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。     

人工真皮修复软组织缺损20例

为了研究及评价人工真皮在皮肤、组织缺损中的应用,北京积水潭医院烧伤科对2008-01/2009-04期间收治的皮肤、组织缺损患者20例应用人工真皮进行修复治疗.对有皮肤缺损、深部组织(肌腱、关节及骨外露)患者行清创、人工真皮移植,待其成活后,进行自体薄断层皮片进行移植,观察人工真皮及自体断层皮片的成活情况.移植后20例患者深部组织被有效覆盖,所有人工真皮成活,自体皮片移植成活,未见有明显瘢痕组织生成.提示应用人工真皮修复组织缺损、深部组织暴露,可以减少手术风险,减轻手术损伤,减轻瘢痕生成.     

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。     

应用人工真皮联合自体薄层皮片移植修复深度皮肤软组织缺损11例

背景：深度皮肤软组织缺损创面积极的治疗方法往往以皮瓣修复为主，但对患者身体状况要求较高，且代价较大。人工真皮是最早开发和成功应用于临床的组织工程化皮肤替代物，主要用于皮肤软组织缺损的修复。目的：拟观察人工真皮联合自体薄层皮片移植对深度皮肤软组织缺损创面的修复效果。设计、时间及地点：病例分析，于200601／2008—03在北京大学第三医院成形科、北京积水潭医院烧伤整形科完成。对象：11例患者均存在由于手术或外伤导致不同程度和部位的皮肤软组织缺损创面，部分病例伴有骨质外露、骨膜缺损。方法：手术中一期扩创，需要时凿骨，移植人工真皮，经2～4周创面破类真皮组织覆盖后，二期进行自体薄层皮片移植。主要观察指标：观察创面愈合及植皮存活情况，供皮区有无明显瘢痕。结果：11例创面均得到良好覆盖。创面愈合后1个月复查，植皮后愈合良好，供皮区均没有明显瘢痕。结论：人工真皮联合自体薄层皮片移植对深度皮肤软组织缺损创面具有良好的修复效果，供区损伤小。人工真皮的应用为修复包含骨外露创面在内的深度皮肤软组织创面提供了一种新方法。     

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。     

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.     

脱细胞真皮基质修复急性外伤性皮肤缺损的临床研究

目的 改善皮肤移植的功能和形态，提高急性外伤性皮肤缺损治疗的临床效果。方法 应用自制脱细胞真皮基质与自体薄皮片复合移植于23例(26次)外伤性皮肤缺损的创面上，观察其成活率和创面愈合后的质量，3例再次手术病人留取创面组织进行组织学检查。结果 复合皮移植后的皮片成活率为100!例24次；余2例2次为90％成活，植皮区光滑平整，供皮区无瘢痕增生，组织学检测提示复合皮血管化明显，胶原排列有序，表皮一真皮连接结构紧密，未见急性和慢性排异反应。结论 脱细胞真皮基质与自体薄皮片复合移植能改善外伤性皮肤缺损创面愈合的皮肤质量，优于单纯自体皮移植。     

人工真皮复合自体刃厚皮移植治疗大面积烧伤瘢痕挛缩

大面积烧伤患者,皮肤损毁严重,多次手术修复创面,愈合后全身瘢痕广泛形成。关节功能部位易出现瘢痕挛缩畸形,由于缺乏良好的供皮区,有时无法完成必要的整形手术,外观及功能的障碍,严重影响了患者的日常生活。目前人工真皮复合刃厚皮片移植应用于皮肤软组织缺损修复,瘢痕整复,慢性创面修复等方面,取得了良好效果。作者将其应用于治疗大面积烧伤后瘢痕挛缩畸形,取得满意治疗效果,现报告如下。     

Bone marrow mesenchymal stem cells increase skin regeneration efficiency in skin and soft tissue expansion

