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.     

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.     

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。     

应用弹性测量仪和超声波评价烧伤后增生瘢痕的粘弹性

目的：研究应用弹性测量仪和超声波测量评价烧伤后增生瘢痕的变化。方法：自1995年1月起，长期随访18例随机选择的烧伤患者（年龄为1－60岁），应用皮肤弹性测量仪及超声波影像对患者每月测量一次皮肤在负压吸引作用下的最大变形度（R0）和粘弹性指数（R8），比较增生瘢痕与身体对侧相应部位测量的区别，并将检查结果与传统临床分度方法进行比较分析。同时也对皮肤弹性值与临床观察的瘢痕硬度进行相关性分析。结果：烧伤后增生瘢痕的R8＞0．193时，临床硬度分度也较高（9％为0度，14％为1度，30％为2度，46％为3度，83％为4度）。结论：R8＞1．93被定为预后数值，大于该数值者需要密切随访。     

A new model for studying the development of human hypertrophic burn scar formation

Hypertrophic scar formation remains the major problem for severely burned patients who survive their injuries. This scarring can result in both cosmetic and functional deformities. One of the major problems in dealing with this complication is the lack of an adequate animal model with which to test various possible therapeutic modalities. We describe an animal model that uses human skin applied to the backs of nude mice to investigate the problem. Immunosuppression is not necessary in this model since the nude mouse lacks a thymus gland and is therefore not able to reject the skin. With this model we have been able to achieve contracture of meshed normal human skin grafts and hypertrophic scar formation in normal human skin that was burned a month after grafting to the mouse. We have also had success in grafting human hypertrophic scars, obtained from burn patients, to the mice. This model offers unique opportunities for investigation of the cause and treatment of burn scars in humans.     

基质金属蛋白酶13和转化生长因子β1在瘢痕疙瘩和增生性瘢痕中的表达

背景：与瘢痕疙瘩和增生性瘢痕发生机制相关的基质金属蛋白酶13和转化生长因子β1信号传递通路研究多集中在体外成纤维细胞的培养上,而在组织中的相关研究少见报道。目的：观察瘢痕疙瘩和增生性瘢痕中基质金属蛋白酶13和转化生长因子β1蛋白的表达。方法：取自2004/2008唐山市工人医院烧伤整形科手术患者,瘢痕疙瘩54例,增生性瘢痕42例。选取同期45例因非感染手术切除的正常瘢痕组织作为对照组,选取同期45例正常皮肤组织作为正常对照组。应用流式细胞仪检测4组中基质金属蛋白酶13和转化生长因子β1的表达,分析两者的相关性。结果与结论：瘢痕疙瘩和增生性瘢痕中转化生长因子β1的表达明显高于正常瘢痕组织和正常皮肤组织;正常瘢痕组织中转化生长因子β1的表达明显则高于正常皮肤组织,而基质金属蛋白酶13的表达与之相反。瘢痕疙瘩、增生性瘢痕和正常瘢痕组织中基质金属蛋白酶13和转化生长因子β1表达呈负相关。由此推测基质金属蛋白酶13和转化生长因子β1在瘢痕组织中异常表达,二者可能具有协同负向作用,共同参与病理性瘢痕的发生发展。     

肥厚性瘢痕胶原酶治疗效果的初步观察

背景肥厚性瘢痕是是烧伤和创伤后局部胶原合成与降解平衡失调,胶原异常聚集的结果.目的观察胶原酶影响裸鼠移植肥厚性瘢痕胶原降解的过程,以及其对肥厚性瘢痕的治疗作用.设计对照实验.单位解放军第三军医大学西南医院康复理疗科.对象实验于1995-07/1997-04在第三军医大学实验动物中心完成.肥厚性瘢痕标本10例,均为第三军医大学西南医院整形外科手术切除的肥厚性瘢痕,术前已征得患者同意.实验动物BAVB/C裸鼠15只,雄性8只,雌性7只.共移植肥厚性瘢痕组织15只,一次存活10只,余2次移植,存活动物2只,死亡3只.将存活裸鼠随机分为胶原酶治疗组和对照组,每组6只.方法将整形手术切除的肥厚性瘢痕移植于裸鼠背部创面,建立肥厚性瘢痕裸鼠移植模型.胶原酶治疗组局部注射1%胶原酶于瘢痕组织,对照组局部注射胶原酶溶解液,1次/周,共4周,治疗结束后取材行肉眼观察、光、电镜观察和分析.主要观察指标①治疗前后瘢痕组织的肉眼观察结果.②治疗前后瘢痕组织的光镜观察结果.③治疗前后瘢痕组织的电镜观察结果.结果移植瘢痕后实验裸鼠存活12只,均进入结果分析,胶原酶治疗组6只,对照组6只.①胶原酶治疗组瘢痕面积变小、高度变低、质地变软,与对照组相差十分显著.②在苏木精-伊红染色、Van Gieson氏胶原纤维染色方法和复合染色法切片上,胶原酶治疗组真皮层变薄,胶原纤维结构模糊,排列较疏散;而对照组瘢痕组织真皮层肥厚,含丰富的胶原纤维,胶原纤维排列紊乱.③在电镜下观察,胶原酶治疗组胶原纤维被破坏,结构不清.对照组胶原纤维排列紊乱,横纹明显,结构清楚.结论胶原酶使肥厚性瘢痕胶原被降解,瘢痕变小变软,提示局部注射胶原酶可能是治疗肥厚性瘢痕较好的方法.     

Analysis of gene expression patterns in human postburn hypertrophic scars

Hypertrophic scars cause cosmetic disfigurement and limited mobility in burn patients. To better understand the molecular pathophysiology of hypertrophic scar formation, microarray analyses were performed on normal skin and hypertrophic scars from four burn patients. Microarray analyses were determined in an effort to identify genes whose expression discriminated between normal skin and mature, hypertrophic scars. Surgical biopsies were obtained from two pediatric and two adult patients 6 to 15 months after burn injury. Total RNA was isolated from the samples and subjected to microarray analysis using the Affymetrix U95Av2 GeneChip. Results from this analysis revealed 31 probe sets representing genes that were consistently up-regulated at least two-fold in hypertrophic scar specimens from all four patients and four probe sets that were down-regulated. The significance analysis of microarrays algorithm also identified 35 probe sets whose increased expression resulted in the hierarchal clustering of the hypertrophic scar and normal tissue, seven of which were identical to the six genes identified by paired analyses. These six genes all displayed elevated levels of expression in the scar tissue. Proteins encoded by the genes identified included germline oligometric matrix protein, matrix metalloproteinase-16, collagen type 1alpha, pleiotrophin, and thrombospondin-4. Although the results presented here suggest that there may be unique patterns of gene expression in hypertrophic scars that may be important in the evaluation and treatment of hypertrophic scarring, the results must be confirmed with larger datasets.     

Microcirculation in hypertrophic scars after burn injury

Hypertrophic scar formation is a common complication after burn injury. Early active scars show hyperemic appearances that change as the scar matures. This is a report on microcirculation in hypertrophic scars after burn injury among 50 Chinese patients with a laser Doppler flowmeter. The average period of follow-up for the patients was 20 months. The microcirculatory response in scars to vasodilation (heat) stimulus was studied. Significant differences (p less than 0.0001) were demonstrated between scars of different clinical grades of maturity when compared with normal skin. The qualitative and quantitative differences in microcirculatory blood flow were correlated with site variations and different physiologic demands from different grades of scars. The study showed that laser Doppler flowmetry was useful in the clinical grading assessment of or for scar maturity.     

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.