异体皮覆盖自体微粒皮治疗Ⅲ度烧伤的病理学研究

Pathologic studies on the covered allogeneic skin grafts in the treatment of full-thickness skin burns with autogenic micro-skin

目的了解断层的异体皮作为生物敷料与自体微粒皮移植治疗大面积深度烧伤中异体皮的表皮层与真皮层的作用，以期为合理利用和加工异体皮提供参考。方法取复温后及移植后５～３０ｄ的异体皮标本，少数病例同时获取异体皮下面的组织，石蜡切片、ＨＥ、Ｍａｓｏｎ、ＰＡＳ染色，光镜观察。结果异体皮移植后５ｄ其表皮层细胞出现泡状变性，逐渐与真皮层分离，形成水泡，然后剥脱。来源于创面的毛细血管长入异体真皮，并有炎症反应。手术后１～２ｗ，存活的自体微粒皮的表皮细胞在异体皮下方开始扩展，伴有新生的小血管。最后，异体真皮形成痂皮脱落，其下面新生的表皮覆盖创面。结论异体皮覆盖烧伤创面后其表皮层很快出现泡状变性，形成水泡，溶解剥脱，因此在烧伤创面覆盖中不会起主要作用。起更大作用的是异体真皮，它不仅覆盖创面，而且当毛细血管长入异体真皮时可以为其下方的自体微粒皮的增殖和扩展提供营养环境。所以，在异体皮的制备过程中，不应该把断层后的真皮深层丢掉，而应该将其收集保存予以利用。

Objective To assess the role of epidermal and dermal layers of allogeneic skin covering in the treatment of extensive burns with autogenic microskin for the reasonable utilization and processing of skin grafts Methods The covred skin allografts were harvested 0 and 530 days after operationTissues under the skin allografts were also harvested in some casesHistological sections were stained with HE,Masson and PAS staining Results From 5 days,there were vesicular degeneration,cleavage,blister and sloughing of allo-epidermis,ingrowth of capillaries from the wound bed into the allo-dermis with inflammatory reactionFrom weeks 12,the survived auto-skin expanded underneath the allo-dermis in the area of capillary ingrowthFinally,the sloughed allo-dermis as a crust was separated from the healed new epidermisConclusion In the covered skin allografts,its allo-epidermal layer was degraded,sloughed and detached few days after operation ,and did not play an important role as the allo-dermal layer in the covering of woundSo the deep layer of allo-dermal layer during the processing of split-skin allografts should not be discarded and could be collected and used for burn coveringIngrowth of capillaries into the allo-dermis will provide nourishing enviroment for the proliferation and expanding of autogenic microskin underneath