保留变性真皮厚度对深Ⅱ度烧伤猪植皮成活率的影响  

Influence of the depth of retained denatured dermis on the survival rate of grafted skin in burn swine with deep partial-thickness burn

作　　者：赵耀华[1] 杨惠光[1] 邓海涛[1] 袁东亮[1] 徐丽红[1] 黄伟琪[1] 沈耀明[1] 

机构地区：[1]东南大学医学院附属江阴医院烧伤整形科,江苏省江阴市214400

出　　处：《中华烧伤杂志》2013年第4期365-370,共6页Chinese Journal of Burns

基　　金：江苏省卫生厅科研课题（Z200908）

摘　　要：目的探讨保留变性真皮厚度对深Ⅱ度烧伤猪植皮成活率的影响。方法将7只中国家猪脊柱两侧各造成4个深Ⅱ度烧伤创面，将其中6只猪的创面按照随机数字表法分为0．25、0．50、0．75、1．00mm组，每组12个创面，分别接受相应厚度削痂自体皮移植术。削痂前在每个创面中心部位采集活检组织样本测量烧伤组织厚度及行组织学观察，削痂后在每个创面中心附近采集活检组织样本测量保留变性真皮厚度及行组织学观察。余1只猪的8个创面设为对照组，不行削痂植皮术，同前取标本后行暴露疗法。伤后即刻到伤后3个月，观察5组创面大体情况。伤后8d，计算0．25、0．50、0．75、1．00mm组创面植皮成活率（以中位数表示）。记录5组创面愈合时间。伤后3个月，再次获取5组创面标本，透射电镜下观察超微结构变化。对数据行成组设计多样本比较的秩和检验、单因素方差分析、LSD检验。结果本实验中烧伤组织厚度为（1．120±0．211）mm。0．25、0．50、0．75、1．00mm组创面保留变性真皮厚度分别为（0．830±0．031）、（0．701±0．010）、（0．382±0．031）、（0．141±0．040）mm。伤后8d，0．25、0．50mm组创面所植皮片全部坏死；0．75mm组创面所植皮片大部分坏死；1．00mm组创面所植皮片大部分成活，少部分溶脱；对照组创面逐渐溶痂。伤后15d，0．25、0．50、0．75mm组创面未成活皮片逐渐脱落，表层有渗出物结痂，1．00mm组创面完全愈合，对照组创面渗出结痂面积最大。伤后3个月，0．25、0．50、0．75mm组和对照组愈合创面因瘢痕收缩而缩小，1．00mm组创面未见明显瘢痕。0．25、0．50、0．75、1．00mm组创面植皮成活率差异有统计学意义（Y。=19．421，P〈0．001）。1．00mm组创面植皮成活率最高为70％（60％，80％），0．75mm组创面植皮成活率为20％（0，30％），0．25、0．5Objective To explore the influence of the thickness of retained denatured dermis on the survival rate of grafted skin in swine with deep partial-thickness burn. Methods Four deep partial-thick- ness wounds were reproduced respectively on both sides of spine in 7 Chinese domestic pigs. The wounds of 6 pigs were divided into 0.25,0.50, 0.75, and 1.00 mm groups with 12 wounds in each group according to the random number table. Tangential excision and autoskin grafting were performed. Before the tangential excision, I tissue specimen was harvested from the center of each remaining wound for the estimation of the depth of burn, and histological observation was done. After the tangential excision, 1 tissue specimen was harvested from the area near the center of each wound for the measurement of the depth of retained denatured dermis with histological examination. The 8 wounds of one pig were set as the control group, and the opera- tion was done, and then they were treated with exposure treatment after biopsy specimens were taken with a- bove-mentioned method. The general condition of wounds in 5 groups was observed from immediately after injury to post injury month （PIM） 3. On post injury day （PID） 7, the survival rate of grafted skin was ob- served in 0.25, 0.50, 0.75, and 1.00 mm groups. Wound healing time was recorded. At PIM 3, the spec- imens were harvested from the wounds of 5 groups, and their ultra microstructures were observed by trans- mission electron microscope. Data were processed with rank-sum test, one-way analysis of variance, anti LSD test. Results The depth of the burn tissue was （ 1. 120 ± 0.211 ） mm. The depths of retained dena- tured dermis in0.25, 0.50, 0.75, and 1.00 mm groups were respectively （0.830 ±0.031）, （0.701 ± 0.010）, （0.382±0.031）, and （0.141 ±0.040） mm. At P1D 8, all grafted skin in0.25 and 0.50 mm groups became necrotic; most grafted skin in 0.75 mm group was necrotic; most grafted skin in 1.00 mm group survived with only a few became necrotic and se

关 键 词：烧伤 皮肤移植 真皮 

分 类 号：R644[医药卫生—外科学]