真皮"生物模板"与自体薄皮复合移植组织学观察

目的探讨真皮“生物模板”移植人体后的动态组织学变化。 方法采用真皮“生物模板”(异体无细胞真皮基质)加自体刃厚皮片复合移植的方法,修复深度烧伤病人切痂后创面,并以单纯自体刃厚皮片移植作对照,分别于术后1、2、3、4、6、8周,3、6、12个月取组织活检标本84例次;采用HE、Masson’s染色和透射电镜的方法,对创面组织标本进行动态组织学观察。 结果真皮“生物模板”与自体刃厚皮片复合移植后,修复细胞和血管循真皮模板胶原束间隙长入,新生胶原纤维排列较为规则有序,真皮修复后其结构接近正常真皮组织;而单纯自体薄皮移植修复创面后,真皮内胶原纤维排列紊乱。 结论真皮“生物模板”可以诱导包括成纤维细胞等修复细胞长入模板,合成新生的胶原和血管,创面修复后形成具有和正常真皮结构相似的“新生真皮”。

The Dynamic Histological Observations of Grafting Dermal Regeneration Template with Thin Autogenic Skin in Burn Patients

Objective To evaluate the dynamic histological changes after the application of dermal regeneration template ( allogenic acellular dermal matrix) with overlying thin split - thickness autograft on deep wounds post - burn injury. Methods Eighty - four eschar excised wounds of deep burn patients were covered by dermal regeneration template with overlying thin split - thickness autograft. The control site received a split - thickness autograft alone. Sections of biopsy specimens were examined for thorough analysis by light microscopy ( Hematoxylin and Masson's dye) and electron microcopy at 1 - 4 weeks, 6, 8 weeks, 3,6, 12 months after operation. Results The autogenous "neodermis" was founded as fibro-blasts and vessels migrated from the wound bed into the dermal template. Using dermal template as scaffolding , the wound synthesized new connective tissue in the collagen fiber pattern of normal dermis rather than the pattern of scar. This replacement dermis functions as normal dermis and not as scar tissue in contrast to the control group. Conclusion Histological observations reveal that dermal template could support fibro-blast infiltration and neovascularization, facilitating the formation of neodermis with regularly rearranged collagen fibers that resembles normal dermis.