脱细胞同种异体真皮与自体刃厚皮复合移植烧伤功能部位修复创面  

Co-transplantation of acellular allogeneic dermis and autologous split-thickness skin for burn repair at functional parts

作　　者：柯昌能 刘坡 陈杰明 李艳华 梁大宁 

机构地区：[1]深圳市龙华新区中心医院烧伤整形外科,广东省深圳市518100

出　　处：《中国组织工程研究》2015年第29期4652-4656,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:临床修复烧伤功能部位创面的主要方法为自体大张刃厚皮片移植,虽能取得一定的治疗效果,但存在移植后质地薄、僵硬、韧差等缺陷,且移植部位瘢痕增生较重,容易引起挛缩畸形,功能恢复比较差。目的:分析复合皮移植烧伤功能部位修复创面的临床效果。方法:将60例(84处)功能部位烧伤创面患者随机均分为2组,观察组给予脱细胞同种异体真皮与自体刃厚皮复合移植修复治疗,对照组给予自体大张刃厚皮片移植修复治疗,比较两组皮片成活率及二次手术率;治疗后1个月,采用温哥华瘢痕评分量表评估皮肤色泽、厚度、血管分布及柔软度,同时判定瘢痕程度。结果与结论:观察组皮片成活率显著高于对照组(93%,70%,P<0.05),二次手术率显著低于对照组(0,13%,P<0.05)。治疗后1个月,观察组皮肤色泽、厚度、血管分布、柔软度各项评分均显著低于对照组(P<0.05),轻度瘢痕增生率显著高于对照组(52%,29%,P<0.05)。说明采用脱细胞同种异体真皮与自体刃厚皮复合移植烧伤功能部位修复创面,能有效提高皮片成活率,降低二次手术率,有利于促进创面愈合,还能有效减轻瘢痕增生程度。BACKGROUND：Autologous split-thickness skin grafting is the main therapy for burn repair at functional sites, which has achieved certain effects, but there are stil some deficiencies, such as poor texture, stiffness and poor toughness, as wel as severer hyperplasia that is easy to result in contracture deformity and poor functional recovery. OBJECTIVE： To analyze the clinical efficacy of skin co-transplantation on burn repair at functional sites. METHODS：Sixty patients with burns at functional sites （n=84） were randomized into two groups： co-transplantation of acelular dermis and autologous split-thickness skin in experimental group and autologous split-thickness skin graft in control group. Survival rate of skin flap and rate of secondary operation were compared between two groups. At 1 month after transplantation, Vancouver Scar Scale was used to assess skin color, thickness, blood vessel distribution and flexibility, and meanwhile, the severity of scar was determined. RESULTS AND CONCLUSION：The survival rate of skin flap was significantly higher in the experimental group than the control group （93%vs. 70%,P 〈 0.05）, and the rate of secondary operation was significantly lower in the experimental group compared with the control group （0vs. 13%,P 〈 0.05）. At 1 month after transplantation, scores on the skin color, thickness, blood vessel distribution and flexibility were al lower in the experimental group than the control group （P 〈 0.05）, but the incidence of mild hyperplasia in the experimental group was significantly higher than that in the control group （52% vs. 29%,P 〈 0.05）. These findings indicate that co-transplantation of acelular alogeneic dermis and autologous split-thickness skin for burn repair at functional sites can effectively enhance the survival rate of skin flap, reduce the rate of secondary operation, contribute to wound healing and reduce the severity of hyperplasia.

关 键 词：瘢痕 烧伤 移植 组织构建 组织工程 脱细胞同种异体真皮 功能部位创面 移植复合皮 修复 

分 类 号：R318[医药卫生—生物医学工程]