异体脱细胞真皮基质与自体皮片复合移植的临床应用

目的:探讨异体脱细胞真皮基质与自体皮片复合移植修复大面积深度烧伤及瘢痕切除后皮肤缺损创面及其愈合后皮肤的外形和功能。方法:应用异体脱细胞真皮基质与自体刃厚皮片组成复合皮移植,以自体刃厚皮片移植作为对照,采用一步移植法治疗切痂后大面积深度烧伤创面及瘢痕切除后皮肤缺损共56例患者60处创面,观察术后皮片的成活情况、外形及功能恢复情况并随访。结果:60处创面全部愈合,移植皮片生长良好,瘢痕增生不明显,未见明显挛缩,皮肤弹性较好。在6～12个月的观察期内,自体刃厚皮片与异体脱细胞真皮基质复合移植后,功能和形态优于单纯自体刃厚皮片移植;随访2年复合移植未发现明显的排异反应。结论:异体脱细胞真皮基质与自体皮片复合移植修复大面积深度烧伤及瘢痕切除后皮肤缺损创面愈合良好,无瘢痕增生,皮肤外观功能满意,无排异反应。     

异体脱细胞真皮基质与自体皮片复合移植的临床应用

目的:探讨异体脱细胞真皮基质与自体皮片复合移植修复大面积深度烧伤及瘢痕切除后皮肤缺损创面及其愈合后皮肤的外形和功能。方法:应用异体脱细胞真皮基质与自体刃厚皮片组成复合皮移植,以自体刃厚皮片移植作为对照,采用一步移植法治疗切痂后大面积深度烧伤创面及瘢痕切除后皮肤缺损共56例患者60处创面,观察术后皮片的成活情况、外形及功能恢复情况并随访。结果:60处创面全部愈合,移植皮片生长良好,瘢痕增生不明显,未见明显挛缩,皮肤弹性较好。在6～12个月的观察期内,自体刃厚皮片与异体脱细胞真皮基质复合移植后,功能和形态优于单纯自体刃厚皮片移植;随访2年复合移植未发现明显的排异反应。结论:异体脱细胞真皮基质与自体皮片复合移植修复大面积深度烧伤及瘢痕切除后皮肤缺损创面愈合良好,无瘢痕增生,皮肤外观功能满意,无排异反应。     

脱细胞异体真皮基质与自体刃厚皮复合移植治疗关节部位深度烧伤

目的:探索一种治疗关节部位深度烧伤的方法。方法:2002～2006年我科收治关节部位深度烧伤患者126例,随机分为两组,治疗组和对照组各63例,治疗组采用J-1型脱细胞异体真皮基质与自体刃厚皮复合移植一次修复关节部位72个;对照组74个关节部位采用自体断层皮移植。结果:两组皮片均成活良好;经随访6～18个月,治疗组脱细胞异体真皮无排斥反应,植皮区光滑平整,色泽及弹性良好,瘢痕增生反应轻,挛缩少,关节运动功能好;对照组植皮区反复起水疱,色泽及弹性较差,瘢痕增生明显,关节活动受限明显。结论:脱细胞异体真皮与自体皮复合移植是治疗关节部位深度烧伤的一种比较理想的方法。     

皮耐克在大面积烧伤患者关节部位瘢痕挛缩修复中的应用

目的:探讨人工真皮皮耐克在大面积烧伤患者关节部位瘢痕挛缩修复中的应用效果。方法:在大面积烧伤患者关节部位瘢痕挛缩的修复应用中,一期行瘢痕切除联合皮耐克覆盖术,2~3周后行二期自体刃厚皮片移植术,观察手术效果。结果:移植皮片全部成活,修复关节功能良好,外观满意。远期随访供皮区仅轻度色素沉着,无瘢痕增生。结论:皮耐克联合自体刃厚皮移植在大面积烧伤患者关节部位瘢痕挛缩的修复中具有良好的应用价值,值得临床推广。     

