异种(猪)脱细胞真皮基质修复大鼠全层皮肤缺损的实验研究  

EXPERIMENTAL STUDY ON PORCINE ACELLULAR DERMAL MATRIX AND SPLIT-THICKNESS SKIN GRAFTS TO REPAIR FULL-THICKNESS SKIN DEFECTS

作　　者：马绍英[1] 李宝明[1] 王旭昇[1] 李幼忱[1] 康悦[1] 董丽[1] 陈学英[1] 赵亚平[1] 李宝兴[1] 

机构地区：[1]中国辐射防护研究院生物材料与制药技术研究所,太原030006

出　　处：《中国修复重建外科杂志》2010年第2期156-160,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：山西省自然科学基金资助项目(2008011079-4)~~

摘　　要：目的比较猪脱细胞真皮基质(porcine acellular dermal matrix,PADM)加大鼠自体刃厚皮与单纯大鼠自体刃厚皮修复全层皮肤缺损的效果,组织学观察PADM在大鼠体内的转归。方法健康雌性SD大鼠20只,体重200～225g。于每只大鼠背部左侧翻起4.0cm×2.5cm皮瓣,达深筋膜,皮下植入4.0cm×2.5cm拉网的PADM,10～14d待植入的PADM血管化后,沿原切口处将左侧4.0cm×2.5cm皮瓣切下,右侧背部也制作4.0cm×2.5cm全层皮肤缺损创面,两侧切除的全层皮肤用鼓式取皮机反取为0.2mm厚刃厚皮片,分别植入左侧PADM上(实验组)和右侧皮肤缺损(对照组)。术后2、4、8、20周,观察创面愈合情况,计算创面愈合率和创面收缩率,并对创面行组织学观察。结果术后2周大体观察,实验组自体刃厚皮与PADM贴合良好,大部分复合皮泛红成活;对照组自体刃厚皮创面绝大部分泛红成活。组织学观察,实验组PADM内有大量成纤维细胞长入,少量中性粒细胞和淋巴细胞浸润,周围可见巨噬细胞;对照组自体刃厚皮下纤维结缔组织充填。术后4～8周大体观察,实验组大部分创面愈合,复合皮挟起时皮片厚,柔软、丰满,有弹性;对照组创面基本愈合,但挟起时皮片薄弱。组织学观察,实验组PADM内炎性浸润逐步消退;对照组自体刃厚皮下层状排列的胶原纤维束平行于表面。术后20周大体观察,实验组复合皮与周围皮肤结合部平坦,复合皮柔软、丰满;对照组皮片薄,弹性较差。组织学观察,PADM内及周围未见炎性浸润,胶原纤维组织结构与自体皮接近;对照组自体刃厚皮皮片薄,内见残存皮肤附件结构,皮下被平行于表面的瘢痕组织充填。实验组4、8周创面愈合率低于对照组(P<0.05);创面收缩率有较对照组低的趋势,但差异无统计学意义(P>0.05)。结论大鼠自体刃厚皮与PADM支架复合移植修复全层皮肤缺损,复合皮片厚,弹性好,PADM在体内逐步被自体胶原所替代。Objective To compare the effect of the composite skin graft consisting of split-thickness skin grafts（STSGs）and porcine acellular dermal matrix（PADM）with STSGs only,and to histologically observe the turnover of the PADM in rats.Methods Twenty female Sprague-Dawley rats,weighing 200-225 g,were included.The size of 4.0 cm×2.5 cm PADM was implanted into hypoderm of the left side of Sprague-Dawley rats＇back.After 10-14 days,the size of 4.0 cm×2.5 cm fullthickness skin defects were made on the left to expose the PADM under the skin and the same size of full-thickness skin defects were made on the right of the rats＇back.The excised full-thickness skin was made to STSGs about 0.2 mm by drum dermatome.The defects were grafted with composite skin（STSGs on the PADM,experimental group）and STSGs only（control group）.The survival rate,the constraction degree of grafts,and the histological change in grafts area were observed at 2,4,8,and 20 weeks after operation.Results At 2 weeks after STSGs（0.2 mm）placed on vascularized PADM,STSGs and PADM adhered together and the composite skin had a good survival.The control group also had a good survival.Histological observations showed that STSGs and PADM grew together,neutrophilic granulocytes and lymphocytes infiltrated in the PADM and some macrophages around the PADM.Fibrous connective tissues were filled under the STSGs in control group.At 4-8 weeks after transplantation,the composite skin had a good survival and the composite skin was thick,soft,and elastic.STSGs survived almost totally in control group,but the grafts were thin.Histological observations showed that inflammatory reactions of PADM faded gradually in experimental group;scar tissues formed under the STSGs in control group.At 20 weeks after transplantation,composite skin was flat,thick,and elastic in experimental group,but the STSGs were thinner and less elastic in control group.Histological observations showed that histological structures of the PADM were similar to the dermal matrix of rats,and

关 键 词：异种(猪)脱细胞真皮基质 复合移植 皮肤缺损 大鼠 

分 类 号：R622.1[医药卫生—整形外科] R318[医药卫生—外科学]