1个LTS）。 LTS组在5天之内的抗张强度显着提高（P <0.001），但等于在7天和10天缝合。 LTS后立即的抗张强度相当于7天的伤口愈合。在第14天，最初留下的伤口和经LTS闭合的伤口比缝合的伤口要强（P <0.05）。 LTS组没有热损伤或异物反应的迹象。 21天时，在所有伤口的真皮中均加入了焊料。焊料的激光激活导致所有三个组织水平的温度均显着升高：深层和浅层皮肤的温度分别为65.0 +/- 5.2和69.9 +/- 6.8摄氏度（两者之间无显着差异），以及101 +/- 15.6摄氏度焊料中的摄氏温度（P <0.001，相对于浅层和深层皮肤）。结论：我们的结果表明，皮瓣的无缝合真皮LTS可以提供​​长达7天的增加的抗张强度，并且在头3天内提供相对较高的抗张强度。我们的激光技术似乎并未改变正常的伤口愈合过程。相反，最初的焊料-组织相互作用以及随后的焊料的细胞外基质浸润为改善伤口强度提供了基础。对于使用皮瓣修复尿道下裂的患者，这些伤口属性可允许进行无缝合手术。

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