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。     

人工真皮修复急性创伤后足背皮肤软组织缺损14例

背景：人工真皮具有硅胶膜和胶原海绵双层结构,是最早开发和应用于临床的组织工程化皮肤替代物,主要应用于皮肤软组织缺损修复。 目的：评价人工真皮在足背严重皮肤软组织缺损中的应用。 方法：选择北京积水潭医院烧伤科于2009-06/2010-12收治的14例急性外伤后足背严重皮肤软组织缺损患者,均有肌腱或骨外露。所有患者经清创后,以人工真皮移植,待人工真皮成活后以自体断层皮片移植,观察人工真皮和自体皮的成活情况。 结果与结论：所有植皮成活,创面愈合良好,供区未见明显瘢痕增生。提示人工真皮联合自体断层皮片移植可以有效修复足背严重皮肤缺损创面,减少供区损伤。     

人工真皮修复骨外露创面23例效果评价

背景：近年来有应用人工真皮修复骨外露创面的报道,但其治疗效果尚不明确。 目的：评价应用人工真皮修复23例骨外露创面的治疗效果。 方法：选取北京积水潭医院烧伤科23例骨外露患者,男18例,女5例。骨外露创面清创后,进行人工真皮移植,待其成活后,进行自体薄断层皮片移植,观察人工真皮及自体断层皮片的成活情况和供皮区瘢痕增生情况。 结果与结论：所有骨外露患者中除1例女性颅骨外露部分修复外,其余患者人工真皮及自体皮片成活良好,骨外露创面均完全修复,供皮区未见瘢痕。结果提示,人工真皮修复骨外露创面效果较好。     

人工真皮联合自体薄层皮片移植修复下肢创伤骨外露创面

目的总结及分析人工真皮联合自体薄层皮片移植修复骨外露创面的临床效果。 方法回顾性分析武汉大学同仁医院暨武汉市第三医院烧伤科自2010年6月至2013年6月收治的11例下肢创伤后骨外露患者的临床资料,男10例,女1例,年龄为23～76岁,所有患者均行一期扩创及人工真皮种植,二期行自体薄层皮片移植修复,通过评估创面恢复情况及取皮创口恢复情况综合评价治疗效果。 结果11例患者供皮区取皮后表皮再次形成时间为(15.5±2.5)d,一期手术后行二期植皮时间为(18.5±2.2)d;创面移植皮片均完好存活,愈合良好,外观平整,皮肤颜色略深于正常皮肤;2例患者供皮区域出现极轻度瘢痕,1例轻度瘢痕,余8例无明显瘢痕形成,整体效果满意。 结论人工真皮联合自体薄层皮片移植是治疗骨外露的有效方法。     

人工真皮＋负压封闭引流技术＋自体刃厚皮片移植联合修复复杂创面的临床应用

目的探讨人工真皮＋负压封闭引流技术＋自体刃厚皮片移植在修复合并肌腱或骨质外露的复杂创面中的应用效果。 方法回顾性选择2012年5月至2016年5月解放军联勤保障部队第九一〇医院烧伤整形科收治的难治性复杂创面26例,所有创面均有肌腱或骨质外露,创面彻底清创后行人工真皮覆盖肌腱或骨质,配合负压封闭引流技术行持续负压吸引,约2周后拆除负压封闭引流装置,可见人工真皮血管化良好,形成类真皮样组织,完全覆盖外露的肌腱及骨质组织,于类真皮样组织表面行自体刃厚皮片移植修复。 结果26例患者移植的刃厚皮片成活佳,其中24例患者经1次植皮手术治愈,2例患者再次行残余小创面清创植皮术后治愈;随访3～18个月后见术区皮片在位良好,瘢痕增生不明显,未出现明显破溃,外观恢复满意。 结论利用人工真皮＋负压封闭引流技术＋自体刃厚皮片移植联合修复肌腱或骨质外露的复杂创面是一种简单、有效的方法。     

负压封闭引流联合Lando ®人工真皮并结合自体皮移植应用于手足部骨肌腱外露伴骨折创面的临床研究

目的探讨应用负压封闭引流联合Lando^?人工真皮并结合自体皮移植修复手足部骨肌腱外露伴骨折创面的临床效果。 方法选取2017年11月至2019年2月郑州仁济医院创伤显微外科收治的手足部骨肌腱外露伴骨折的35例患者(手部23例,足部12例)。一期先行骨折复位,彻底清创和止血后,使用负压封闭引流装置进行创面床准备。二期行Lando^?人工真皮移植,待创面完全血管化后,揭除硅胶膜,移植自体皮。术后随访6～12个月,观察植皮成活情况和远期外观恢复情况。 结果35例患者人工真皮覆盖术后10～15 d拆除负压装置,支架血管化良好,完全覆盖裸露的骨肌腱。自体皮移植术后除1例因未及时引流而导致植皮部分坏死,经换药后再次植皮创面愈合,其余患者移植的自体皮片基本存活。术后6～12个月随访发现,移植区无破溃,皮肤颜色与周围正常皮肤颜色接近,无明显瘢痕和挛缩形成,未发生肌腱粘连,功能恢复满意。 结论负压封闭引流联合Lando^?人工真皮并结合自体皮移植修复手足部骨肌腱外露创面,可直接覆盖外露骨肌腱,术后移植区外观恢复平整,功能恢复良好,值得推广。     

