脱细胞异体真皮与自体大张薄皮修复功能部位创面的疗效观察

目的:总结功能部位创面用脱细胞异体真皮与自体大张薄皮修复的疗效。方法:对感染创面清创,控制感染。移植脱细胞异体真皮与自体大张薄皮封闭创面。结果:该技术操作简单,皮片成活良好,外观平整,皮肤弹性好,修复区无功能障碍。结论:关节功能部位创面用脱细胞异体真皮与自体大张薄皮移植能恢复关节功能,避免或减少后期整形。     

组织工程化真皮在四肢关节部位瘢痕整形术中的应用

目的：探讨应用脱细胞异体真皮与自体表皮复合移植，修复四肢关节挛缩瘢痕切除后的创面的临床效果。方法：肘关节、腕关节、膝关节和距小腿(踝)关节挛缩瘢痕切除松解后。以脱细胞异体真皮与自体表皮构成复合皮，Ⅰ期移植修复创面，创面最小7cm&;#215;11cm，最大12cm&;#215;19cm，其中肘关节部位6例，距小腿(踝)关节部位7例，膝关节部位5例，腕关节部位3例。观察移植复合皮的成活率及愈合皮片色泽、质地和关节功能改善情况。结果：临床应用21例，术后移植复合皮成活率93．7％，随访3个月～2年，移植皮片颜色与周围正常皮肤颜色接近，皮片柔软，瘢痕增生不明显，关节功能较术前显著改善。结论：组织工程化脱细胞异体真皮和自体表皮复合移植修复关节部位的切瘢后创面不失为一种较理想的材料，尤其对自体皮源有限的患者。     

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。     

异种（猪）脱细胞真皮与自体薄皮片联合移植的初步应用

目的：寻找在深度烧伤的治疗中一种较理想的创面覆盖物，方法：应用５０ｋｇ左右健康小白猪的皮肤，制成０．４ｍｍ厚度的细网状脱细胞真皮，移植于烧伤切痂后或烧伤瘢痕切除后的创面上，手术当天或１周后在脱细胞真皮移植自体薄皮片，结果：１５例中１４例成活良好，随访３个月～１年，移植处皮肤生长良好，手及关节部位功能恢复良好。结论：异种（猪）脱细胞真皮与自体薄皮联合移植是９深度烧伤切痂入烧伤瘢痕切除术后创面修复的良好方法之一。     

功能部位创面修复中脱细胞异体真皮与自体皮复合移植的作用

目的探讨脱细胞异体真皮与自体薄断层皮片复合移植用于修复功能部位肉芽创面的临床疗效。方法1999-03/2004-03广西医科大学第一附属医院烧伤整形康复中心收治功能部位肉芽创面患者48例,随机分成2组,治疗组与对照组各24例,治疗组采用J-1型脱细胞异体真皮与自体薄断层皮复合移植一次性完成创面修复共28个功能部位;对照组共30个功能部位仅移植自体薄断层皮片。结果两组皮片均成活良好;经随访观察6～24个月,治疗组脱细胞异体真皮无排异反应,植皮处光滑平整,色泽及弹性良好,瘢痕增生轻,关节运动角度正常;对照组表皮反复起水泡,瘢痕增生重,关节运动角度较正常小。结论复合皮移植一次性完成对功能部位肉芽创面的修复是一种理想的方法,皮片成活率高,远期瘢痕增生轻,关节活动功能无明显受限。     

组织工程化真皮在四肢关节部位瘢痕整形术中的应用

目的:探讨应用脱细胞异体真皮与自体表皮复合移植,修复四肢关节挛缩瘢痕切除后的创面的临床效果。方法:肘关节、腕关节、膝关节和距小腿(踝)关节挛缩瘢痕切除松解后,以脱细胞异体真皮与自体表皮构成复合皮,I期移植修复创面,创面最小7cm×11cm,最大12cm×19cm,其中肘关节部位例,距小腿(踝)6关节部位例,膝关节部位例,腕关节部位例。观察移植复合皮的753成活率及愈合皮片色泽、质地和关节功能改善情况。结果:临床应用21例,术后移植复合皮成活率93.7%,随访3个月～2年,移植皮片颜色与周围正常皮肤颜色接近,皮片柔软,瘢痕增生不明显,关节功能较术前显著改善。结论:组织工程化脱细胞异体真皮和自体表皮复合移植修复关节部位的切瘢后创面不失为一种较理想的材料,尤其对自体皮源有限的患者。     

功能部位创面修复中脱细胞异体真皮与自体皮复合移植的作用

目的探讨脱细胞异体真皮与自体薄断层皮片复合移植用于修复功能部位肉芽创面的临床疗效.方法 1999-03/2004-03广西医科大学第一附属医院烧伤整形康复中心收治功能部位肉芽创面患者48例,随机分成2组,治疗组与对照组各24例,治疗组采用J-1型脱细胞异体真皮与自体薄断层皮复合移植一次性完成创面修复共28个功能部位;对照组共30个功能部位仅移植自体薄断层皮片.结果两组皮片均成活良好;经随访观察6～24个月,治疗组脱细胞异体真皮无排异反应,植皮处光滑平整,色泽及弹性良好,瘢痕增生轻,关节运动角度正常;对照表皮反复起水泡,瘢痕增生重,关节运动角度较正常小.结论复合皮移植一次性完成对功能部位肉芽创面的修复是一种理想的方法,皮片成活率高,远期瘢痕增生轻,关节活动功能无明显受限.     

