无细胞真皮基质与自体皮片复合移植的临床应用

目的：改善烧伤创面移植皮片愈合后皮肤的外形和功能，并减轻供皮区瘢痕增生。方法：应用自制的无细胞真皮基质与自体刃厚皮片复合移植于4例切（或削）痂后的烧伤创面。结果：未发现对复合移植皮片的排异反应。创面愈合后，大体观察发现移植自体网状皮片及自体小皮片的轮廓界面变得不明显或基本消失，自体大张皮片与真皮基质复合移植区出现较厚而特殊的脱屑，均反映了愈合过程的特殊性。光镜和电镜观察发现复合皮片移植区棘细胞间桥粒清晰，基底膜连续而完整等。与对照部位相比，复合皮片移植区瘢痕增生减轻，未见明显挛缩，皮肤弹性较好。结论：在3－4个月的观察期内，自体刃厚皮片与无细胞真皮基质复合移植后，功能和形态等同或优于单纯自体刃厚皮片移植。

The clinical application of composite transplantation of acellular dermal matrix with autograft

Objective To improve the appearance and function of the grafted site and meanwhile reduce the scarring of the donor site. Methods\ An acellular dermal matrix with intact basement membrane complex and normal collagen bundle structure and arrangement was prepared and grafted to the eschar excised burn wounds in four patients. An overlying thin split thickness autograft was placed simultaneously. Results\ No rejection to this composite skin graft was observed. It was found that after epithelialization of the wound was complete, the transplanted mesh or small stamps of autografts formed a continuous sheet and lost their previous patterns. Thicker and special desquamation appeared on the composite graft site of large sheet of autograft with allograft dermal matrix. All of these phenomena reflected the specialty of the healing processes. It was demonstrated by light and transmission electron microscopy that the desmosome between the spinous cells is clear and the basement membrane is continuous and intact in the composite graft site. In comparison with the control site, the composite skin graft has less contracture, less scarring and better elasticity. Conclusion\ Through the observation of 3 to 4 months so far, thin split thickness autograft with the acellular dermal matrix was equivalent to or even better than simple split thickness autograft in respect to the appearance and function.