异体真皮移植术后感染原因分析以及在烧伤整形中的安全性和应用效果评估

了解脱细胞异体真皮移植术后发生感染的主要原因，并探讨脱细胞异体真皮移植在烧伤整形中的安全性和临床疗效。方法　选取２０１０年１月—２０１４年１月期间收治的５８例行早期手术切痂，脱细胞异体真皮与自体刃厚皮移植修复治疗的患者作为试验组，另选同期４９例行单纯自体刃厚皮移植修复治疗的患者作为对照组。治疗后随访患者半年，对异体真皮移植术后发生感染者总结其原因。同时，分别对两组患者创面修复的总成活率及修复效果进行评价，并观察两组患者的围手术期出血量、及术后并发症的发生率差异，评价其安全性。结果　异体真皮移植术后感染发生率为１２９％，其感染原因主要是手术区内残留瘢痕组织、创面清创不彻底。试验组手术皮片成活率为９３１０％，对照组为７１４３％，差异具有统计学意义（Ｐ＜００５）。异体真皮移植术在创面愈合时间、６月后创面修复效果、ＶＳＳ评分、术后活动功能恢复方面优于单纯自体刃厚皮移植术（Ｐ＜００５）；治疗后，试验组患者术后并发症的总发生率１５５％，对照组为２２４％，差异具有统计学意义（Ｐ＜００５）。异体真皮移植术的皮肤感染、移植皮片液化或移位、皮下坏死发生率低于单纯自体刃厚皮移植术（Ｐ＜００５）。结论　应用脱细胞异体真皮基质与自体刃厚皮移植成活率高，可有效修复烧伤创面及瘢痕创面，安全有效。可进一步观察研究并宣传改进，使其在临床更好的推广应用，从而真正解决目前烧伤整形自体移植的难题。

Analysis the allogeneic dermis transplantation of postoperative Infective cause and evaluation its safety and effect applied in burn plastic

To understand the main postoperative infective causes of the decellularized allograft dermis trans-plantation and to explore its safety and clinical efficacy in burn plastic. Methods Select 58 patients admitted during Janu-ary 2010 to January 2014 underwent surgery for decellularized allogeneic dermis and autologous split - thickness skingraft repair as treat group, while 49 patients with autologous split - thickness skin graft to repair as the control group.Follow - up patients with half a year, and summarizes the reasons of postoperative infections. At the same time, respec-tively evaluate two groups of patients about the general survival rate and repair effect, and observe and compare the twogroups of patients with perioperative blood loss. the incidence of postoperative complications and safety. Results The in-cidence of infection after decellularized allogeneic dermis transplantation was 12. 9% , and causes mainly by residualscar tissue and incomplete wound debridement in the area of operation. The operation survival rate of decellularized allo-geneic dermis transplantation was 93. 10% . while the control group was 71. 43% . The difference is statistically signifi-cant ( P < 0. 05 ). The allogeneic dermis transplantation are significantly better than pure autologous split - thickness skingraft at the aspects of wound healing time, half a year wound repair effect , VSS score, postoperative function recovery activities (P < 0. 05 ) ; Additionally , the incidence of postoperative complications in treat group total( 13. 33% ) significantly lower than control group( 20% ) ( P < 0. 05 ) . The rate of skin infections ,skin piece of liquefied or shift, skin necrosis in transplantation of allogeneic dermis transplantationare lower than pure autologous split - thickness skin graft ( P < 0. 05 ) . Conclusion The survival rateof decellularized allogeneic dermis matrix with autologous split - thickness skin graft is so high that ef-fectively repair the burn wound and scar tissue. It is safe and effective. we should make it improveand a better clinical application by the further study and propaganda, and finally really solve theproblem in the burn plastic autograft transplantation