富血小板血浆联合人工皮负压吸引修复腓骨长短肌腱外露及软组织缺损的临床研究

目的 评价富血小板血浆联合人工皮负压吸引修复腓骨长短肌腱外露及软组织缺损的临床疗效。方法 2018年1月至2020年12月荆门市第一人民医院采用PRP联合VSD治疗腓骨长短肌腱外露及软组织缺损创面20例,观察创面愈合率及创面愈合时间。结果 20例患者中18例直接愈合,2例肉芽组织生长丰富,覆盖肌腱组织后创面植皮均愈合;创面平均愈合时间为55 d。结论 自体PRP移植治疗联合人工皮负压吸引治疗腓骨长短肌腱外露及软组织缺损创面,能有效缩短足踝部骨、肌腱创面缺损愈合时间,促进创面修复。     

人工真皮联合负压封闭引流技术修复糖尿病足跟部骨外露15例

目的探讨人工真皮联合负压封闭引流技术对糖尿病足跟部骨外露修复的临床疗效。方法选择2012年8月至2017年8月于本院接受治疗的15例糖尿病足跟部骨外露患者为研究对象,常规手术清创后持续负压封闭引流,待肉芽组织生长良好后行人工真皮胶原支架结合自体皮片移植,观察手术时间、住院时间、术后创面愈合率、术后创面愈合时间、术后创面外观进行统计。分别于术后1个月、3个月、6个月、12个月对患者进行随访并进行优劣效评价,计算有效率。结果 15例均获得定期随访,随访12个月。所有病例跟部骨外露创面完全愈合,手术时间(67.3±14.1) min、平均住院时间(32.4±14.6) d、术后创面愈合时间(21.3±7.6) d,创面外观良好,行走无疼痛。1例植皮后皮肤部分边缘坏死,经换药1个月愈合。人工真皮修复的骨外露创面全部愈合,未发生创口感染、创口出血、神经损伤、过敏反应等并发症及不良反应;术后随访骨外露创面均完全愈合,无疤痕及形态异常,皮肤弹性及耐磨性良好,无反差色改变,无再发皮肤破损,能满足负重功能需求。结论负压封闭引流术后,人工真皮通过胶原支架诱导创面形成类真皮组织覆盖骨外露创面,促进肉芽组织增生,具有手术操作简单,创面柔韧性、耐磨性好,复发率低,疗效满意,是修复糖尿病足跟部骨外露的理想方法。     

皮能快愈敷料修复皮肤软组织缺损的临床应用

目的探讨皮能快愈敷料修复皮肤软组织缺损的的治疗效果。方法选择2005年至2010年接受治疗的皮肤软组织缺损患者共30例,随机分为2组:治疗组15例,采用皮能快愈敷料复合自体刃厚皮片修复创面;对照组15例,采用异体脱细胞真皮支架与自体刃厚皮片复合移植修复创面。观察、评估两组患者治疗6个月后植皮区存活皮片色泽及弹性,记录骨、肌腱外露创面的皮片存活情况。结果 Ridit分析显示治疗组移植皮片的色泽和弹性均优于对照组(P0.05);治疗组中6例伴有部分骨、肌腱外露,所覆盖的皮能快愈敷料均成活,对照组中3例伴有部分骨、肌腱外露,覆盖的异体脱细胞真皮支架未能成活。结论皮能快愈敷料复合自体刃厚皮片移植是修复皮肤软组织缺损的一种新方法,修复后的色泽和弹性较好,且应用广泛。     

小腿骨外露及皮肤软组织缺损的修复

目的探讨修复小腿骨外露及皮肤软组织缺损的各种方法，以便于更好地用于临床。方法25例小腿不同部位的骨外露分别采用皮片移植、带蒂皮瓣及肌皮瓣转移、皮瓣及肌皮瓣游离移植等方法，覆盖外露的骨面。结果19例全部存活，3例皮瓣部分坏死，2例创口延迟愈合，1例游离皮瓣失败。结论对小腿骨外露及皮肤软组织缺损应尽量采用皮瓣及肌皮瓣的转移或移植来修复，修复创面、恢复功能的目的。     

