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MAJ David K. Hayes, MC; MAJ Michael E. Berkland, MC; LTC Kweon I. Stambaugh, MC

Arch Otolaryngol Head Neck Surg. 1990;116(7):794-797.

Abstract
• Like cells respond to injury through repair mechanisms unique for each cell type (eg, regeneration of the epidermis, granulation over exposed fat). How simultaneous chemical peel affects a local skin flap and why minimal differences in chemical peels can result in significant differences in outcome is not fully understood. In this study guinea pig skin was exposed to skin flap elevation, chemical peel, or a combination of the two. Biopsy specimens were taken at 3 to 35 days after injury and the histologic sections were studied. Results demonstrate that (1) lifting a flap causes changes in the subcutaneous tissue and reticular dermis that makes it more vulnerable to secondary injury and (2) the reticular dermis responds to injury as two physiologically distinct layers, although it appears histologically homogeneous. The upper reticular dermis heals by reorganization, while the deeper reticular dermis heals by scar formation. The differing response to injury of these cell layers may in part explain the low safety margin in aggressive chemical peels.

(Arch Otolaryngol Head Neck Surg. 1990;116:794-797)

Author Affiliations
USA; USA; USA

From the Otolaryngology Service (Drs Hayes and Stambaugh) and Department of Pathology (Dr Berkland), Brooke Army Medical Center, Fort Sam Houston, Tex. Dr Hayes is now with the Walter Reed Army Medical Center, Washington, DC.

Footnotes
Accepted for publication March 20, 1990.

The opinions or assertions contained herein are the private views of the authors and are not to be construed as reflecting the views of the Department of the Army or the Department of Defense.

Presented at the annual fall meeting of the American Academy of Facial Plastic and Reconstructive Surgery, New Orleans, La, September 22, 1989.

Reprint requests to the Department of Surgery, Otolaryngology Service, Walter Reed Army Medical Center, Washington, DC 20307-5001 (Dr Hayes).

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