异体脱细胞真皮基质加自体刃厚皮复合移植远期随访评价

目的 评价异体ADM+自体刃厚皮复合移植的临床远期效果.方法 选择2001年3月-2008年10月,笔者单位收治的19例行异体ADM+自体刃厚皮复合移植患者为复合移植组(34个创面),同期9例行自体刃厚皮移植患者为对照组(11个创面).患者术后均随访2年以上.随访时,在曼彻斯特瘢痕量表的基础上设计随访对象评估表,评估移植皮肤的颜色、平整度、质地、挛缩、感觉、并发症情况,分值1～4分,得分越高、情况越差;采用温哥华瘢痕量表评估供皮区瘢痕形成情况;发放问卷调查患者满意度、移植期内健康记录;组织病理学方法观察其中4例患者皮肤组织结构.采用中立位法描述术前、术后及随访时患者关节活动范围.对数据进行非参数秩和检验、t检验或x2检验.结果 (1)复合移植组皮肤平整度、挛缩、质地评分分别为(1.6±0.5)、(1.8±0.8)、(1.5±0.8)分,显著低于对照组的(2.0±0.7)、(2.2±0.9)、(2.3±0.7)分(Z值分别为-2.058、-2.220、-2.323,P值均小于0.05);2组皮肤颜色、感觉、并发症评分结果相近(Z值分别为-0.628、-0.428、-2.520,P值均大于0.05).(2)复合移植组仅1个供皮区部分区域有轻度瘢痕.(3)复合移植组和对照组患者在疼痛、瘙痒和满意度方面比较,差异均无统计学意义(x2值分别为0.187、0.019、2.628,P值均大于0.05).(4)病理结果显示,手部复合移植后2年可见神经纤维结构,ADM在受体内未引起强烈的炎症反应.(5)复合移植组11处关节部位功能得到恢复或改善,另2处需再次手术.对照组2处关节部位均明显挛缩.结论 异体ADM+自体刃厚皮复合移植在防止瘢痕挛缩,改善功能及外观方面效果明显,长期存留于成人和儿童患者体内均未出现安全问题.

Follow-up review on the long-term effect of composite transplantation of allogeneic acellular dermal matrix and split thickness skin autograft

Objective To review the long-term clinical effect of composite transplantation of allogeneic acellular dermal matrix (ADM) and split thickness skin autograft (STSG). Methods Nineteen patients with 34 wounds transplanted with allogeneic ADM combined with STSG who were hospitalized from March 2001 to October 2008 were enrolled as composite transplantation group (CT). Another 9 patients with 11 wounds transplanted with STSG admitted within the same time frame were enrolled as control group (C).All patients were followed up for longer than 2 years. Color, evenness, texture, contracture, sensation, and complications of transplanted skin were assessed using a modified Manchester Scar Scale ( 1-4 scores, the higher the score, the poorer the situation). The scar formation on skin donor sites was assessed by the Vancouver Scar Scale. Patients' degree of satisfaction and health status during the transplantation period were investigated in the form of questionnaire. The skin tissue structure of 4 patients was observed with histological method. The joint range of motion was assessed by the neutral position before and after operation and at follow-up. Data were processed with nonparametric test, chi-square test or t test. Results ( 1 ) The evenness, contracture, and texture of transplanted skin in CT group scored ( 1. 6 ± 0. 5 ), ( 1.8 ± 0.8 ), and ( 1. 5 ± 0.8), respectively, which were significantly lower than those in C group ( 2.0 ± 0. 7 ), ( 2.2 ±0. 9 ), and ( 2.3 ± 0. 7 ) , with Z value respectively - 2. 058, - 2.220, - 2. 323, P values all below 0.05].Scores of color, sensation, and complications of transplanted skin in two groups were close to each other ( with Z value respectively - 0. 628, - 0. 428, - 2. 520, P values all above 0.05 ). ( 2 ) Mild scar formation was observed in one of the skin donor sites in CT group. ( 3 ) Information as obtained from questionnaire showed no statistical difference between two groups in pinching, itching, and satisfaction degree (with x2 value respectively 0. 187, 0. 019, 2. 628, P values all above 0. 05 ). (4) Nerve fibers were seen in hand tissue 2 years after operation. ADM did not induce severe inflammatory responses in the site of grafting. (5)Eleven joints in CT group recovered or improved in function; while the other two joints required secondary surgery. Obvious contracture was observed in the two joints in C group. Conclusions Allogeneic ADM combined with STSG transplantation prevents scar contracture and has obvious effect in improving function and appearance. There is no problem in regard to safety for its existence in either adult or children.