脱细胞异体真皮与自体刃厚表皮复合移植的应用

Clinical application of composite transplantation of acellular allogeneic dermis with autologous epidermis

目的利用脱细胞异体真皮（ADM）与自体大张刃厚表皮进行复合移植，解决临床皮源不足或中厚供皮区瘢痕问题，建立一种取代中厚植皮的微创治疗模式。方法2002年11月-2007年5月，选择该院整形外科收治的灼伤后瘢痕挛缩畸形、外伤性大面积皮肤缺损患者共26例34个创面，针对各种创面（瘢痕切除松解、灼伤、外伤皮肤缺损、大面积体表肿瘤切除创面）进行彻底止血、清创，湿敷换药1周后，将ADM与自体大张刃厚表皮复合移植覆盖创面，观察愈合能力，随访术后瘢痕增生（温哥华评分、组织学检测）及功能恢复情况，评价临床疗效。结果26例患者34个创面中，除2个创面皮片〉10％坏死外，余均大部成活（≥90％面积）。术区平整、柔软、弹性佳、轻微挛缩，功能恢复良好，供皮区无瘢痕增生。术前瘢痕温哥华评分为（10．83±1．91）分，术后6月为（5．25±0．73）分，治疗前后有显著性差异（P=0．0046）。结论ADM和自体大张刃厚表皮薄皮复合移植可节省皮源，减轻供皮区瘢痕，是一种适用于多种创面并有希望取代中厚植皮的微创治疗模式。

Objective To establish an ideal treatment for diversiform wound by composite transplantation of acellular allogeneic dermis （ADM） with autologous epidermis in order to save the skin resources of patients and decrease the contraction of wound. Methods From November 2002 to May 2007,26 patients （34 wounds） with cicatricial contracture deformity after burning and a large area of cutaneous deficiency by trauma from the Department of Plastic and Reconstructive Surgery of this hospital were selected. Dealing with diversiform raw surface such as burns, scar excisions, traumas and huge skin tumour excisions, the wounds were debrided, stanched and covered with acellular allogeneic dermis and autologous epidermis composite transplantation one week later. The rate of healing was measured, and the degree of hypertrophic scar was assessed by Vancouver scar scale and histological examination after operation. Results In the 26 patients （34 wounds） , all the grafts survived favourably with a healing area t〉 90% except 2 necrosed partially with a necrosis area 〉 10%. The wounds were smooth and soft, grafts contracted slightly without scarring, and the function well recovered. The preoperative Vancouver scar scale was 10.83 ± 1.91, and that of 6 months postoperation was 5.25 ± 0.73, with a significant difference before and after the treatment （ P = 0. 0046）. Conclusion The composite transplantation of acellular allogeneic dermis with autologous epidermis is an effective approach to functional reconstruction of diversiform raw surface, which can save skin resources of patients and decrease the hypertrophic scar formation of donor site.