异种微粒化脱细胞真皮基质复合MEEK微小皮片移植修复大面积三度烧伤创面的应用研究

Application of xenogeneic micronized acellular dermal matrix combined with MEEK micro skin graft in the repair of large area third degree burn wounds

目的观察异种微粒化脱细胞真皮基质复合MEEK微小皮片移植修复大面积三度烧伤创面的效果,并探讨其机制。方法选择徐州仁慈医院整形烧伤科给予2018年6月至2021年6月收治20例符合入选标准的大面积深度烧伤患者,按随机数字表法将患者分为对照组和试验组。对照组切痂创面用大张异种真皮材料覆盖,试验组切痂创面将微粒化异种脱细胞真皮基质材料均匀喷洒至创面表面,将大张异种真皮材料覆盖于创面。7天后,两组行二期自体MEEK微小皮片移植术。第二次术后10天,观察MEEK微型皮片成活和融合情况,并计算皮片成活率和融合时间,苏木精-伊红染色观察MEEK微型皮片脂肪组织断层表面的形态,免疫组织化学染色观察MEEK微型皮片脂肪组织微血管增生情况并计数。结果术后10天,试验组的MEEK微小皮片存活率显著高于对照组,皮片融合时间、创面愈合时间显著短于对照组(P<0.05)。试验组创面脂肪组织表面的脂肪细胞排列较为规律、紧密,细胞间隙中新生肉芽组织。对照组中脂肪细胞之间的间隙间质较少。试验组MEEK微型皮片脂肪组织微血管密度显著高于对照组(P<0.05)。结论异种微粒化脱细胞真皮基质复合MEEK微小皮片移植修复大面积三度烧伤创面的效果良好,能够显著提高植皮存活率,缩短创面愈合时间,其机制与促进创面脂肪组织血管新生,改善受皮条件有关。

Objective To observe the effect of xenogeneic micronized acellular dermal matrix combined with MEEK micro skin graft in the repair of large-area third degree burn wounds,and to explore its mechanism.Methods From June 2018 to June 2021,20 patients with large-area deep burn who met the inclusion criteria were treated in the plastic and burn department of Xuzhou benevolent hospital.The patients were randomly divided into control group and experimental group.The escharectomy wound in the control group was covered with large xenogeneic dermal material.The escharectomy wound in the experimental group was evenly sprayed with micronized xenogeneic acellular dermal matrix material on the surface of the wound,and the large xenogeneic dermal material was covered on the wound.7 days later,two groups underwent two-stage autologous MEEK micro skin grafting.The survival rate and fusion time of skin grafts,the morphology of fat tissue section surface of MEEK micro skin grafts and microvascular proliferation were compared between the two groups.Results The survival rate of MEEK micro skin graft in the experimental group was significantly higher than the control group,and the skin graft fusion time and wound healing time were significantly shorter than the control group(P<0.05).The adipocytes on the surface of wound adipose tissue in the experimental group were arranged regularly and closely,and there was new granulation tissue in the cell space.There was less interstitial space between adipocytes in the control group.The microvessel density of adipose tissue in MEEK micro skin in the experimental group was significantly higher than the control group(P<0.05).Conclusion Xenogeneic micronized acellular dermal matrix combined with MEEK micro skin graft has a good effect in repairing large-area third degree burn wounds.It can significantly improve the survival rate of skin grafting and shorten the wound healing time.Its mechanism is related to promoting the angiogenesis of wound adipose tissue and improving the skin receiving conditions.