去细胞异体真皮、去细胞猪真皮和自体刃厚皮移植在临床中的应用

摘要

Objective To observe the effect of acellular allogenic dermis or acelludar porcine dermis together with split-thickness autologous skin graft on coverage of deep burn wound and the wound of scar excision． Methods Acellular allogenic dermis or acellular porcine dermis produced by our unit, with split-thickness autologous skin graft, were used in repairing various wounds in 119 cases． The take rate of various wounds was compared, and the take rate of wounds in which autologous skin fr-om different sites was used to cover either acellular allogenic dermis or acellular porcine dermis was also compared． Histological examination and follow-up were made in some cases． Results After tangential excision, eschar excision and scar excision, the wounds were covered with either allogenic acellular dernis or porcine acellular dermis and autologous split-thickness skin． The take rate was found to be (93．4 ± 3．4) %, ( 92．1 ± 4．6) %, (94．5 ± 3．5) %, respectively． There was no a significant defference in take rate( P > 0．05)． No significant difference in take rate between the transplantation of allogenic acellular dermis with autologous split-thickness skin and transplantation of porcine acellular demis with autologous split-thickness skin was found (P>0．05)． When autologous split-thickness skin harvested from the trunk or extremites was used, the take rate was(93．1 ±4．8)%, (89．0±6．2)%, respectively, whereas the take rate was only about 70% ～ 80% when skin harvested from the scalp was used． The take rate was only about 40% when ace llalar allogenic dermis and autologous micro-skin graft were used to cover the wound． Histological examination 19 months after the transplantation revealed normal structure． Collagenous fibers were orderly arranged． There was no apparent hyperplasia of collagenous fibers． Hair follicles, sweat glands and other skin appendages were not found in the healed area． Grossly, no obvious pigmentation was seen, the surface was smooth with slight wound contraction, and the consistency was flexible． Conclusion Acellular allogenic spiit-thickness dermis or acellular porcine split-thickness dermis with autologous split-thickness dermis for coverage of deep buru wound and the wound of scar excision is an ideal material．%目的观察去细胞异体真皮或去细胞猪真皮加自体刃厚皮移植在深度烧伤和整形外科中的应用效果。方法采用去细胞异体真皮或我们研制的去细胞猪真皮加自体刃厚皮移植的方法，修复各种创面119例次，比较不同创面的植皮成活率，观察应用不同部位的皮肤覆盖去细胞异体真皮或去细胞猪真皮与植皮成活的关系，并对部分病例进行了组织学观察和随访。结果削痂、切痂和切瘢创面植皮成活率分别为(93．4％±3．1)％、(92．1±4．6)％和(94．5±3．8)％，三者间差异无显著意义；去细胞异体真皮加自体刃厚皮移植与去细胞猪真皮加自体刃厚皮移植，二者植皮成活率差异无显著意义。躯干、四肢自体刃厚皮覆盖的去细胞异体真皮或去细胞猪真皮，植皮成活率分别为(93．1±4．8)％、(89．0±6．2)％，而应用刃厚头皮或自体微粒皮加异体皮覆盖的去细胞异体真皮或去细胞猪真皮，植皮成活率明显下降(P<0．05或0．01)。组织学观察，术后19个月时表皮、真皮形态正常，胶原纤维排列规则，未见胶原纤维明显增生和瘢痕化，无皮肤附件。成活的复合移植皮肤，与邻近正常肤色近似，色素沉着轻，无明显皱缩，触之软，活动度好。结论去细胞异体真皮或去细胞猪真皮加自体刃厚皮移植修复深度烧伤创面或切瘢后创面不失为一种较理想的材料。