摘要
目的为深度烧伤创面的修复寻求良好的覆盖材料。方法采用固定剂对异体皮肤细胞外基质固定交联,再用胰蛋白酶和 EDTA 鳌合剂去表皮,保留基底膜,用 DNA 酶、RNA 酶和化学制剂对真皮内可引发宿主细胞识别反应的细胞成分进行处理,保留完整的基底膜和细胞外基质的形态,制成网状“脱细胞异体真皮”。结果通过动物实验(纯种 Wister 大鼠)证明移植成活率高,无排斥反应,组织学观察术后8周形状结构完整,炎性反应消失,12周钉突与脱细胞真皮结合良好,胶原排列整齐。37例烧伤病人Ⅲ度创面和瘢痕切除后,进行脱细胞真皮+自体薄皮片(8‰英寸)移植。成活率平均为96.2％±3.4％。创面收缩轻,外观平整,色较深,触软,功能良好。结论脱细胞同种真皮+薄自体皮移植是修复烧伤深度创面比较理想的材料。
Objective To prepare acellular dermal matrix for the coverage of deep burn wounds. Methods After conjugation of extracellular matrix,the allogeneic skin was treated with trypsin and EDTA chelating agent to remove epidermis.The cells,which could induce recognition reaction by cellu- lar immunity of the host,were further removed with the treatment of DNA and RNA enzymes and chemical agents,and intact basement membrane and extracellular matrix were preserved,finally form- ing“acellular allogeneic dermis”.It was used to cover burn wounds together with split-thickness autol- ogous skin only.Results In Wistar rats,it was proved that the transplantation of aeellular allogeneic dermis and split-thickness autologous skin graft resulted in high rate of take without signs of rejection. Histological examination 8 weeks after the transplantation revealed intact structure,with subsidence of inflammation.12 weeks after the transplantation,it was shown that the dermis joined well with epider- mal fete,and collagen was orderly arranged.Eschar excision or scar excision was performed in 37 pa- tients,and the wounds were covered with allogeneic acellular dermis and autologous split-thickness skin (8‰ inch).Take rate was found to be 96.2%±3.4%。There was only slight wound contraction,the surface was smooth,the color was darker,the consistency was soft,and the function was good.Con- clusion Acellular dermis with only split-thickness autologous skin graft is an ideal covering material for deep burns.
