组织工程同种异体脱细胞真皮复合自体刃厚皮微粒皮移植

为观察组织工程同种异体脱细胞真皮复合自体刃厚皮、微粒皮移植的临床应用效果,选择2005-04/2008-06海南省农垦三亚医院烧伤整形科严重烧伤和瘢痕患者8例12个创面,采用脱细胞真皮复合自体刃厚皮片、脱细胞真皮复合自体微粒皮移植修复创面.12创面中,10个创面复合皮完全成活,1个创面出现散在点状坏死,经换药8 d愈合.1例植皮部分成活,经补充游离植皮后创面愈合.随访6～12个月,复合移植皮肤质地柔软,弹性良好,无瘢痕增生,类似全厚皮片.提示采用脱细胞真皮复合自体刃厚皮、微粒皮移植修复严重烧伤创面,疗效满意,没有排斥反应,是理想的治疗方法.     

异体脱细胞真皮联合自体皮复合移植在创面修复中的应用及远期疗效观察

目的寻找功能部位深度烧伤创面与瘢痕畸形修复的理想覆盖材料。方法将功能部位的深度烧伤、瘢痕切除后创面或溃疡创面行脱细胞异体真皮＋自体刃厚皮复合移植。结果30例患者复合皮全部成活,复合皮光滑柔软,局部弹性好,关节功能恢复良好。结论脱细胞异体真皮＋自体皮是功能部位创面修复的理想覆盖材料。     

复合皮移植术治疗瘢痕挛缩畸形患者的护理

总结报道异体脱细胞真皮与自体刃厚皮片复合移植治疗瘢痕挛缩畸形患的护理方法。对20例实施异体脱细胞真皮与自体刃厚皮片复合移植术的瘢痕挛缩畸形患术前进行心理护理，认真做好植皮区的皮肤准备、术后着重病房准备，肢体制动护理，密切观察病情．加强营养支持疗法，康复期护理等。本组18例移植皮片全部1次成活．2例大部分成活，小部分经第2次移植后成活，肢体活动功能恢复满意。     

脱细胞异体真皮与自体刃厚皮复合移植的手术配合

目的探讨脱细胞异体真皮与自体刃厚皮复合移植的手术配合方法。方法对63例脱细胞异体真皮与自体刃厚皮复合移植手术患者的术前、术中、术后的临床资料进行了归纳。结果63例手术均顺利完成,其中瘢痕切除植皮患者术后外以平整,功能良好,无明显瘢痕增生。烧伤切(削)痂创面植皮患者术后皮片易成活,修复效果理想,无并发症。结论充分做好术前准备,术中妥善保管脱细胞异体真皮,正确掌握复合皮片的移植方法以及手术护士熟练的术中配合是手术成功的关键。     

脱细胞异体真皮与自体刃厚皮复合移植的手术配合

目的 探讨脱细胞异体真皮与自体刃厚皮复合移植的手术配合方法.方法 对63例脱细胞异体真皮与自体刃厚皮复合移植手术患者的术前、术中、术后的临床资料进行了归纳.结果 63例手术均顺利完成,其中瘢痕切除植皮患者术后外以平整,功能良好,无明显瘢痕增生.烧伤切(削)痂创面植皮患者术后皮片易成活,修复效果理想,无并发症.结论 充分做好术前准备,术中妥善保管脱细胞异体真皮,正确掌握复合皮片的移植方法以及手术护士熟练的术中配合是手术成功的关键.     

脱细胞异体真皮与自体皮复合移植改善功能部位烧伤后瘢痕

目的：无细胞真皮基质与自体皮片复合移植用于治疗深度烧伤创面、皮肤撕脱伤以及烧伤后增生性瘢痕的较好方法，探讨该方法应用中的具体操作及注意事项。方法：在8例患者共15个创面上用商品化的同种异体无细胞真皮与自体大张皮片复合移植，采用一步法。结果：13个创面的复合移植完全成活，皮片外观、质地和弹性均令人满意，无明显瘢痕形成；2个创面因基底血运不良成活欠佳，残留明显瘢痕。     

异体脱细胞真皮基质联合自体刃厚皮移植在功能部位深度烧伤中的应用

目的通过运用异体脱细胞真皮基质(ADM)联合自体刃厚皮移植修复人体功能部位深Ⅱ～Ⅲ°烧伤创面,改善创面愈合后皮肤功能及外型,减轻瘢痕挛缩。方法将15例患者分为A、B、C3组,每组各5例,A组创面采用保痂治疗加自身刃厚皮片游离移植,B组采用切、削痂处理加自身刃厚皮片游离移植,C组采用ADM联合自体刃厚皮移植,比较创面修复后和随访半年各组的外型、功能及瘢痕增生情况。结果愈合时间、外观、瘢痕和肢体功能方面C组疗效优于A、B组。3组患者创面均痊愈出院。结论采用ADM联合自体刃厚皮移植修复人体功能部位深度烧伤创面,其修复后外观平整光滑,瘢痕增生不明显,功能活动良好,效果满意。     

