全层皮肤缺损创面移植异种脱细胞真皮基质与薄自体皮重塑基底膜的实验观察(英文)

Basement membrane remodeling after repair of full thickness skin defects with the combined grafting of xenogenic acellular dermal matrix and thin autoskin

背景:异种脱细胞真皮基质与薄自体皮复合移植修复全层皮肤缺损创面取得了良好的效果,但对移植后基底膜的重塑尚不十分清楚。目的:观察异种(猪)脱细胞真皮基质与薄自体皮复合移植模型中基底膜重塑的变化规律。设计:随机对照实验研究。地点和材料:动物实验在上海市烧伤研究所完成,指标检测在上海第二医科大学细胞生物学教研室完成。清洁级雄性SD大鼠(由中国医学科学院上海实验动物中心提供),体质量200～250g。干预:将SD大鼠随机分为两组,每组42只。所有动物均饲养在层流房间内,恒定的湿度与温度,单笼饲养。A组:单纯移植薄自体皮组;B组:脱细胞猪真皮基质(江苏启东医疗用品研究所提供)+薄自体皮复合移植。将异种猪脱细胞真皮基质与薄自体皮复合移植于大鼠创面,分别()于移植后1,2,3,4,8,12,16周留取标本,采用免疫组化、透射电镜等方法。主要观察指标:观察基底膜中层粘连蛋白的变化规律及12周时基底膜的超微结构,同时以单纯薄自体皮移植进行对照。结果:B组移植后1,2,3,4,8,12,16周,层粘连蛋白的表达分别为88.32±2.72,89.22±2.16,88.84±3.43,93.49±4.59,87.57±3.33,95.87±1.84,86.57±2.45,A组分别为78.96±1.68,85.37±5.41,82.49±3.73,84.27±2.69,72.88±3.57,88.19±3.36,82.82±2.86,12周时复合皮?

BACKGROUND:The combined grafting of xenogenic acellular dermal matrix with autoskin has achieved good results in repairing full thickness skin defects.However,the mechanism of basement membrane remodeling remains unclear. OBJECTIVE:To observe the dynamic process of basement membrane remodeling after the combined grafting of xenogenic acellular dermal matrix with autoskin. DESIGN:A randomized controlled experimental trial was conducted. SETTING and MATERIALS:Skin graft operation was performed on 84 male Sprague Dawley rats(clean grade,supplied by Shanghai Laboratory Animal Center,Chinese Academy of Medical Sciences),weighing 200 g to 250 g,in Shanghai Burn Institute.The samples were tested in the Department of Cell Biology,Shanghai Second Medical University. INTERVENTIONS:The rats were randomly divided into two groups with 42 in each,group A and group B.In group A,skin defects received thin split thickness autografts alone.In group B,skin defects received porcine xenogenic acellular dermal matrix directly on top of the wound bed,followed by thin split thickness autografts.The rat skin wounds were covered with xenogenic porcine acellular dermal matrix overlaid with razor thin autoskin.The skin samples were collected at 1,2,3,4,8,12 and 16 post grafting weeks.The changes in laminin expression in the basement membrane and the ultrastructure of the basement membrane at 12 post grafting week were observed by immunohistochemistry and transmission electron microscopy.The results were compared with those in simple thin autoskin grafting as the control. MAIN OUTCOME MEASURES:The expression of laminin was detected by immunohistochemistry,and the ultrastructure of the basement membrane was observed by transmission electron microscopy. RESULTS:The expression absorbance(A) value of laminin at 1,2,3,4,8,12 and 16 post grafting weeks in group B was 88.32±2.72,89.22±2.16,88.84±3.43,93.49±4.59,87.57±3.33,95.87±1.84,86.57±2.45 and in group A was 78.96±1.68,85.37±5.41,82.49±3.73,84.27±2.69,72.88±3.57,88.19±3.36,and 82.82±2.86,respectively.At 12 post grafting week the basement membrane in the combined grafting rats was clear and continuous and the hemidesmosome was relatively more in amount and distributed evenly.By contrast,in the autoskin group the lamina densa in the basement membrane was blurred and discontinuous with decreased and uneven distribution of hemidesmosome. CONCLUSION:The increased expression of laminin in the basement membrane in the combined grafting rats may be beneficial to the remodeling of the basement membrane and to strengthening the connection of epithelium to the dermis,thus improving wound healing quality.