猪脱细胞真皮与自体皮复合移植的临床应用及远期疗效

目的 了解异种脱细胞真皮基质与自体皮复合移植修复深度创面的临床效果,并进行不同时期随访及组织学观察. 方法 2000年2月-2003年7月,采用猪脱细胞真皮基质与自体刃厚皮二步复合移植法修复深度创面152例.观察移植后1周的皮片成活率及移植后1、3、6、12个月瘢痕增生情况;5例患者在移植72个月后取该部位样本进行组织学检查,其中2例进行透射电镜观察.对本组患者进行不同时期随访并与自身其他部位其他移植方式比较. 结果 创面植皮完全成活者116例占76.3%,95%以上成活者36例占23.7%,无一例补充植皮.1个月后随访到127例患者,可见移植局部有轻度挛缩,皮片连接处有条索状瘢痕,质地比较柔软,无明显瘙痒或起疱.3个月随访到101例,见复合移植物有轻度挛缩,但与刃厚皮移植部位比较明显减轻,关节功能良好.6个月随访到82例,复合移植皮肤颜色、质地接近正常,瘢痕增生不明显.12个月随访到58例,移植皮肤接近正常,未见明显排异现象.72个月以上随访到16例,移植局部稍显干燥,无其他异常.组织学观察结果提示:移植部位组织结构与正常皮肤基本一致,真皮支架中可见不完整的小汗腺及参与汗腺组成的细胞. 结论异种脱细胞真皮基质与自体刃厚皮复合移植,可以与人体局部组织长期共存,无明显排异反应.不完整小汗腺及汗腺细胞的出现,可能成为皮肤功能重建中新的关注点.

Clinical application and long-term follow-up study of acellular dermal matrix combined with auto-skin grafting

OBJECTIVE: To investigate the clinical effect of acellular dermal matrix (ADM) combined with auto-skin grafting on deep burn wound ,and the result of long-term follow-up and histological examination. METHODS: One hundred and fifty-two patients with deep burn hospitalized from February 2000 to July 2003 were repaired with porcine ADM and auto split-thickness graft. Wound healing rate was assessed 1 week after operation. Degree of cicatricial hyperplasia was examined 1, 3, 6, 12 months after operation. Wound samples from 5 patients were harvested for histological examination 72 months after operation, for which transmission electron microscopy were employed in 2 cases. RESULTS: Grafts completely survived was seen in 116 patients (accounting for 76.3% of cases), survival rate over 95% were observed in 23.7% of cases. One hundred and twenty-seven patients were followed up 1 month after operation, in whom mild local contraction, cord like scar was seen along its junction with skin, its texture was soft ,and there was no pruritus or blister formation. One hundred and one patients were followed up 3 months after operation, and the graft showed mild contraction less marked when compared with that of the site where auto split-thickness skin grafting was used. Articular function was good. Eighty-two patients were followed up 6 months after operation,color and texture of grafts were similar to normal skin with no obvious cicatricial hyperplasia. Fifty-eight patients were followed up 12 months after operation, the texture of grafts was similar to normal skin without obvious reject reaction. Sixteen patients were followed up over 72 months after operation, the grafts appeared dry compared with normal skin. Histological examination showed: tissue structure of grafts was similar to normal skin, intact small sweat gland and sweat gland cells were not found in dermal layer. CONCLUSION: Heterologous ADM combined with auto split-thickness graft can survive in human body without obvious immune rejection reaction for a long time. No intact small sweat gland or sweat gland cells in dermis is a problem worth of study in regeneration of skin function.