激光微孔猪脱细胞真皮基质制备及创面移植的观察

Study on preparation of laser micropore porcine acellular dermal matrix combined with split-thickness autograft and its application in wound transplantation

目的 制备激光微孔猪脱细胞真皮基质（PADM），寻找其与自体刃厚皮复合移植的最佳孔间距。方法 采用胰蛋白酶法制备PADM，用激光加工机打孔，制备孔间距为0．8、1．0、1．2、1．5mm的激光微孔PADM。在144只SD大鼠背部制作全层皮肤缺损创面，分为微孔Ⅰ、Ⅱ、Ⅲ、Ⅳ组，依次采用前述4种孔间距的激光微孔 PADM＋自体刃厚皮移植；网状组采用网状PADM＋自体刃厚皮移植；对照组单纯移植自体刃厚皮。每组24只大鼠。观察移植后2、4、6周各组创面愈合情况，计算移植物成活率和创面收缩率，并行组织学观察。结果 移植后2、4周，微孔Ⅰ、Ⅱ组移植物成活率均低于对照组（P〈0．05），但与网状组比较，差异无统计学意义（P〉0．05）；移植后6周，微孔Ⅰ、Ⅱ组成活率明显高于网状组（P〈0．05）。移植后4、6周微孔Ⅰ、Ⅱ组创面收缩率较对照组显著降低（P〈0．05），移植后6周[（16．0±2．6）％、（15．1±2．4）％]明显低于网状组[（19．3±2．4）％，P〈0．05]。组织学观察见各微孔组上皮化良好，胶原纤维排列整齐，基底膜结构完整。结论 孔间距为0．8mm或1．0mm的激光微孔PADM与自体刃厚皮复合移植可提高创面修复质量，其中孔间距1．0mm效果最佳。

Objective To prepare a porcine acellular dermal matrix （PADM）, and to optimize the interpore distance between PADM and co-grafted split-thickness autologous skin. Methods Porcine skin was treated with trypsin/Triton X-100 to prepare an acellular dermal matrix. Micropores were produced on the PADM with a laser punch. The distance between micropores varied as 0.8 mm, 1.0 mm, 1.2 mm and 1.5 mm. Full-thickness defect wounds were created on the back of 144 SD rats. The rats were randomly divided into 6 groups as follows, with 24 rats in each group. Micropore groups Ⅰ-Ⅳ ： the wounds were grafted with PADM with micropores in four different intervals respectively, and covered with split-thickness autolo- gous skin graft. Mesh group： the wounds were grafted with meshed PADM and split-thickness autograft. Control group ： with simple split-thickness autografting. The gross observation of wound healing and histological observation were performed at 2, 4, 6 weeks after surgery. The wound healing rate and contraction rate were calculated. Results Two and four weeks after surgery, the wound healing rate in micropore groups Ⅰ and Ⅱ was lower than that in control group（ P 〈0.05 ）, but no obvious difference was between micropore groups Ⅰ ,Ⅱ and mesh group（ P 〉0.05） until 6 weeks after grafting（ P 〈0.05）. The wound contraction rate in micropore groups Ⅰ and Ⅱ （ [ （ 16.0 ±2.6）% ,（ 15.1 ±2.4）% ]was remarkably lower than that in control group 4 and 6 weeks after grafting （ P 〈 0.05 ） , and it was significantly lower than that in mesh group[ （19. 3 ± 2.4）% ] 6 weeks after surgery （ P 〈 0.05 ）. Histological examination showed good epithelization, regularly arranged collagenous fibers, and integral structure of basement membrane. Conclusion Laser micropore PADM （0.8 mm or 1.0 mm in distance） grafting in combination with split-thickness auto- grafting can improve the quality of wound healing. PADM with laser micropores in 1.0 mm distance is the best choice among them.