脱细胞异体真皮基质与自体微粒皮混合移植关节部位的临床应用

The clinical application of composite graft of acellular allo dermal matrix and auto microskin in joint place

目的观察脱细胞异体真皮基质与自体微粒皮混合移植后创面修复情况。方法将18例烧伤总面积50％TBSA以上，Ⅲ度烧伤面积20％，TBSA以上患者随机分为两组。治疗组：9例患者Ⅲ度烧伤创面早期切痂，15个关节部位采用38块脱细胞真皮基质移植固定，在异体皮的真皮面上均匀涂布备好的微粒皮，覆盖于脱细胞真皮基质上，同一肢体其余创面常规用自体微粒皮加异体皮移植缝合包扎固定。对照组：9例12个肢体使用传统微粒皮移植，观察16个关节部位，微粒皮与创面比例为1：13．1：8。结果治疗组脱细胞异体真皮基质与微粒皮混合移植皮肤成活率为92％，对照组微粒皮成活率94％。随访3—17个月，治疗组残余创面发生率为13．3％，对照组为50％，有显著性差异。皮肤弹性、关节活动度等愈合质量治疗组优于对照组。结论应用脱细胞真皮基质与自体微粒皮混合移植，效果明显优于传统的微粒皮移植，具有较好的临床应用前景。

Objective To explore the promoting effects of composite graft of acellular allo-dermal matrix （ADM） and auto-microskin on burn wound healing. Methods Eighteen burns invariably over the area 50% TBSA, Ⅲ degree over the burn 20% TBSA were randomly and equally divided into two groups. Treatment group： 9 inpatients with 38 full thickness skin burn wounds were transplanted with allo-ADM after eschar was excised in 15 joint places, then the auto-microskin and allo-human skin were covered on the area of the matrix. The control groups ： the wound with no allo-ADM grafting was covered only with auto-microskin and allo-human skin. The area of donor to wound was 1 ： 8-1 ： 13. Results Survived rate of 38 pieces of composite skin that allo-ADM with auto-microskin was grafted was 92%. After following up for 3 to 17 months, the skins of complex grifting had well elastic and smooth texture compared to auto-microskin grafted, which appeared less cicatrisation and ulceration. Conclusion The graft effectiveness of allo-ADM and automicroskin was better than that of auto-microskin, and this method could be used in major deep burn wound healing.