复合皮移植的实验研究与临床应用

Experimental study and clinical application of composite skin grafting

目的 寻求一种较理想的真皮替代物 ,用以修复全厚皮肤缺损创面。 方法 (1 )将异体 /异种脱细胞真皮基质 (allo/xeno ADM) +自体刃厚皮组成复合皮 (CS),以自体刃厚皮作对照 ,采用一步移植法进行实验研究和临床研究。移植术后应用生物化学及免疫学方法观察移植物抗原性的改变、表皮 真皮连接区 (DEJ)基底膜带结构的再形成情况。 (2 )在此基础上 ,应用前述CS移植技术治疗5 3例全厚皮缺损或瘢痕切除患者 ,观察术后皮片成活情况并作随访。 结果 CS一步法移植后的成活情况良好。 (1 )移植后 2 8周可见DEJ基底膜带重新形成 ,基底膜细胞呈极性生长并呈波浪形排列 ,真皮乳头与皮钉再生。allo ADM的抗原性明显低于xeno ADM,仅在术后早期有少数炎性细胞浸润 ,未见明显的免疫排斥反应。 (2 )移植于 5 3例患者的 70块CS中 ,6 5块完全存活占 92 9%,2块因更换敷料不当部分存活 ,3块因创面感染移植失败。患者最长随访时间为 8.5年 ,所移植的CS质地和色泽接近正常皮肤。 结论 allo/xeno ADM的抗原性很低 ,移植后能发挥长期的真皮支架或诱导组织再生的真皮“模板”作用。

Objective To explore an ideal skin substitute with its appearance and texture similar to normal skin, to repair wounds with full-thickness skin defect . Methods Composite skin (CS) in question was composed of allo/xenogeneic acellular dermal matrix (ADM) and razor thin autoskin. One step skin grafting was employed in the experimental study and clinical trial. Razor thin autoskin alone was used as the control in the study. Changes in the antigenicity of ADM and the reformation of basement membrane(BM) structure at epidermis-dermis junction (EDJ) of ADMs were studied at designated time points after the grafting with biochemical and immunohistochemical methods. Fifty-three patients with full thickness skin defects due to various causes,including scar exicision were grafted with CS ,and survival rate and long-term result were observed. Results The grafted CS survived satisfactory. The reformation of the basement membrane structure was clearly observed at the 28th post-graft week. The basement membrane cells grew with polarization in an undulating arrangement. There was reformation of dermal papillae and ridges .The antigenicity of allo-ADM was obviously lower than that of xeno-ADM. Sixty-five out of 70 pieces of CS grafting (92.9%) survived totally, two of them survived partially, and three failed due to infection. The longest follow-up period was 8 and a half years. The grafted CS appeared similar to the normal skin in regard to the texture and color, especially allo-ADM, and no evident rejection reaction was seen. Conclusion ADM possessed very low antigenicity, thus serving a lasting framework after grafting. In addition, it could serve as a “dermal template” for the induction of tissue regeneration.