Use of omentum flap for induction of free skin graft healing

ABSTRACT The objective of this study was to assess healing induction of free skin grafts following transposition of omental flap through a subcutaneous tunnel to the recipient bed. Macroscopic and microscopic evaluations were performed. Nineteen piglets were used. Two surgical wounds were created of each subject. The graft removed from the left side (LS) was placed on the right side (RS) without the omental flap in the graft-bed (control group-CG). On the LS, an omental flap was placed between the graft removed from the RS and the recipient bed (omentum group-OG). Macroscopic evaluations showed edema, which gradually decreased on both groups. Suture dehiscence was highest at day 10 compared to other days in both groups. The CG had a higher incidence of unvitalized tissue compared to OG, although no difference was found among days of postoperative evaluation. The presence of unvitalized tissue was seen on 32% on OG and 53% on CG. Microscopic evaluations revealed higher collagenization, reepithelization, keratinization and less swelling in the OG compared to CG. In conclusion, mesh skin grafts evolved satisfactorily in swine even in newly created bedding without granulation tissue, but with appropriate vascularization. The omentum flap provided better macroscopic and microscopic outcomes regarding graft integration.

摘要
本研究旨在评估通过皮下隧道将网膜瓣（omental flap）转位至受区（recipient bed）后，游离皮肤移植物（free skin grafts）的愈合诱导效果。实验共纳入19头仔猪，每头仔猪均制备两处手术创面：从左侧（LS）取下的皮片被移植至右侧（RS）创面，移植物床不放置网膜瓣，设为对照组（CG）；在左侧创面，则将从右侧取下的皮片与受区之间放置网膜瓣，设为网膜瓣组（OG）。
大体评估结果显示，两组均出现组织水肿，且随术后时间推移逐渐消退；两组的缝线裂开发生率均在术后第10日达到峰值。尽管术后各评估时间点之间无显著差异，但对照组的失活组织（unvitalized tissue）发生率高于网膜瓣组：网膜瓣组失活组织发生率为32%，对照组为53%。
微观组织学评估显示，与对照组相比，网膜瓣组的胶原化（collagenization）、再上皮化（reepithelization）与角化（keratinization）程度更高，组织肿胀程度更低。综上，即使在无肉芽组织（granulation tissue）但血管化良好的新建受区床中，猪的网状皮片（mesh skin grafts）移植也可获得满意效果；网膜瓣可显著提升移植物整合的大体与微观组织学表现。