【摘要】 目的探讨脱细胞(猪)真皮支架在深度烧伤创面及切瘢创面修复中的临床应用。方法应用脱细胞(猪)真皮支架与大张自体刃厚皮复合移植治疗15例切(削)痂后的深度烧伤创面和47例切除瘢痕后的创面,术后于复合移植区和对照区(单纯移植大张自体刃厚皮)切取标本行光镜及电镜观察,并记录随访结果。结果 15例深度烧伤创面和47例切瘢创面复合移植后未发现明显排斥反应。与对照创面部位相比,复合移植创面愈合后大体观察见创面光滑、平整,无明显瘢痕挛缩,皮肤弹性良好,尤其关节部位功能恢复良好。组织切片光镜观察见复合移植60d后基底膜清晰、连续,皮肤结构逐渐融合为一体,角质层连续而成熟,钉突下伸,真皮胶原纤维粗细基本一致,排列较为规则,毛细血管数量较前减少,而对照区域表、真皮易分离,连接不紧密,基底膜不清晰。电镜下见复合移植区棘细胞间桥粒清晰,基底膜清晰连续。随访观察5个月～7年,复合移植后外形和功能恢复均比单纯大张自体刃厚皮移植好。结论深度烧伤创面和切瘢创面行脱细胞(猪)真皮支架与大张自体刃厚皮复合移植可发挥诱导组织再生的真皮引导作用,移植后外形和功能恢复好,具有广泛的临床应用价值。更多还原

【Abstract】 Objective To explore the clinical application of xenogenic (porcine) acellular dermal matrix (ADM) in treatment of deep burn and scars. Methods Fifteen patients suffering from deep burn undergoing escharectomy and/or tangential excision,and 47 patients undergoing scar excision received porcine acellular dermal matrix xenografting combined with razor-thin skin autografting. Specimens from composite grafting regions and control regions (razor-thin skin autografting only) were obtained and examined with light and electron microscopy,and the follow-up data were recorded and analyzed. Results No obvious rejection reaction was found in all the 62 patients after composite grafting. Compared with control regions,the surface of composite grafting regions was smooth and flat with no obvious scar contracture,the skin elasticity was good,and the adjacent joint function recovered well. Light microscopic observation showed that the basement membrane was clear and in good continuity,and the skin structures merged well,and the stratum corneum was in continuity and matured,with regular downward projections; the diameter of dermal collagen fiber was more or less uniform and regularly arranged,and the number of capillary decreased 60 days after composite grafting. On the contrary,the epidermis and dermis was loosely connected and easy to separate,and the basement membrane was unclear in control regions. The electron microscopic observation showed that the desmosomes among prickle cells were clear and basement membrane was clear and continuous. The recovery of dermal shape and function in composite grafting was better than that in razor-thin skin autografting during the period of 5 months to 7 years follow-up. Conclusion The application of ADM combined with razor-thin skin autografting may lead to dermis regeneration,and the shape and function of the skin recovered well after composite grafting.更多还原