臺灣博碩士論文加值系統

如何改善皮膚傷口癒合以及避免在傷口癒合中留下不正常疤痕一直以來是一個重要的議題。在傷口癒合過程中，有可能不會留下疤痕；也有可能會留下疤痕。每年全球超過1億人口產生疤痕，其中有31％的疤痕源自於皮膚的創傷。在過去以來，許多專家學者致力於研究傷口癒合的過程機制以及許多改善傷口癒合的方法被發表出來，例如探討：縫合力、應力刺激、藥物注射、營養攝取等因子對傷口癒合的影響。傷口癒合的過程可以簡要分為三個階段，分別為發炎期、增生期和成熟期。
在探討傷口癒合時，力學性質應為一個重要因子，因為皮膚必須要能承受各種不同情形的張力。然而，在過去的研究中，關於傷口癒合的探討主要是著重於組織切片的觀察；由力學角度來分析皮膚癒合的情形較少。
因此，在之前的實驗中，我們由力學角度來分析不同縫合技術對傷口癒合的影響。本論文將立基於之前動物實驗模型的基礎上，繼續由力學角度來探討不同因子對傷口癒合的影響。本論文首先將探討近年來常用於治療不正常疤痕增生的藥物—舒痕凝膠。將之用於我們的動物實驗模型上，分別在術後一、二、四、六週，來觀察其對傷口癒合的影響。我們使用癒合指標來正規化不同老鼠之間因體重及生理狀況不同所產生的差異。癒合指標的定義為同一隻老鼠，受傷皮膚的拉力強度/正常皮膚的拉力強度，而得的值。
實驗結果發現：使用舒痕凝膠用於治療切痕傷口上，和沒有使用舒痕凝膠的切痕傷口，在癒合第六週時，比較其癒合指標，其結果在統計上並沒有差異(p=0.093)；然而，在各癒合時間點，使用舒痕凝膠的切痕傷口，其癒合指標卻至少都和沒有使用舒痕凝膠的切痕傷口，具有23%以上的差異。再搭配病理切片染色的結果來觀察，舒痕凝膠的確可以幫助傷口癒合。
此論文的第二部份將探討遠紅外光照射對於傷口癒合的影響。近年來，由於遠紅外光已用於臨床治療局部缺血症狀以及慢性癒合傷口。因此，本實驗將探討遠紅外線於我們的動物實驗模型上對傷口癒合的影響。我們使用和之前實驗相同的三種常見的縫合方式作縫合，再照射遠紅外線於癒合傷口上，並分別在術後一、二、四、六週作觀察。實驗結果發現：和我們之前動物模型傷口的癒合情形比較起來，有照射遠紅外線的傷口在癒合第六週時並沒有明顯改善的癒合情形。

How to improve wound healing such as preventing hypertrophic scarring and keloids formation is an important clinical issue. The wound healing process would end in ranging from nearly scarless healing to an extent of abnormal scar formation. There are almost 100 million people annually developing a scar worldwide with 31 percent of the scar as a remain of a trauma.
Many physical and chemical treatments for wound healing are intensively studied in order to find the key factors that influence the mechanisms of wound healing and to improve healing. Factors such as closing tension, mechanical stimulation, injection, and nutrition etc. had been studied on wound healing. Wound healing contains a sequence of complicated, concurrent biological responses including inflammation, remodeling, and maturation.
In investigating wound healing, the tensile strength of the healing skin ought to be one of the critical indicators of skin recovery because skin must be able to sustain stress. However, most studies on wound healing in the past were mostly relied on gross and pathologic observations. Studies in the past focused on mechanical evaluations are rare seen.
Thus, in our previous study, we had investigated the influence of different suture methods on skin wound healing. The present study based on our previous animal model, continued to investigate other parameters on skin wound healing in the mechanical respect. First, we investigated the substance for prevention and managements of abnormal scars formation—Dermatix . We applied Dermatix on the incision wound of our animal model and observed its effects on wound healing at healing time 1, 2, 4 and 6 weeks. We introduced the recovery index to normalize the variations in mechanical properties of each rat skin at different growing conditions. The recovery index (%) was defined as (tensile strength of the wounded skin)/(tensile strength of unwounded skin) on the same rat dorsal skin.
The results were that wounds treated with Dermatix did not have significant differences in recovery index from untreated wounds statistically (p=0.093). However, at all the healing time points, there are at least 23% differences between the recovery index of Dermatix treated wounds and untreated wounds. Coupling with pathological observations helped clarify the effects of Dermatix on would healing.
Second part of this thesis focused on the influence of far infrared radiation (FIR) on skin wound healing. Recently, FIR had been used to treat partially ischemia and chronic ulcer wound. Thus, the study investigated the influence of FIR on the incision wound of our animal model. Wounds secured with the same suture methods as previous study did were exposed to FIR 5 times per week and observed at healing time 1, 2, 4 and 6 weeks. Results showed that there are no significant improvements comparing the wounds exposed to FIR with the wounds without FIR at healing time 6 weeks.

中文摘要 I
ABSTRACT III
誌 謝 V
TABLE OF CONTENTS VI
LIST OF TABLES IX
LIST OF FIGURES X
Chapter 1 Introduction 1
1.1 The importance and problems in wound healing 1
1.2 Wound healing process 1
1.2.1 Inflammatory phase 1
1.2.2 Proliferation phase 2
1.2.3 Maturation phase 2
1.3 General types of wound models 4
1.3.1 Acute wound models 5
1.3.2 Impaired healing models 6
1.3.3 Chronic wound models 7
1.4 Previous studies 7
1.5 Silicone gel: Dermatix 8
1.5.1 Dermatix- Silicone gel for scar reduction 8
1.5.2 Clinical evaluations of Dermatix 8
1.6 Far infrared radiation 11
1.7 Motivation and purpose 12
Chapter 2 Materials and Methods 13
2.1 Animal Experiment 13
2.1.1 Dermatix part 13
2.1.2 FIR part 15
2.2 Soft tissue tensile test 18
2.3 Pathology 20
2.4 Statistics 21
Chapter 3 Results 22
3.1 Results- Dermatix part 22
3.1.1 The gross examination of the wounds 22
3.1.2 Tensile strength and recovery index 23
3.1.3 Pathology 26
3.2 Results –FIR part 29
3.2.1 The gross examination of the wounds 29
3.2.2 Tensile strength and recovery index 30
Chapter 4 Discussion 35
4.1 Discussion- Dermatix part 35
4.1.1 Effects of Dermatix 35
4.1.2 Influences of different suture size on tensile strength 36
4.2 Limitations of Dermatix study 37
4.3 Discussion –FIR part 37
4.3.1 Influences of FIR on wound healing 37
4.3.2 The influence of suture methods on wound healing under FIR exposure 39
4.3.3 The effects of FIR on normal tissues 40
4.4 Limitations of FIR study 41
Chapter 5 Conclusion 42
5.1 Dermatix part 42
5.2 FIR part 42
REFERENCES 43
APPENDIX 46
自 述 50

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