脱细胞异体真皮在功能部位深度烧伤早期治疗中的应用

12例Ⅲ度烧伤创面早期切削痂，采用脱细胞异体真皮 自体薄皮复合移植固定，与创面行刃厚皮片移植做对照观察。随访4～12个月，证实复合移植皮肤愈合质量优于对照部位创面。     

脱细胞异体真皮在功能部位深度烧伤早期治疗中的应用

12例III度烧伤创面早期切削痂,采用脱细胞异体真皮+自体薄皮复合移植固定,与创面行刃厚皮片移植做对照观察。随访4～12个月,证实复合移植皮肤愈合质量优于对照部位创面。     

脱细胞异体真皮在手深度烧伤中的应用

目的:评价脱细胞异体真皮在深度手烧伤治疗中的应用价值.方法:2004年1月至2006年8月对20例深Ⅱ度以上手烧伤患者进行了切削痂后脱细胞异体真皮和刃厚皮片复合移植.结果:20例复合移植皮片均成活,2例皮片边缘滑脱,创面换药后愈合,1年后随访患手颜色和外观与正常接近,功能无明显受限.结论:脱细胞异体真皮是手深度烧伤修复时理想的材料.     

The application of acellular dermal matrix allograft in functional position of patients with post-barns plastic operation

AIM: To investigate the effect of allogeneic acellular dermal matrix(ADM) on cograft in joint functional positions of patients with post-burn plastic operation. METHODS: 9 patients vrith hypertrophic scar and joint dysfunction after severe burns were used After pre-treating with trypsin and TritonX-100, 13 reticulated ADM were overlapped with autogenous ultrathin split-thickness skin grafts (USTS), and were transplanted to the scar excision wounds in the joints of four limbs at the same time. The neighbouring autogenous thin split-thickness skin grafts(TSTS) were used as control RESULTS: The composite skin grafts as well as the controls were all survived The rejection and hypertrophic scars were not found during (1-5) years follow-up studies. The appearance, fiber and function of composite skin grafts were near to normal skins. CONCLUSION: The ADM could be used to joint functional positions of patients with post-burn hypertrophic scan and could produce satisfactory plastic results as dermal substitute.     

无细胞异体真皮基质在烧伤后整形患者功能部位的应用

AIM:To investigate the effect of allogeneic acellular dermal matrix(ADM) on cograft in joint functional positions of patients with post burn plastic operation. METHODS:9 patients with hypertrophic scar and joint dysfunction after severe burns were used. After pre treating with trypsin and TritonX 100, 13 reticulated ADM were overlapped with autogenous ultrathin split thickness skin grafts(USTS), and were transplanted to the scar excision wounds in the joints of four limbs at the same time. The neighbouring autogenous thin split thickness skin grafts(TSTS) were used as control.RESULTS:The composite skin grafts as well as the controls were all survived. The rejection and hypertrophic scars were not found during (1- 5) years follow up studies. The appearance, fiber and function of composite skin grafts were near to normal skins. CONCLUSION:The ADM could be used to joint functional positions of patients with post burn hypertrophic scars and could produce satisfactory plastic results as dermal substitute.     

瘢痕削除后刃厚皮片移植治疗烧伤后增生性瘢痕

目的：探讨烧伤后增生性瘢痕修复的手术方法。方法：1998-2004年，对14例30个部位烧伤后增生性瘢痕进行瘢痕削除后刃厚皮片移植。结果：所有病人术后外观改善，症状消除，效果满意。结论：瘢痕削除后刃厚皮片移植手术简单实用，在大面积深度烧伤后非功能部位增生性瘢痕的修复中尤为适用。     

整形美容外科技术在头面部皮肤软组织外伤修复中的应用

目的:探讨头面部皮肤软组织急性外伤时应用整形美容外科修复的方法及其原则.方法:回顾性分析2006年7月至2009年12月急诊收治的216例头面部皮肤软组织外伤患者应用整形美容外科处理的临床资料.结果:除1例头皮撕脱伤术后远端部分坏死,1例鼻再植术后组织坏死,余患者伤口均Ⅰ期愈合;随访3-6月,6例植皮患者有局部轻度色素沉着.1例面颊部凹陷畸形,1例下睑外翻,余患者无明显疤痕增生、疤痕收缩等并发症,外形及功能恢复良好.结论:在头面部皮肤软组织急诊外伤处理时,恰当地运用整形美容外科原则及其技术,使局部创伤得到最大限度的功能及美学修复.     