双层人工真皮联合自体刃厚皮移植修复烧创伤后骨/肌腱外露创面的临床效果

目的探讨双层人工真皮联合自体刃厚皮移植修复烧创伤后骨/肌腱外露创面的临床效果。 方法选择2019年11月至2022年8月期间内蒙古包钢医院烧伤科收治的符合入选标准的60例烧创伤后骨/肌腱外露患者作为研究对象,对其病例资料进行回顾性分析。根据创面修复方法不同将患者分为对照组和观察组,每组各30例。患者入院后完善相关检查,常规应用青霉素类抗生素控制感染,根据创面细菌培养结果及药物敏感试验结果调整抗生素的应用。观察组患者Ⅰ期行手术清创及双层人工真皮移植;待人工真皮完全血管化后,Ⅱ期去除人工真皮的硅胶层,再次修整创面,移植自体刃厚皮片。对照组待创面具备植皮条件后行单纯皮瓣或皮片移植修复创面。比较2组患者皮片/皮瓣成活率和创面愈合率、住院时间及住院费用、瘢痕生长情况。数据比较采用t检验及χ²检验。 结果术后10 d,观察组患者创面植皮术区皮片均成活,皮下无淤血及积液,皮片成活率为100%;对照组4例皮片移植患者皮下淤血较明显,皮片溶解坏死,2例皮瓣移植患者部分皮瓣远端血运障碍,缺血坏死,皮片/皮瓣成活率为80%,2组比较差异有统计学意义(χ²＝4.63, P＝0.03)。术后28 d,观察组创面全部愈合,术区无渗液、无红肿,创面愈合率为100%;对照组有6例患者创面未完全愈合,创面愈合率为80%,2组比较差异有统计学意义(χ²＝4.63, P＝0.03)。观察组患者平均住院时间及平均住院费用分别为(28.31±3.39) d、(6.58±1.21)万元,对照组患者平均住院时间及平均住院费用分别为(35.42±4.22) d、(3.27±1.10)万元,2组比较差异均有统计学意义(t＝7.21、11.13, P<0.05)。术后6个月,观察组温哥华瘢痕量表评分为(4.72±1.93)分,对照组为(5.88±2.12)分,2组比较差异有统计学意义(t＝2.22, P<0.05)。 结论双层人工真皮联合自体刃厚皮移植修复烧创伤后骨/肌腱外露创面,皮片/皮瓣成活率及创面愈合率高,可缩短平均住院时间,术后瘢痕增生较轻,值得临床推广应用。     

人工真皮支架联合灌洗式负压封闭引流在肌腱或骨外露创面修复中的应用

目的探讨人工真皮支架联合灌洗式负压封闭引流修复肌腱或骨外露创面的疗效。 方法选择2018年1月至2020年1月安徽医科大学第一附属医院烧伤科收治的肌腱或骨外露创面39例,其中急性创面26例(外伤10例,烧伤11例,热压伤4例,虫咬伤1例);慢性创面13例(糖尿病足皮肤溃疡2例,烧伤后期创面7例,瘢痕溃疡4例)。在全身麻醉或神经阻滞下行创面清创,在肌腱或骨外露处植入加强型人工真皮支架,外加负压封闭引流敷料覆盖,术后使用不同冲洗液进行间歇性灌洗,直至组织红润,达到二期植皮手术要求。观察并记录人工真皮支架使用次数,清创后人工真皮支架植入与二期植皮间隔时间和植皮成活情况。 结果39例肌腱或骨外露的急慢性创面经清创后覆盖人工真皮支架,术后经不同冲洗液间歇性灌洗式负压封闭引流治疗,均形成新鲜肉芽组织,二期经刃厚皮片植皮手术,植皮均100%成活,未出现感染等并发症。 结论人工真皮支架植入联合灌洗式负压封闭引流可有效地覆盖外露的肌腱和骨,是急慢性创面合并肌腱、骨外露的有效修复方式之一。     

Dermal Fibroblasts from Different Layers of Pig Skin Exhibit Different Profibrotic and Morphological Characteristics

In vitro studies of human dermal fibroblast (DF) heterogeneity have long been reported, yet in vivo studies and related research on animals are rare. The objectives of the study were to determine whether the DFs of pigs exhibit heterogeneity and to identify an animal model for the in vivo study of DF heterogeneity. The skin of three female red Duroc pigs (FRDPs) was separated into six layers, and the second and fifth layers (i.e., the superficial and deep dermis) were used in the establishment of wound models and cell cultures. To create the wound models, 54 tongue‐shaped flaps were created on one side of the dorsum, and the underlying dermis was then fully replaced with the superficial or deep dermis (the superficial and deep groups, respectively). Skin samples were harvested at postoperative weeks 1, 2, and 3 for measurements of the normal and wounded skin thicknesses. Cells cultured from the superficial and deep dermis (i.e., superficial and deep DFs) were subjected to quantitative estimation of collagen and electron microscopy. The wounded skin thickness in the deep group was significantly greater than that in the superficial group. In contrast with the long deep DFs, the superficial DFs were short and exhibited microvilli‐like cell surface projections. Compared with the superficial DFs, the deep DFs exhibited a greater density of rough endoplasmic reticulum and produced significantly more collagen. Similar to humans, FRDPs exhibit DF heterogeneity and should thus be a good animal model for in vivo studies of DF heterogeneity. Anat Rec, 299:1585–1599, 2016. © 2016 Wiley Periodicals, Inc.     