脱细胞异体真皮与自体刃厚皮复合移植在烧伤整形中的应用

目的：探讨烧伤后全层皮肤缺损创面新的修复手术方法。方法：回顾分析2000～20HD4年16例26个部位深度烧伤及烧伤后期 瘢痕整形患者的脱细胞异体真皮与自体刃厚皮片复合移植手术效果。结果：复合皮成活良好，成活率95%以上，外观及功能接近正常 皮肤，取得良好效果。结论：脱细胞异体真皮与自体刃厚皮片复合移植可有效保证移植部位外观及功能，减轻供皮区瘢痕。     

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。     

异种(猪)脱细胞真皮与自体薄皮片联合移植的初步应用

目的寻找在深度烧伤的治疗中一种较理想的创面覆盖物.方法应用50kg左右健康小白猪的皮肤,制成0.4mm厚度的细网状脱细胞真皮,移植于烧伤切痂后或烧伤瘢痕切除后的创面上,手术当天或1周后在脱细胞真皮表面移植自体薄皮片.结果15例中14例成活良好.随访3个月～1年,移植处皮肤生长良好,手及关节部位功能恢复良好.结论异种(猪)脱细胞真皮与自体薄皮片联合移植是深度烧伤切痂及烧伤瘢痕切除术后创面修复的良好方法之一.     

全层皮肤缺损创面移植异种脱细胞真皮基质与薄自体皮重塑基底膜的实验观察

背景异种脱细胞真皮基质与薄自体皮复合移植修复全层皮肤缺损创面取得了良好的效果,但对移植后基底膜的重塑尚不十分清楚.目的观察异种(猪)脱细胞真皮基质与薄自体皮复合移植模型中基底膜重塑的变化规律.设计随机对照实验研究.地点和材料动物实验在上海市烧伤研究所完成,指标检测在上海第二医科大学细胞生物学教研室完成.清洁级雄性SD大鼠(由中国医学科学院上海实验动物中心提供),体质量200～250 g.干预将SD大鼠随机分为两组,每组42只.所有动物均饲养在层流房间内,恒定的湿度与温度,单笼饲养.A组单纯移植薄自体皮组;B组脱细胞猪真皮基质(江苏启东医疗用品研究所提供)+薄自体皮复合移植.将异种(猪)脱细胞真皮基质与薄自体皮复合移植于大鼠创面,分别于移植后1,2,3,4,8,12,16周留取标本,采用免疫组化、透射电镜等方法.主要观察指标观察基底膜中层粘连蛋白的变化规律及12周时基底膜的超微结构,同时以单纯薄自体皮移植进行对照.结果B组移植后1,2,3,4,8,12,16周,层粘连蛋白的表达分别为88.32±2.72,89.22±2.16,88.84±3.43,93.49 ±4.59,87.57±3.33,95.87±1.84,86.57±2.45,A组分别为78.96±1.68,85.37±5.41,82.49±3.73,84.27±2.69,72.88±3.57,88.19±3.36,82.82±2.86,12周时复合皮移植组基底膜结构清晰连续,而单纯移植薄自体皮组基底膜模糊、不连续.结论异种脱细胞真皮基质与薄自体皮复合移植后,基底膜中层粘连蛋白表达增高,可能有利于复合皮移植后基底膜的重塑,增强表皮和真皮之间的连接,进而改善创面愈合质量.     

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.     

Acellular porcine dermal matrix produced with different methods and an experimental study on its transplantation to skin wound.]

OBJECTIVE: To observed the effect of healing quality of composite skin grafting consisting of acellular porcine dermal matrix combined with autologous split-thickness skin graft. METHODS: Porcine skin was treated with dispase II/triton X-100 or hyperosmotic saline/sodium-dodecyl-sulfate (SDS) respectively, and acellular porcine dermal matrix I (APDMI) and APDM II were obtained. Sixty-three Sprague-Dawley rats with full-thickness skin defects on the back were separately covered with APDMT + split-thickness autologous skin, or APDM II + split-thickness autologous skin. The quality of wound healing was observed, the rates of survival and contraction of the grafts were calculated, the tissue samples were harvested for histological examination, and compared with that of autologous split-thickness skin graft. RESULTS: The wound healing quality of composite skin I, and II was good. There was no significant difference in the rate of survival and contraction of the grafts between the two composite skin grafting groups. It was indicated by histological examination intact basal membrane. There was no significant difference in the survival rate between composite skin grafting groups and autologous split-thickness skin at the 6 th week after operation, but the contraction rates of the grafts in the composite skin groups were lower. CONCLUSION: Full-thickness skin defect can be healed by covering with acellular porcine dermal matrix produced by two methods combined with split-thickness autolograft, and it can help improve the quality of wound healing.     

