异体脱细胞真皮基质与自体皮片复合移植治疗增生性瘢痕临床应用探讨

目的:异体脱细胞真皮基质与自体皮片复合移植是治疗深度烧伤增生性瘢痕的较好方法,可以明显改善手术部位的外观及功能,探讨该方法在不同部位中的应用及具体操作方法和注意事项.方法:在56例患者共78个创面上用商品化的同种异体脱细胞真皮与自体大张刃厚皮片复合移植,术区选择前臂、小腿、大腿、胸部等非功能部位以及膝关节、踝关节、肩关节、髋关节等功能部位,采用一步法.结果:76个创面的复合移植皮片完全成活,前臂、小腿、大腿等非功能部位术区皮片外观、质地和弹性均令人满意,无明显瘢痕形成;胸部术区皮片外观、质地和弹性欠佳,膝关节、踝关节、肩关节、髋关节等功能部位术区皮片外观、质地和弹性绝大多数令人满意,无明显瘢痕形成,关节活动功能明显改善,2个创面因基底血运不良成活欠佳,残留明显瘢痕.结论:一步法复合移植具有较高的成功率,术后效果与术区部位、网状异体脱细胞真皮基质拉网大小、创面基底、自体刃厚皮片质量有关.

The clinical application of Treating Hyperplastic Scar with Composite Graft of Allograft Dermal Matrix,adm and Autograft Skin Flap

Objective： Composit graft of allograft dermal matrix, adm and autologous skin flap, which can obviously improve the appearance and function of the surgical sites, is the better method to treat hypertrophic scars caused by deep bum. To explore the application, specific operations and attentions of the method in treating different parts of the body. Method： 56 cases （78 wounds） were treated with composite graft of commercialization of allogeneic acellular dermal matrix and autologous large sheet blade thickness flap. Operation area were selected including non - functional parts such as forearm, calf, thigh, chest et al, as well as function part such as knee and ankle joints, shoulder and hip joints et al. And one - step method was used to make skin graft. Result： All of 76 wounds survived completely. The appearance, texture and elasticity of flap in operation area including forearm, calf, thigh and other non -functional parts were satisfactory and no obvious scar formation was observed, except with thoracic surgery area skin appearance, texture and elasticity poor. Flap in functional parts such as knee joint, ankle joint, shoulder joint and hip joint appeared satisfactory appearance, texture and elasticity and without obvious scar formation. Moreover, joint function has been significantly improved. But only 2 wounds were observed obvious scar formation due to bad blood circulation. Conclusion： The composite graft of One - step method has higher successive rate. There is relativity between postoperative results and surgery area location, mesh net size of allogeneic acellular dermal matrix, wound base and the quality of autologous blade thickness flap.