가토에서의 삽입물 피막피판에 관한 실험적 연구 = AN EXPERIMENTAL STUDY OF PERI-IMPLANT CAPSULE FLAP IN THE RABBIT

다국어 초록 (Multilingual Abstract)

Silicones are a group of inert and inorganic compounds that were introduced three decades ago and can be prepared in a wide variety of forms, varying from hard rubber to the liquid crystals. Use of the silicone is widely accepted in almost every medical and dental specialty, perhaps most commonly in reconstructive surgery.
A silicone implant elicits a capsular response in surrounding soft tissue. This phenomenon is well documented since significant capsular contracture occurs commonly as a complication of brest implants.
The capsules are built up of an extremely tough, tendon-like collagenous material, which is arranged in a layer and surrounds the prosthesis completely.
Three to four weeks after insertion of the implant, the capsule is already formed and it is made of capillaries, larger blood vessels, active macrophages, fibroblasts and a small amount of collagen. Later the capsule becomes less vascularized, more and more collagen are laid down and macrophages become inactive.
The aim of this study was to examine whether or not this side effect could be used as a new source of flaps since the capsule has a structure and texture similar to fascia. With this objective, capsule formation was induced in rabbits by implanting spherical tissue expanders under the skin vascularized by the inferior epigastric vessels.
When expansion was completed and the capsule was formed, the expander was removed and the animals were categorized into three groups. In the first group, the roof of the capsule was simply everted as hinge flap. in the second group, a capsule island flap was raised and orthotopically placed. In the third group, a capsule flap was raised and transferred to the ipsilateral injured Achilles tendon area for evaluation of ability to provide gliding surface. Four months later, a tendon-capsule-skin unit was excised and microscopically studied for late changes of capsule flap. The inner side of the various flaps for the first and second experimental groups and the outer side of the island flaps for the third group were covered with autologous full thickness skin graft to find out whether a peri-implant capsule was an adequate recipient site and this might be a new source of flaps for use in reconstructive surgery. In the three experimental groups, there was complete 'take' of the skin grafts in 80% of the animals.
In conclusion, island or free flaps of capsular tissue may be raised and transferred safely. And the capsular flap, which provides a good gliding surface without adhesion even in the late stage, can be very useful if it is used as a fascia-like tissue to cover tendons.