人工真皮复合自体薄皮移植治疗皮肤软组织缺损

背景：修复皮肤软组织缺损自体或异体植皮治疗,往往需要多次植皮。而国内临床上应用人工真皮较少,应用经验亦不足。目的：评价人工真皮治疗皮肤软组织缺损的疗效。方法：收集因皮肤软组织缺损,行人工真皮结合自体薄皮移植修复创面的22例患者,其中骨外露6例,肌腱外露2例,表皮肿瘤切除3例,其他11例。一期清创移植人工真皮,2～4周后局部肉芽组织生长良好,外露肌腱、骨组织被类真皮组织覆盖,二期移植自体薄层皮片。观察取皮部位、损伤部位、操作性能、密封性、不良反应情况,结合评价临床效果及综合评价。结果与结论：20例患者人工真皮结合二期自体薄皮移植全部存活,至二期植皮所需时间（18.50±4.27）d,其中1例患者因感染再次手术,2例患者行人工真皮后未行二期植皮,而自动上皮化;随访至3个月,21例损伤部位表皮生长性、外观性均良好、无瘢痕增生,1例因感染而致瘢痕增生严重、外观不良,但生长性良好;20例患者取皮部位无明显的色素沉着及色素脱出,无严重增生性瘢痕,上皮形成时间为（15.35±4.67）d。说明人工真皮结合自体薄皮移植修复皮肤软组织缺损,操作简便,创面愈合质量高,供皮区损伤轻微,至二期植皮时间较长,总体临床效果良好。     

The use of bioelectric dressings in skin graft harvest sites: a prospective case series

Despite advances in wound care treatments for the management of acute and chronic wounds, there remains an unmet need for interventions that accelerate epithelialization. Many authors in the past have advocated the use of electric currents to accelerate wound healing. Novel wound dressings with inherent electric activity are emerging, and studies of these specific modalities are lacking. The principal aim of this study is to evaluate the impact of a bioelectric dressing on acute wound healing. Thirteen patients who underwent skin grafting were enrolled. One half of all skin graft donor sites were treated with the bioelectric dressing and semi-occlusive dressing (SOD) and the other half using solely a SOD. Epithelialization was rated by a blinded burn surgeon attending. Participants also provided a self-assessment of their scar appearance. At week 1 postprocedure, average epithelialization of 71.8% was noted on the bioelectric dressing-treated side, compared with 46.9% on the SOD side, representing an average 34.62% faster wound healing (P = .015). At 1 month, patients rated the bioelectric dressing-treated half as superior in terms of scar color (P = .198), stiffness (P = .088), thickness (P = .038), and overall quality (P = .028). These early data show promise in terms of faster healing, improved scarring, and improved patient subjective outcome with the use of the bioelectric dressing on acute wounds. With fulfillment of an extended study population, the authors hope to provide a solid foundation for extrapolating their data beyond skin graft donor sites to all areas of wound care.     

负压封闭引流装置用于全厚皮移植术后加压固定

目的 探讨封闭负压引流(vacuum sealing drainage,VSD)装置用于全厚皮移植术后加压固定对全厚皮片移植成活的影响.方法 新西兰大白兔24只,在脊柱两侧2个术区建立全厚皮片移植模型.每只兔2个术区分别采用VSD(A组)、传统缝合打包加压包扎(B组),做自身对照.第3、5、7天各随机处死8只兔,观察皮...     

脱细胞异体真皮对功能部位深度烧伤创面愈合瘢痕增生的改善作用

BACKGROUND:Because there was no thick skin for skin grafting supplied by enough area of supplying skin of patients with extensive area burn only autograft skin particle,split thickness autologous skin graft or cultural autograft can be applied in repairing wound,which cannot resolve the problems of contracture and deformity caused by scar proliferation after healing of wounds and dysfunction of joint.Acellular allodermis matrix of J 1 type is a kind of tissue with lowest antigenicity and thought as an ideal substituted material for resolving difficult problem of scar proliferation and dysfunction.     

手部深度烧伤的早期手术处理

目的：探讨手部深度烧伤早期手术的几种方法。方法：1995-2004年，对53例65只手部深度烧伤患者进行早期切削痂，分别采用网状皮移植、大张皮移植、筋膜皮瓣移植及真皮下血管网薄皮瓣移植等手术方法。结果：所有患者术后外形及功能均较满意，取得良好效果。结论：网状植皮最为简便实用；大张植皮外观及韧性较为理想；累及深部组织时须行皮瓣移植，筋膜皮瓣移植和真皮下血管网薄皮瓣移植效果满意。     

瘢痕削除、刃厚皮片移植治疗增生性瘢痕的疗效观察

目的 探讨对大面积、非功能部位的增生性瘢痕的最佳手术治疗方法。方法 18例已处于成熟期的，面积为300—1500m^2的非功能部位的增生性瘢痕患者施行瘢痕削除、刃厚皮片移植手术。结果 18例患者移植的皮片成活良好，术后植皮区持续加压包扎4-6个月，随访1～2年，植皮区平整，质软，无瘢痕增生，皮片收缩不明显，颜色均匀，供皮区愈合后功能及外观恢复正常，患者满意。结论 对大面积、非功能部位的增生性瘢痕，采用瘢痕削除，刃厚皮片移植进行治疗是一种有效的治疗方法。