Background: Skin and soft tissue expansion has limitations such as long hospitalization time and flap retraction after expansion. Our previous study suggested that bone marrow-derived stem cells contribute skin regeneration in skin and soft tissue expansion. In this study, the authors explored the feasibility of applying the bone marrow mesenchymal stem cells (BMMSCs) to the treatment of skin and soft tissue expansion and increasing the skin regeneration efficiency. Methods: Sixty silicone expanders were implanted in the backs of 15 pigs, and allogeneic BMMSCs were transplanted to skin shallow fascia layer (local transplantation, Group A) or via ear vein (systemic transplantation, Group B). Group C was the Sham operation control; and then the expanders were injected with normal saline (N.S.). Skin was obtained at different time points (days 0, 14, 21, 28, 35, and 42). The organizational structure changes of the target skin were observed in the expansion process. The distribution, differentiation, and paracrine function of labeled BMMSCs were detected. Results: Comparing with Group B (25.00 ± 1.98 cm(2)) or Group C (24.00 ± 1.10 cm(2), no transplantation), the expanded skin area of Group A (28.82 ± 1.43 cm(2)) increased, with the morphology of epidermis thickened, and dermis thinned. The BMMSCs differentiated into vascular endothelial cells and dermal fibroblasts. The quantity of newborn cells was proportional to the number of transplanted cells. The gene expression of VEGF, bFGF, EGF, and SDF in Group A was higher than those in Group B or C. The most obvious changes were on day 35. Conclusions: The local transplanted BMMSCs could increase the skin regeneration efficiency in skin and soft tissue expansion and reduce skin shrinkage effectively after removing the expander. Growth factors, VEGF, bFGF, EGF, and SDF, are favorable to this process.     

针刺过程中的针体受力分布

背景：针刺过程针体受力分布，不仅取决于不同穴位处组织结构，更受行针手法的影响。目的：就一般穴位所共有的表皮、真皮和皮下结缔组织的组织结构和力学性质，分提插和捻转法进行针体受力研究。方法：以提插法和捻转法为前提，以表皮组织、真皮组织和皮下结缔组织为区域对象，在前期研究的基础上建立类固体和软物质两种生物力学模型，对行针过程中的针体阻力分布进行分析，以得出定性化的结论。结果与结论：表皮无血管无神经，致密而坚硬，可以看作类固体；真皮及皮下结缔组织中血管神经等分布广泛，疏松而柔软，是典型的软物质。提插行针过程中非“得气”时阻力主要来自表皮部分，在“得气”状况下阻力应该来自表皮和结缔组织中的纤维细胞共同作用，对针体而言，进入皮肤的所有针体部分都是受力点，只是靠近针尖部分的针体受力稍大一些，但是随着提插操作，进入皮肤的针体长度不断在发生变化。捻转法行针的主要阻力来自胶原纤维和弹性纤维的缠绕，对针体而言受力点主要集中在针尖及附近部位。     

Bone marrow mesenchymal stem cells increase skin regeneration efficiency in skin and soft tissue expansion

Background: Skin and soft tissue expansion has limitations such as long hospitalization time and flap retraction after expansion. Our previous study suggested that bone marrow-derived stem cells contribute skin regeneration in skin and soft tissue expansion. In this study, the authors explored the feasibility of applying the bone marrow mesenchymal stem cells (BMMSCs) to the treatment of skin and soft tissue expansion and increasing the skin regeneration efficiency.

Methods: Sixty silicone expanders were implanted in the backs of 15 pigs, and allogeneic BMMSCs were transplanted to skin shallow fascia layer (local transplantation, Group A) or via ear vein (systemic transplantation, Group B). Group C was the Sham operation control; and then the expanders were injected with normal saline (N.S.). Skin was obtained at different time points (days 0, 14, 21, 28, 35, and 42). The organizational structure changes of the target skin were observed in the expansion process. The distribution, differentiation, and paracrine function of labeled BMMSCs were detected.

Results: Comparing with Group B (25.00 ± 1.98 cm²) or Group C (24.00 ± 1.10 cm², no transplantation), the expanded skin area of Group A (28.82 ± 1.43 cm²) increased, with the morphology of epidermis thickened, and dermis thinned. The BMMSCs differentiated into vascular endothelial cells and dermal fibroblasts. The quantity of newborn cells was proportional to the number of transplanted cells. The gene expression of VEGF, bFGF, EGF, and SDF in Group A was higher than those in Group B or C. The most obvious changes were on day 35.

Conclusions: The local transplanted BMMSCs could increase the skin regeneration efficiency in skin and soft tissue expansion and reduce skin shrinkage effectively after removing the expander. Growth factors, VEGF, bFGF, EGF, and SDF, are favorable to this process.     