异体表皮干细胞与猪脱细胞真皮构建复合皮移植6例

2005-01/2006-10在南昌大学第一附属医院烧伤科就诊的深度烧伤患者6例,均为四肢Ⅲ度烧伤创面.异种(猪)脱细胞真皮与异体表皮干细胞构建的复合皮由南昌大学第一附属医院烧伤中心提供.清创消毒后,6例患者均进行复合皮移植、自体刃厚皮移植,共移植复合皮12块,自体刃厚皮96块.复合皮移植是将复合皮剪成1.5 cm×1.5 cm,粗糙面向下、光滑面向上植于创面上;自体刃厚皮移植是将大片自体刃厚皮铺于矾土林纱布上,剪成1.5cm×1.5 cm,植于复合皮的四周.移植后3 d揭去创面外层纱布,见复合皮及自体刃厚皮与创面粘连好、湿润,呈淡红色:7 d复合皮及自体刃厚皮大部分成活,随后成活的皮片向四周扩展,至14 d大部分皮片接近融合,21 d时创面已基本愈合.移植的复合皮、自体刃厚皮成活数量比较,差异无显著性意义(P＞0.05).因复合皮扩展情况不如自体刃厚皮,所以复合皮移植后的创面愈合面积小于自体刃厚皮移植(P＜0.01).在临床观察中6例患者暂末发生不良事件和副反应.提示表皮干细胞和(猪)脱细胞真皮构建的人工复合皮移植到受区,可建立血液循环,并保持一定的活力,达到覆盖创面、防止感染、防止体液流失的目的.     

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。     

复合皮移植在整形外科中的应用

目的:总结脱细胞异体真皮与自体刃厚皮复合移植在整形中的应用体会与经验。方法:本组16例,其中男14例,女2例,年龄2~48岁。总共19个部位;受皮区面积最小为20cm2,最大260 cm2。结果:本组16例19个部位全部成活。功能部位植皮区外观平整,柔软度和弹性可以满足功能部位需要,颜色接近正常皮肤。结论:复合皮可以替代自体中厚皮,其存活率高,能减少供皮区瘢痕,术后恢复功能。     

微孔异种无细胞真皮复合移植用于烧伤创面烧伤创面F功能评估

目的 观察微孔异种无细胞真皮 (acellular xeno- drmal matrix,ADM)与自体皮片复合移植的临床效果. 方法 将打孔的无细胞真皮与自体的大张刃厚皮、网状皮、邮票皮微粒皮等复合移植 ,用于深度烧伤创面的修复 ,观察自体皮片存活率及创面愈合的色素沉着、弹性与柔韧性等 ,并与单纯自体皮片移植部位进行比较. 结果 微孔无细胞真皮与自体刃厚皮、网状皮及邮票皮移植 ,存活率达 100% ,而与微粒皮移植存活率较低.与单纯自体皮片移植相比 ,复合移植后 3个月 ,色素沉着浅 ,富有弹性与柔韧性 ,明显改善创面愈合质量. 结论 微孔无细胞真皮具有完整的基底膜结构 ,胶原排列规则有序 ,可重建高质量真皮层 ,提高柔韧性、耐磨与耐压性.     

Reduction of pacemaker pressure symptoms using nonantigenic preserved human dermis grafts

Skin pressure symptoms can occur in thin patients with pacemakers, with erosion through the skin surface a possibility. To correct this problem without device removal, two patients had nonantigenic preserved human dermis grafts placed over their pacemakers. This acellular nonantigenic human dermal substitute provided significant thickness over the devices and improvement in pressure symptoms.     

Observations on stability and contraction of composite skin grafts: xenodermis or allodermis with an isograft overlay

Composite skin grafts of xenodermis or allodermis with a thin split-thickness isograft overlay were evaluated for stability and contraction. Male inbred Lewis rats were used as recipients, with Buffalo rats serving as allogeneic dermis donors. Cryopreserved human skin was used for xenodermis grafts. The two components of the composite graft, the xenodermis or allodermis and the isograft overlay, were grafted in one operation to a surgically created wound. Wounds were observed for 1 year. The composite skin grafts took fairly well, although spotty loss of the overlaid isograft was noted. The xenodermis and allodermis remained grossly intact even at 1 year after grafting. However, composite skin grafts in this animal model contracted more than did sheet isografts alone.