脱细胞异体真皮加微粒皮移植治疗深度烧伤创面的研究  

RESEARCH OF ACCELLULAR ALLODERMIS MATRIX AND MICROSKIN AUTOGRAFTS IN DEEP BURN WOUNDS

作　　者：蒙诚跃[1] 王润秀[1] 梁自乾[1] 张立明[1] 李德绘[1] 林源[1] 向军 黄运严[3] 

机构地区：[1]广西医科大学第一附属医院烧伤整形外科,南宁530021 [2]上海市烧伤研究所 [3]广西医科大学第八附属医院烧伤科

出　　处：《广西医科大学学报》2005年第2期160-163,共4页Journal of Guangxi Medical University

基　　金：国家973项目资助课题(No.G1999054205~2~3);广西卫生厅资助课题(No.9909)

摘　　要：目的:为大面积深度烧伤创面修复寻找理想的真皮替代物,以解决自体中厚皮源不足的难题。方法:对23例大面积深度烧伤患者的功能部位行手术切、削痂后分为二组植皮:试验组创面移植脱细胞异体真皮加自体微粒皮(简称复合皮),对照组创面单行自体微粒皮移植。术后观察两组移植皮肤的临床疗效,并采用光镜及透射电镜观察组织学变化。结果:术后6周试验组移植的复合皮成活率达87%(20/23),对照组为91.3%(21/23),两组比较差异无统计学意义(P>0.05);术后6、12个月复诊见复合皮的外观、质地、耐磨性及关节功能等方面明显优于对照组。组织学检查:术后6周见试验组的复合皮融合为一体,角质层连续而成熟,对照组自体表皮轻微增生;术后3～12个月试验组脱细胞异体真皮中胶原纤维粗细基本一致、排列规则,对照组自体真皮中胶原纤维粗细不一、排列不规则。结论:对大面积深度烧伤患者功能部位进行复合皮移植,可减轻瘢痕增生、改善创面外观及关节功能。Objective:To seek ideal dermis substituted material for the deep burn wounds,which would resolve the problem of autologous skin deficiency in the patients with large area burns.Methods:23 patients of large area burns were admitted into our hospital from December 1999 to December 2003, the wounds of deep burns of function positions in patients with large area burns were divided into 2 groups after cutting scab: accellular allodermis matrix and autologous microskin graft were applied in the wounds of test group, autologous microskin graft and cadaveric allograft were applied in the wound of contrast group. The curative effect of 2 group skin graft were recorded, the change of histology were observed by optics microscope and electron microscope after operation.Result:The survival rate of implanted graft in test group reached 87%(20/23),but that of the contrast group was 91.3%(21/23) 6 weeks after operation, there were no significant difference in survival rate between test group and contrast group (P>0.05). The appearance, quality and joint function of the implanted graft in test group were better than that of the contrast group after 6 months, 12 months. Histological examination: the implanted grafts in test group became confluent fully, cuticular layers were continuous and mature,and epidermis of implanted graft in the contrast group proliferated lightly 6 weeks after operation; the degree of thickness of collagen fibers in the implanted graft in test group was coincident,it was not uniform in contrast group; the arrangement of collagen fibers in the implanted graft in test group was in order; it was not in order in contrast group.Conclusion:using accellular allodermis matrix and microskin autograft in the deep burn wound of the function positions in the patient with large area burns could ease scar proliferation and improve the surface of wounds and joints function.

关 键 词：烧伤 脱细胞异体真皮 微粒皮 复合移植 

分 类 号：R644[医药卫生—外科学]