Engineering a human skin equivalent to study dermis remodelling and epidermis senescence in vitro after UVA exposure

Utra Violet type A (UVA) exposure strongly affects the ageing of human skin by modifying both epidermis and dermis and their cross talk as well. The possibility to get a deep understanding in vitro of such crucial mechanism would have a huge impact in the development of antiageing compounds. Here, we present a full thickness model of human skin equivalent formed by a millimeter‐sized dermis completely composed of fibroblasts embedded in their own extracellular matrix. We show that such endogenous nature of the dermis compartment allows the replication of the complexity of the mutual interactions occurring between cellular and extracellular components of the skin under UVA exposure: (a) oxidative stress formation in the whole tissue (dermis and epidermis); (b) senescence of germinative layer of epidermal tissue in terms of p63, ki67, and activated caspase‐3 regulation; (c) modification of the collagenous network architecture in the dermis compartment. By using this human skin model, it is possible to study a widely shared assumptions not yet proved in vitro such the effect of UVA on the self‐renewal capability of skin stem cells.     

皮肤扩张器的改造及其在构建自体复合皮中的应用

背景:置入正常皮肤软组织下的皮肤软组织扩张器,通过定期向扩张囊内注入生理盐水使其不断扩张,可获得"额外"皮肤软组织.目的:对传统皮肤扩张器进行改造并应用于构建自体复合皮.方法:将传统单注射壶皮肤扩张器改造成双注射壶,原有的注射壶通向扩张囊内,添置的注射壶通向囊外,扩张囊容量10 mL.将改造后的扩张器埋植于10只新西兰大耳白兔背部皮下,扩张器埋置2周后,经注射壶注入原代培养的自体表皮细胞悬液,即种植于扩张囊和纤维包囊的腔隙内.结果与结论:新西兰大耳白兔完全存活,扩张器未出现破损渗漏,伤口均愈合,无排异反应.注入表皮细胞种植1周后,纤维包囊表面可见较多的上皮细胞岛,但未形成完整的细胞层;2周后的纤维包囊表面可见完整的类似于假复层鳞状上皮的细胞层,两者结合紧密.提示经改造的新型皮肤扩张器用于体内构建自体复合皮是可行的,发挥着关键性的作用.     

Minimal contraction for tissue‐engineered skin substitutes when matured at the air–liquid interface

The structural stability of skin substitutes is critical to avoid aesthetic and functional problems after grafting, such as contractures and hypertrophic scars. The present study was designed to assess the production steps having an influence on the contractile behaviour of the tissue‐engineered skin made by the self‐assembly approach, where keratinocytes are cultured on tissue‐engineered dermis comprised of fibroblasts and the endogenous extracellular matrix they organized. Thus, different aspects were investigated, such as the assembly method of the engineered dermis (various sizes and anchoring designs) and the impact of epithelial cell differentiation (culture submerged in the medium or at the air–liquid interface). To evaluate the structural stability at the end of the production, the substitutes were detached from their anchorages and deposited on a soft substrate, and contraction was monitored over 1 week. Collected data were analysed using a mathematical model to characterize contraction. We observed that the presence of a differentiated epidermis significantly reduced the amount of contraction experienced by the engineered tissues, independently of the assembly method used for their production. When the epidermis was terminally differentiated, the average contraction was only 24 ± 4% and most of the contraction occurred within the first 12 h following deposition on the substrate. This is 2.2‐fold less compared to when the epidermis was cultured under the submerged condition, or when tissue‐engineered dermis was not overlaid with epithelial cells. This study highlights that the maturation at the air–liquid interface is a critical step in the reconstruction of a tissue‐engineered skin that possesses high structural stability. Copyright © 2012 John Wiley & Sons, Ltd.     

交叉乳腺瓣修复重度乳头内陷

目的:为了修复重度乳头内陷从1992年至1998年修复重度乳头内陷47例,83只乳头。方法:采用交叉乳腺瓣修复。手术时充分松解乳头深面所有癍痕组织,充填了乳头内不足的组织量;利用4个乳腺瓣交叉重叠缝合,加固了乳头的基底,增加了乳头向外突出;并切除乳头及乳晕部4个交错的三角形区表皮以增加乳头基底部皮肤的环形张力,防止乳头的回缩。结果:经过3月至5年的随访(平均2年),乳头坚挺,持久,无一例复发,无一例乳头坏死及感觉障碍。结论:该术式操作简便,效果良好,是修复重度乳头内陷较好的一种方法。