复合植皮治疗功能部位烧伤感染创面

大面积烧伤患者抢救后期均存在感染的肉芽创面 ,一般常以自体刃厚皮片移植来覆盖创面 ,但愈合后常出现明显瘢痕 ,特别是功能部位 ,瘢痕挛缩、粘连、牵拉导致功能障碍。很多患者不得不再次手术。为此 ,在治疗中要求尽可能在功能部位植皮时使用厚皮片。但对于大面积烧伤患者 ,有时很难达到。近年来 ,有数种真皮替代材料用于整形手术中。能否在大面积烧伤治疗中使用真皮替代材料 ,结合自体刃厚皮片移植以改善创面愈合以后的状况 ,预防畸形的发生、保留完好的功能是需要解决的问题。目前 ,可见到的数种真皮替代材料均注明 :创面有感染存在时禁用…     

无细胞真皮基质与自体皮片复合移植的临床应用

目的：改善烧伤创面移植皮片愈合后皮肤的外形和功能,并减轻供皮区瘢痕增生。方法：应用自制的无细胞真皮基质与自体刃厚皮片复合移植于4例切（或削）痂后的烧伤创面。结果：未发现对复合移植皮片的排异反应。创面愈合后,大体观察发现移植自体网状皮片及自体小皮片的轮廓界面变得不明显或基本消失,自体大张皮片与真皮基质复合移植区出现较厚而特殊的脱屑,均反映了愈合过程的特殊性。光镜和电镜观察发现复合皮片移植区棘细胞间桥粒清晰,基底膜连续而完整等。与对照部位相比,复合皮片移植区瘢痕增生减轻,未见明显挛缩,皮肤弹性较好。结论：在3－4个月的观察期内,自体刃厚皮片与无细胞真皮基质复合移植后,功能和形态等同或优于单纯自体刃厚皮片移植。     

复合皮移植修复烧伤功能部位创面疗效评价

目的探讨脱细胞同种异体真皮与自体刃厚皮复合移植修复深度烧伤功能部位创面的疗效。方法 2002年6月-2008年12月,收治30例烧伤及瘢痕整形患者共42个创面。男25例,女5例;年龄3～52岁,中位年龄31岁。烧伤24例35个创面,其中深Ⅱ度23个创面,Ⅲ度12个创面;病程3～45 d,平均24 d。瘢痕整形6例7个创面;病程9～21 d,平均16 d。42个创面分别位于颈部2个,手部4个,前臂及肘部8个,肩部3个,腘窝6个,膝部4个,小腿及足踝部15个。彻底清创、削痂及切除瘢痕后,创面范围为10 cm×10 cm～30 cm×20 cm。采用一步法将脱细胞同种异体真皮与自体刃厚皮复合移植修复创面。结果术后27例39个(92.9%)创面复合皮移植完全成活;3例3个(7.1%)创面复合皮部分坏死,分别经换药和自体皮片移植术后愈合。患者均获随访,随访时间30～34个月,平均32个月。复合皮有轻度色素沉着,外观平整,质地柔软,弹性好,皮肤耐磨;复合皮无挛缩及瘢痕增生,功能部位活动正常。刃厚皮供皮区未见瘢痕增生。结论脱细胞同种异体真皮与自体刃厚皮复合移植修复功能部位深度烧伤及瘢痕整形创面,可获得良好外形及功能。     

脱细胞异体真皮支架加自体刃厚皮移植治疗深度创面的临床观察

深度烧伤和烧伤晚期瘢痕整形时常采用不同厚度的自体皮片移植。若皮片太薄，受皮区易产生瘢痕挛缩，甚至继发畸形，影响功能；中厚皮片移植，供皮区易产生瘢痕；全厚皮移植供皮区有限。2004年7月～2005年10月，我们采用脱细胞异体真皮支架加自体刃厚皮移植术治疗各种原因引起的烧烫伤创面和瘢痕整形继发创面81例，术后获随访6～20个月，效果满意。报告如下。     

