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The mandibular defect Maxillofacial Surgery common, often caused by tumor surgery, trauma, inflammation, and other reasons, vascularized composite flap is a common way to repair the defects of the jaw bone and soft tissues in the mouth, dentition defect and lack of repair is complete masticatory function the last link of the recovery, the implant denture has good resistance, retention and comfort, has become the preferred repair dentition defect and dentition missing. Vascularized composite flap mandibular defects after completion, the bone surface is often movable skin tissue is too thick, activity degree, result in combination with the implant gingival bad, can not achieve a good biological containment, often occurs inflammation around the implant, implant surgery failed. The thickness of the soft tissue of the soft tissue of the ideal planting beds require planting area requirement is less than 4mm, a width of at least 6mm, bone surface closely integrated, no activity. Vascularized composite graft repair mandibular defect in order to construct the ideal planting beds of soft tissue, we have taken a free skin transplant bone surface embedded to solve this problem, we also bone after bone surface skin graft - leather attached form made a preliminary exploration, and a preliminary understanding of the bone surface after skin graft in the bone surface alterations in different time periods. The specific contents are as follows: 1, free skin graft skin graft bone surface embedded the feasibility study Objective: To explore the feasibility of grafting bone surface embedded and various thickness skin graft success rate. Method: application of different thickness free skin graft bone surfaces embedded transplantation Compare transplant success rate, gross observation, histological observation (HE staining, MASSON staining) were statistically analyzed. Results: of thick free skin in the bone surface and a high success rate of the buried graft similar revascularization good gliding flaps success rate, and its thickness, elasticity, pressure resistance, abrasion resistance to meet the planting beds Implant requirements, is a viable method. Free skin graft bone burying bone - skin attached observational study Objective: To study free skin graft bone surface of the embedded bone - skin attached binding mode. Method: full-thickness skin graft bone surface in embedded transplant successful animal model gross observation, histological observation (HE staining, MASSON staining), transmission electron microscopy. Results: skin surface of the cortical bone healing, skin activity. Microscopically, bone - skin interface seamless surface is not smooth cortical bone area combine to provide a greater area of ??leather - cortical bone, may also exist between the leather - bone surface mechanical fitting role, help to improve skin - the adhesion of the bone to restrict the degree of motion of the skin, in the horizontal and vertical directions. The transmission electron microscope observation of the collagen fibers within the dermal tissue extends to the cortical bone, and connected to the cortical bone of collagen, forming a structure similar to the pass-through fiber, similar to the way of the connection with the periosteum and the bone. The skin after skin and bone healing activity and high strength connection. 3, new bone - skin attached after the formation of cortical bone changes Objective: To study bone - leather new attachment after the formation of the cortical bone changes. Method: sliding flap covering the surface of the cortical bone and healing, four weeks, eight weeks, 12 weeks gross observation, histological observation. Results: When the skin directly covering the surface of the cortical bone, the initial role of osteoclast osteoclast osteoclast activity decreases with time, osteogenesis began to show, the basic completion of 12 weeks of bone remodeling, leather layer close to the surface of the cortical bone at the formation of a dense layer of cells with a possible role of partially compensated periosteum.
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