Development of an artificial dermis composed of hyaluronic acid and collagen

This study aimed to investigate the efficacy of an artificial dermis composed of hyaluronic acid (HA) and collagen (Col) with or without epidermal growth factor (EGF), both in in vitro and in vivo. The cross-linked high molecular weight HA spongy sheet was prepared by freeze-drying. The spongy sheet was immersed in a mixed solution of high molecular weight HA, low molecular weight HA, and heat-denatured Col, and then lyophilized to obtain a two-layered spongy sheet. Cross-linking among Col molecules was induced by ultraviolet irradiation to prepare the artificial dermis (Type I). In a similar manner, a two-layered artificial dermis containing EGF (Type II) was prepared using a similar mixed solution containing EGF. The in vitro experiments demonstrated that EGF released from the Type II artificial dermis stimulates fibroblasts to produce increased amounts of vascular endothelial growth factor and hepatocyte growth factor. The therapeutic efficacy of artificial dermis was evaluated in animal tests using Sprague Dawley (SD) rats. The dorsal skin of the SD rat was shaved and then exposed to boiling water for 3?s to induce a deep dermal burn. The necrotic tissue was then excised 3?days later. Each artificial dermis was applied to the skin defect for 7?days and assessed for its ability to generate a wound bed. The in vivo experiments demonstrated that the Type II artificial dermis promotes angiogenesis to a greater extent at an early stage (within 3?days), and also suppresses the inflammatory reaction more successfully compared with the Type I artificial dermis. In further animal tests, an autologous skin graft was performed by excising a piece of skin from the abdominal region and then grafting it onto the wound bed prepared using each artificial dermis for 7?days. Although the Type II artificial dermis had the highest potential to promote angiogenesis, in this animal study, each artificial dermis induced excellent wound bed formation acceptable for autologous skin grafting.     

Differential collagen-glycosaminoglycan matrix remodeling by superficial and deep dermal fibroblasts: potential therapeutic targets for hypertrophic scar

Skin substitutes are the preferred treatment option in the case of extensive skin loss following burns or other injuries. Among skin substitutes, cultured skin substitutes containing autologous fibroblasts and keratinocytes on collagen-glycosaminoglycan (C-GAG) matrix are most preferred for wound repair. A significant negative outcome of wound healing is hypertrophic scarring (HTS), a dermal fibroproliferative disorder, that leads to considerable morbidity. To examine the role of superficial and deep dermal fibroblasts in HTS, and determine if they differentially remodel C-GAG matrices, fibroblasts were isolated from superficial and deep dermis of lower abdominal tissue of abdominoplasty patients and cultured on C-GAG matrices for four weeks. Over time, deep fibroblasts contracted and stiffened the matrices significantly more and decreased their ultimate tensile strength compared to superficial fibroblasts. Differential remodeling of C-GAG matrices by fibroblasts obtained from different locations of the same organ has not been reported before. Deep fibroblasts were found to express significantly more osteopontin, angiotensin-II, peroxisome proliferator-activated receptor (PPAR)-α, and significantly less tumor necrosis factor-α, PPAR-β/δ, PPAR-γ, and the proteoglycan, fibromodulin compared to superficial fibroblasts. These molecular targets could potentially be used in therapeutic strategies for treatment of HTS.     

Local treatment of burns

Local burn care is one among the components of the total burn care. However since local wounds initiate and maintain the systemic disorders and provoke the aesthetic and functional sequellae, its significance must be stressed. The quality of the results relies upon teams trained and organized to control infection hazards in centres specifically designed. Closure of the wounds, through spontaneous healing of superficial burns or surgical techniques in deep ones, represents the aim of local care which includes the cleaning and dressing of superficial wounds and deep ones before and after grafting, with topical antibacterial (or not) agents, and also excision and grafting procedures. Today skin autografts remain the basic technique for closing deep burns. However because of the inadequacy between donor and wound areas either they must be meshed or other methods are added especially skin allografts, keratinocytes cultures or artificial skin. Local care does not come to an end when wound closure is achieved because of the lengthy rehabilitation cares such as massages, wearing of custom-fitted pressure garments, cures at specialized spas and some patients also need secondary surgery. Burn injuries remain one of the most devastating ordeal that a human being can sustain, because most of them provoke permanent and severe after-effects, whatever their extend and areas, that initial local care must aim at minimizing.