异体脱细胞真皮基质在烧伤后遗畸形中的应用

目的:探索一种治疗烧伤后遗畸形的方法。方法:针对各关节烧伤后遗瘢痕松解切除后创面,采用异体脱细胞真皮基质与刃厚皮形成复合皮片移植一步法修复。2002~2005年共对31例患者进行手术治疗,术后随访半年至2年。结果: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:异体脱细胞真皮基质与刃厚皮形成复合皮片移植是一种较理想的治疗烧伤后遗瘢痕方法,值得推广应用。     

复合皮移植功能部位的临床应用

笔者单位于2000年1月-2003年1月应用脱细胞异体真皮 自体刃厚皮片复合移植（以下称复合皮），治疗大面积烧伤功能部位深度创面及功能部位瘢痕增生整形患者共32例，效果满意，现报告如下。     

脱细胞异体真皮在烧伤后瘢痕修复中的应用

目的：探讨脱细胞异体真皮在烧伤后期瘢痕修复中的应用价值。方法：2006年2月-2007年2月入院治疗的21例烧伤后遗留瘢痕患者（A组）,采用切开并充分松解挛缩的瘢痕组织,利用脱细胞异体真皮加自体刃厚皮移植于继发创面的方法治疗。随机抽取同期21例采用瘢痕松解切除后进行中厚皮移植的患者（B组）及21例进行次全厚皮移植的患者（C组）作对照,比较3组患者的皮片成活情况以及术后1年的随访情况。结果：A组中皮片坏死率较其余两组略高;1年后随访发现,A组在受皮区皮片挛缩程度,外观平整度、色素改变及供皮区瘢痕形成方面均明显优于B组,与C组相当;C组仅适用于较小瘢痕的修复。结论：脱细胞异体真皮加自体皮复合移植是烧伤后期瘢痕修复的有效手段。     

微粒皮移植治疗大面积深度烧伤后关节瘢痕挛缩的初步体会

目的 探讨大面积深度烧伤病人自体微粒皮与大张异体皮移植术治疗关节部位瘢痕挛缩的方法.方法 选择大面积深度烧伤后期瘢痕严重增生挛缩造成关节畸形而自体皮匮乏的病人11例,共31个关节,在全麻下切除部分瘢痕,彻底松解,矫正关节畸形,用微粒皮加异体皮覆盖创面,术后进行植皮区压迫和早期功能锻炼.随访12个月以上.通过术前、术后的皮肤外观、关节功能、组织学观察等进行效果评价.结果 微粒皮移植者皮肤外观及关节功能明显改善;组织学可见表皮较厚,部分可见表皮脚,真皮层较薄,胶原纤维排列较有规律.结论 微粒皮加大张异体皮移植术可用于治疗大面积深度烧伤病人关节部位瘢痕挛缩.     

采用人工真皮修复大面积烧伤早期手部创面的疗效观察

目的:观察早期应用人工真皮修复大面积烧伤患者手部创面的效果.方法:选取2009年1月-2010年9月就诊于北京市右安门医院的大面积烧伤患者38例,采用随机分组方法分为两组.人工真皮组19例在早期修复手部创面手术中用人工真皮覆盖创面,2周后用自体刃厚皮片覆盖.对照组19例创面早期切痂、行自体微粒+异体皮移植,后期肉芽组织...     

脱细胞异体真皮与自体瘢痕薄皮复合移植的临床应用

目的:为大面积深度烧伤后期继发瘢痕挛缩、功能障碍且皮源不足的患者寻求比较理想的治疗手段.方法:切开松解功能区孪缩的瘢痕组织,将脱细胞异体真皮与自体大张瘢痕薄皮复合移植覆盖创面,加压固定包扎.结果:5例患者12个创面中,除一个创面皮片部分坏死外,余均成活.术区平整、柔软,所植皮片挛缩轻,无瘢痕增生,功能恢复良好.结论:脱细胞异体真皮 自体瘢痕薄皮复合移植是目前修复大面积深度烧伤患者功能部位创面,实现功能重建的有效方法.     

