无细胞异体真皮基质在关节功能部位整复中的应用

The Application of Acellular Dermal Matrix Allograft in Repairing Joint Functional Position of Patients With Plastic Operation

目的 观察无细胞异体真皮基质 (ADM)在功能部位的移植效果。方法 选择 11例大面积烧伤后产生增生性瘢痕伴有关节功能障碍的患者 ,将 13块经胰蛋白酶等处理制成的网状ADM与超薄断层自体皮片 (USSG)重叠 ,一次性移植于 9例患者四肢关节部位的切瘢创面上 ,并以邻近的断层中厚自体皮片 (TSSG)移植物为对照组 ,2W后首次换药 ,定期作CS随访和组织活检观察。结果 与对照组一样 ,CS移植物全部成活 ,随访 1～ 5年未见排异反应和瘢痕增生 ,外观质地和功能接近正常皮肤 ,真皮层无皮肤附件 ,胶原排列有序 ,仅有少量淋巴细胞散在浸润。结论 充当真皮替代物的ADM可以用于功能部位瘢痕挛缩的整复治疗。

Objectives To investigate the effect of allogeneic acellular dermal matrix(ADM) on cograft in joint functional positions of patients with post-burn plastic operation. Methods 9 patients with hypertrophic scar and joint dysfunction after sever burns were used. After pre-treating with trypsin and TritonX-100, 13 reticulated ADM were overlapped with autogenous ultrathin split-thickness skin grafts (USSG), and were transplanted to the scar-cutting wounds in the joints of four limbs at the same time. The neighbouring autogenous thin split-thickness skin grafts (TSSG) were used as control. After 2 weeks, the dressings were changed, and the long-term follow-up studies and pathological observations of tissue biopsies were carried out. Results The composite skin grafts as well as the controls were all survived. The rejection and hypertrophic scars were not found during 1-5 years follow-up studies. The appearance, fiber and function of composite skin grafts were similar to normal skins. There were no skin appendages in dermal layer, and collagen was lined up orderly. It was infiltrated by small number of lymphocytes only. Conclusions The ADM could be used to joint functional positions of patients with post-burn hypertrophic scars and could produce satisfactory plastic results as dermal substitute. We recommend it to be applied to the patients after the large area burns when lacking skin source.