选择性脱细胞猪皮研制及早期临床应用

目的介绍选择性脱细胞猪皮覆盖大面积烧伤早期创面的研制方法及临床应用效果. 方法 2001年1月～2002年5月,对1例深Ⅱ度15%、Ⅲ度25%烧伤患者的右前臂和右小腿,行选择性脱细胞中厚猪皮早期覆盖.戊二醛交联后表皮面黏贴于容器,边缘包埋.在含0.25%胰酶的PBS液中37℃消化2小时,去污剂处理24小时后,漂洗备用.将处理后猪皮应用于1例切削痂自体微粒植皮创面覆盖约2%,大体和光镜观察其功能和外观恢复情况. 结果组织学观察见表皮层基本完整,真皮内无细胞.初步临床观察显示,选择性脱细胞猪皮的真皮可在创基成活,失活表皮可被宿主自体表皮替代. 结论选择性脱细胞猪皮有望替代现有材料用于大面积烧伤切削痂创面的早期覆盖.

DEVELOPMENT OF SELECTIVE ACELLULAR PORCINE SKIN AND ITS PRELIMINARY CLINICAL APPLICATION ON BURN WOUNDS

OBJECTIVE: To develop a new kind of skin substitute, selective acellular porcine skin, to cover excised wounds in treatment of extensive deep burns on the basis of controlled de-cell technique. METHODS: Partial thickness porcine skin was treated with 0.25% trypsin for 2 hours at 37 degrees C after crosslinked with glutaraldehyde, and then it was glued to a container with the edge embedded with glue. The skin was shaken in 0.5% SDS for 24 hours, and then washed before use. The selective acellular skin was used with micro-autografts on the dermal side to cover 2 surgically excised burn wounds in a patient. The recoveries of function and appearance were observed. RESULTS: Morphological observation showed that the treated porcine skin had an intact epithelial layer and an acellular dermis. After being used to cover burn wounds, its acellular dermis could serve as host dermal matrix, and its devitalized epithelial layer could prevent the dermis from drying. The devitalized epithelium was finally replaced by host epithelial cells, and the healed wounds could achieve good cosmetic and functional results. CONCLUSION: Selective acellular porcine skin can be used as promising skin substitute to cover excised wounds.