A long-term follow-up study of acellular dermal matrix with thin autograft in burns patients

We report long-term follow-up results of acellular dermal matrix (ADM) allograft combined with thin split-thickness skin autograft (STSG) for burn treatment. Between March 2001 and May 2007, we treated 19 cases of burn wounds or scar wounds at 34 different body sites with ADM allograft combined with STSG. All patients were monitored, with the mean follow-up period being 3.3 ± 1.4 years. Transplant skin was assessed by using a modified Manchester Scar Scale. The control sites that were treated with STSG at the same time were also monitored. There were significant differences in contour, contracture, and texture between the treatment and control sites (P < 0.05), but not in color, sensation, and complications (P > 0.05). All composite-grafted joints showed recovery and improvement in function postoperatively. The aesthetic contour of the skin donor site was satisfactory. Composite graft with ADM produces a supple texture without contractures, approaching the normal skin contour, and leading to adequate improvement in function.     

Use of artificial dermis graft for covering the femoral vessels after groin dissection

An artificial dermis graft has been used to cover exposed femoral vessels after groin dissection in five patients. After the silicone membrane was dissected off with a scalpel, the artificial dermis was applied. The femoral vessels were successfully covered without either postoperative infection or allergic reaction in all patients. In two patients, full-thickness skin necrosis occurred. However, the femoral vessels were not exposed since they were covered by the artificial dermis, and subsequent skin grafting was performed. There was no postoperative contracture in any of the patients, and the grafted area was soft. It can thus be concluded that artificial dermis is an easy, less invasive, and useful option for covering the femoral vessels after groin dissection, especially in patients with a thin and fragile sartorius muscle. Received: 15 February 1999 / Accepted: 15 June 1999     

负压封闭引流技术联合人工真皮治疗足踝部皮肤软组织缺损

目的 :探讨负压封闭引流技术(VSD)联合人工真皮治疗足踝部皮肤软组织缺损的临床治疗效果。方法 :自2011年1月至2013年12月间收治15例足踝部皮肤软组织缺损患者,其中男10例,女5例;年龄3~55岁,平均32.5岁;车祸伤8例,机器绞伤2例,碾压伤5例;单纯的肌肉软组织外露8例,肌腱外露2例,骨外露5例。清创后VSD覆盖创面并持续负压引,Ⅱ期待创面肉芽组织生长良好后用人工真皮覆盖创面,再次VSD覆盖创面并负压吸引,7~14 d后去除负压封闭引流,人工真皮上方移植游离皮片,无菌纱布加压包扎。结果 :所有患者获得随访,时间3~14个月,平均6.5个月。15例患者植皮片全部存活,人工真皮移植后植皮间隔时间为7~14 d,平均9.5 d。术后移植皮肤未见明显瘢痕增生及挛缩,无明显色素沉着,外观及功能恢复满意。结论:人工真皮植入后再行植皮传统的方法需2~3周,负压封闭引流技术联合人工真皮治疗足踝部皮肤软组织缺损,操作简单,明显缩短Ⅱ期植皮时间,无须皮瓣修复,供皮区损伤少,创面愈合质量高,临床效果满意。     

