Ⅲ度烧伤后肉芽切除断层皮下组织创面自体皮移植对创面愈合的影响  

EFFECT OF AUTOSKIN GRAFTING IN FAULT HYPODERMIS WOUND OF GRANULATION EXCISION ON FULL-THICKNESS BURN HEALING

作　　者：宋国栋[1] 张磊[1] 贾军[1] 辛乃军[1] 杨涛[1] 汤华林[1] 尚兴红[1] 郭成浩[2] 

机构地区：[1]山东大学临床医学院济南市中心医院烧伤科,济南250013 [2]山东大学医学院病理学教研室

出　　处：《中国修复重建外科杂志》2004年第6期449-453,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的　探讨对 度烧伤后肉芽切除断层皮下组织创面 ,采用自体皮移植修复的机制 ,并评价其疗效。方法　采用肉眼、病理组织学、免疫组织化学、电镜和流式细胞术 ,动态观察成年 系小型猪 度烧伤后肉芽切除断层皮下组织创面自体植皮术 (A组 )后 ,移植皮片活性与结构 ,移植床肉芽组织、胶原纤维、微血管、碱性成纤维细胞生长因子(basic fibroblast growth factor,b FGF)蛋白表达和成纤维细胞超微结构变化 ,并与 度烧伤后传统的肉芽刮除纤维板创面自体植皮术 (B组 )进行比较 ,另设对照组 ,皮肤仅剃毛 (C组 )。　结果　术后 3天 ,移植皮片成活 ,A组较 B组皮片损伤轻、皮肤细胞增殖指数高、移植床血管内皮细胞及肉芽组织增生 ,b FGF表达明显。5天 ,两组血管内皮细胞及肉芽组织增殖旺盛 ,成纤维细胞呈蛋白合成旺盛和功能活跃象 ,新生胶原纤维出现 ,但 B组增殖更加明显。 7～ 14天 ,A组表皮结构及真皮毛细血管密度逐渐恢复正常 ,移植床肉芽组织逐渐成熟为纤维结缔组织 ,而 B组则延后 2天左右。 2 1天后 ,A组愈合创面病理改变轻于 B组。 30～ 6 0天 ,A组创面收缩及改容程度明显轻于 B组 ,且触之较软、移动度尚可。　结论Objective To explore the mechanism of full-thickness burn wound healing with autoskin grafting in fault hypodermis wound of granulation excision and to evaluate its effect.Methods By the techniques of clinical observation, histopathology, immunohistochemistry,TEM and FCM,we observed changes of the activity and structure of grafted skin and the granulation tissue,collagnous fiber,microvessels,the ultramicrostructure of fibroblasts and the expression of basic fibroblast growth factor(bFGF) in the base of autoskin grafting in fault hypodermis wound in burned adult minipigs(Group A), and compared with traditional method of autoskin grafting on the basilar fibrous tissue wound of scraped partly granulation being(Group B) and control group (Group C, without treatment except de-fur).Results The grafted skin survived after 3 days of operation, and it had less injury and higher proliferative index(PI) in group A than in group B. The hyperplasia of granulation tissue and vascular endothelial and the expression of bFGF were more evident in group A. After 5 days, the proliferation of endothelial cells and granulation and the protein synthesis of fibroblasts were more active in group A, and at this moment, fresh collagen appeared and proliferated more actively in group B. After 7-14 days, epidermic structure and dermic microvascular density became normal gradually, the granulation on grafting base matured and transformed into fibrous connective tissue in group A. The same change deferred about 2 days in group B. After 21 days, the above pathologic change in group A was less than that in group B. After 30-60 days of operation, Group A achieved much less contraction and transfiguration than Group B, and the grafted skin was tender and movable. Conclusion Autoskin grafting in fault hypodermis wound of granulation excision has a better effect than traditional operation.

关 键 词：烧伤 肉芽组织 皮下组织 皮肤移植 创面愈合 

分 类 号：R644[医药卫生—外科学]