摘要
目的观察异体无细胞真皮基质(ADM)在深度烧伤的四肢关节部位的临床移植效果。方法以11例四肢关节部位深Ⅱ和Ⅲ度烧伤的患者为对象,采用复合皮(CS)移植技术将20块网状ADM(每块150～400cm2)与自体超薄断层皮片(UTSG,厚度0.05cm)重叠,组成CS,一次性移植于患者14处四肢关节区域的切痂或削痂创面上,并在邻近的烧伤部位移植自体断层中厚皮片(STSG,厚度0.15～0.20cm)作为对照。术后10～14d首次换药,定期随访和行移植皮片组织学观察。结果术后2周CS成活率93.7%,STSG成活率为97.2%,二者比较差异无统计学意义(P>0.05)。随访1～3年,CS组未见明显的瘢痕增生和挛缩,所有患者关节屈伸范围正常。组织学观察显示,CS真皮层无皮肤附件,胶原纤维排列有序,仅有少量淋巴细胞浸润。但在烧伤后期感染创面上的CS移植效果(外观质地和组织结构)不及烧伤早期的清洁创面。结论深度烧伤患者关节部位尽早应用ADM能够产生满意的整形效果并满足关节功能需要。
Objective To investigate the effects of acellular dermal matrix (ADM) grafting on the functional area of joints in patients with deep burn. Methods A total of 11 patients with II or III degree burn in the joints of the limbs were enrolled into this study. Twenty pieces of reticulated allogeneic ADM (sized 150-400 cm2) were overlapped with 0.05-cm thick autogenous ultrathin split-thickness skins (UTSG) to form composite skin (CS) grafts. The CS grafts were then transplanted to 14 joint areas with eschar-excised or eschar-shaved burn wounds in the 11 patients. Autogenous split-thickness skin grafts (STSG, 0.15-0.20 cm in thickness) were transplanted into the neighboring areas as a control. 10-14 days after the transplantation, the dressings were changed for the first time. During a long-term follow-up, the pathology of the skin grafts were observed regularly. Results Two weeks after grafting, the survival rate of CS grafts was 93.7%, and that of STSG grafts was 97.2%. No significant difference exited in the survival rate between the two groups (P>0.05). During a 1 to 3 years follow-up, no hypertrophic scar and contracture were found in the CS grafted areas, all the patients could bend and stretch their injured joints normally. Light microscopy showed that there was no skin appendage, collagen fibers were lined up orderly, and only a small number of lymphocytes infiltrated into the CS dermal layer. Furthermore, the effects of CS grafting (include the appearance texture and histological structure) on the clean wound at an early stage after burn injury was better than that at a late stage. Conclusions ADM as a dermal substitute should be grafted to the injured joint areas in the patients with deep burn as early as possible. The graft can produce satisfactory plastic results and recover the functions of the joints.
出处
《中国医药生物技术》
CSCD
2007年第1期23-27,共5页
Chinese Medicinal Biotechnology
基金
国家自然科学基金(30670571)
关键词
烧伤
皮肤移植
无细胞真皮基质
复合皮
Burns
Skin transplantation
Acellular dermal matrix
Composite skin
作者简介
姜笃银,250033 济南,山东大学第二医院美容整形烧伤外科,Email:jdybs2@vip.163.com 通讯作者