去细胞异体真皮、去细胞猪真皮和自体刃厚皮移植在临床中的应用

目的观察去细胞异体真皮或去细胞猪真皮加自体刃厚皮移植在深度烧伤和整形外科中的应用效果。方法采用去细胞异体真皮或我们研制的去细胞猪真皮加自体刃厚皮移植的方法,修复各种创面119例次,比较不同创面的植皮成活率,观察应用不同部位的皮肤覆盖去细胞异体真皮或去细胞猪真皮与植皮成活的关系,并对部分病例进行了组织学观察和随访。结果削痂、切痂和切瘢创面植皮成活率分别为(93．4％±3．1)％、(92．1±4．6)％和(94．5±3．8)％,三者间差异无显著意义;去细胞异体真皮加自体刃厚皮移植与去细胞猪真皮加自体刃厚皮移植,二者植皮成活率差异无显著意义。躯干、四肢自体刃厚皮覆盖的去细胞异体真皮或去细胞猪真皮,植皮成活率分别为(93．1±4．8)％、(89．0±6．2)％,而应用刃厚头皮或自体微粒皮加异体皮覆盖的去细胞异体真皮或去细胞猪真皮,植皮成活率明显下降(P<0．05或0．01)。组织学观察,术后19个月时表皮、真皮形态正常,胶原纤维排列规则,未见胶原纤维明显增生和瘢痕化,无皮肤附件。成活的复合移植皮肤,与邻近正常肤色近似,色素沉着轻,无明显皱缩,触之软,活动度好。结论去细胞异体真皮或去细胞猪真皮加自体刃厚皮移植修复深度烧伤创面或切瘢后创面不失为一种较理想的材料。     

Skin regeneration for children with burn scar contracture using autologous cultured dermal substitutes and superthin auto-skin grafts: preliminary clinical study

We have evaluated a novel treatment of burn scar contracture in children. This method involves the application of an autologous cultured dermal substitute (CDS), followed by a graft of superthin split-thickness skin. In the first operation, the autologous CDS was applied to the skin defect that had occurred after releasing the scar contracture. In the second operation, a superthin thickness skin graft (4 approximately 6/1000 inches) was applied 5 approximately 12 days after the first operation. The autologous CDS was applied to 10 sites of 5 children. On 8 sites, the skin grafts were contracted to some extent at an early stage. However, these skin grafts were stretched gradually to a range from 60% to 100% of an original size. At 2 sites, the skin grafts had stretched from 110% to 130% of the original size. This strategy may be useful for the treatment of burn scar contracture in children.     

Comparison of therapeutic effects between artificial dermis combined with autologous split‐thickness skin grafting and autologous intermediate‐thickness skin grafting alone in severely burned patients: A prospective randomised study

The purpose of this study was to evaluate the therapeutic effects of artificial dermis combined with autologous split‐thickness skin grafting (STSG) compared with autologous intermediate‐thickness skin grafting (ITSG) alone in severely burned patients. Fifty‐six severely burned patients admitted to our hospital from December 2017 to January 2019 were enrolled and evenly grouped according to the random number table method [AD‐STSG group: 28 patients, receiving the treatment of artificial dermis (AD) combined with autologous STSG; ITSG group: 28 patients, receiving autologous ITSG treatment alone]. The healing time and Vancouver Scar Scale (VSS) score of the donor area and graft area, survival rate and infection status of the autologous skin, psychological status (determined by Self‐rating Anxiety Scale and Self‐rating Depression Scale), and the activity of functional parts of all enrolled patients were included in the evaluation. General items of patients in AD‐STSG group and ITSG group, including age, sex, and degree of burn, were all comparable. A significantly shortened healing time of donor skin in AD‐STSG group was observed when compared with ITSG group (P < .05) while the recipient skin healed in the same tendency between the two groups. In addition, 21 days after the operation, AD‐STSG group presented with significantly higher survival rate of graft skin than ITSG group (P < .05) while same infection status was observed in the two groups. Significantly lower VSS scores were found in AD‐STSG group than that in ITSG group 3‐, 6‐ and 10‐months after operation (P < .05). Statistical difference regarding psychological status of patients from two groups was unobservable before operation while significantly lower Self‐rating Anxiety Scale (SAS) and Self‐rating Depression Scale (SDS) scores were found in AD‐STSG group than that in ITSG group 3‐, 6‐ and 10‐months after operation (P < .05). Also, AD‐STSG group presented improved mobility of functional part than that in ITSG group 10‐months after operation without statistical difference (P = .051). Artificial dermis combined with autologous split‐thickness skin grafting showed better therapeutic outcomes for the treatment of severely burned patients than autologous intermediate‐thickness skin grafting in terms of graft healing time, scar formation, psychological recovery, and perhaps in functional reconstruction.