无细胞真皮基质与自体皮复合移植愈合过程的观察

Observation on healing process of composite transplantation of acellular dermal matrix with skin autograft

目的 :为改善植皮区外观和功能 ,并同时减轻供皮区瘢痕增生。方法 :应用自制的无细胞真皮基质与薄的刃厚自体皮复合移植应用于 2例切削痂后的烧伤创面。结果 :未发现对复合移植物的排异反应。创面愈合后 ,大体观察发现移植网状自体皮的网状形式已变得不明显 ,自体小皮片的轮廓基本消失 ,均反应了愈合过程的特殊性。光镜和电镜观察发现复合移植区基底膜清晰、连续且完整等。与对照部位相比 ,复合移植区瘢痕增生减轻 ,未见明显挛缩 ,皮肤弹性较好。结论 :至少到目前为止的观察期 (3～ 4个月 )内 。

Objective: To improve the appearance and function of the graft site and meanwhile reduce the scarring of donor site. Methods: An acellular dermal matrix with intact basement membrane complex and normal collagen bundle structure and arrangement was prepared, and grafted together with an overlying thin split thickness skin autograft simultaneously on the eschar-excised burn wounds of two patients. Results: No rejection to this composite skin graft was observed. It was found that after comlete epithelialization of the wound the transplanted mesh autografts or small stamps of autografts formed a continuous sheet and lost their former patterns( small stamp or mesh pattern). All of these phenomena indicated the peculiarity of the healing processes. It was demonstrated by light and transmission electron microscopy that the basement membrane was continuous and intact. In comparison with the control site, the composite transplantation skin graft has no remarkable contracture with less scar formation and better skin elasticity. Conclusion: At least during the observation period up to now(3 or 4 months), thin split thickness autograft with acellular dermal matrix was equivalent to or even better than simple split thickness autograft in respect to its appearance and function.