自体焦痂与异种脱细胞真皮作覆盖物的微粒皮肤移植术的对比研究

摘要

Objective To compare the efficacy of autologous burn scar with porcine acellular dermal matrix ( ADM ) as a substitute inmicroskin grafting.Methods 14 patients with ?-degree burn underwent scar removal and microskin grafting within 3 to 7 after burn.In each patient,autologous burn scars were implanted in one limb ( scar side ),while porcine acellular dermal matrix was used as a dermal substitue in the other limb( dermis side ).The survival time of two types of skin coverage was observed and the wound healing rate in the implanted area was determined after surgery.Results The time for the implanted scar to completely detach from the burn wound was longer than that for porcine ADM [( 43.66 ±3.03 ) d vs.( 35.08 ± 2.54 ) d,P ＜ 0.01].The rate of wound healing for scar implant was significantly higher than that for porcine ADM 6 week after surgery [( 85.23 ± 5.13 )％ vs.( 63.23 ± 4.89 )％,P ＜ 0.01] at 6 weeks after the procedure.Conclusions Autologous scar can be used to replace xenogenic skin in microskin grafting,and it has a better efficacy than xenogenic ( porcine )acellular matrix and a better clinical value.%目的 比较自体焦痂与用异种(猪)脱细胞真皮作覆盖物用于微粒皮肤移植术的临床效果.方法 14例Ⅲ度烧伤患者于伤后3～7天内行切痂微粒皮肤移植术,采用自身同体对照法,术中一侧肢体用自体焦痂原位回植作覆盖(焦痂回植侧),而另一侧肢体用异种(猪)脱细胞真皮作覆盖(猪真皮侧),术后比较两种覆盖物的存留时间、自体微粒皮存活情况及创面愈合率.结果 焦痂回植侧覆盖物术后第3～4周开始干燥分离,残留创面较少；猪真皮侧覆盖物术后第2周末开始溶解脱离,残留创面较多.回植焦痂完全脱离创面的时间[( 43.66±3.03)天]长于猪真皮[( 35.08±2.54)天],差异有极显著性(P＜0.01)；回植焦痂组术后6周的创面愈合率[( 85.23±5.13)％]高于猪真皮[(63.23±4.89)％],差异有极显著性(P＜ 0.01).结论 自体焦痂用于替代异体皮进行微粒皮肤移植可行,其效果优于异种(猪)脱细胞真皮,有较好的临床应用价值.