烧伤早期切痂脱细胞异体真皮基质与自体皮浆复合移植的临床应用

The clinical application on composite graft of acellular allo-dermal matrix and auto-microskin on escharectomy after deep burns

目的 探讨脱细胞异体真皮基质与自体皮浆复合移植的可行性。方法 在 8例患者Ⅲ°烧伤创面早期切痂 ,13个部位采用 18块脱细胞真皮基质移植固定 ,在异体皮的真皮面上均匀涂布备好的皮浆 ,覆盖于脱细胞真皮基质上 ,缝合包扎固定。同一肢体其余创面常规用自体皮浆加异体皮移植做对照观察 ,皮浆与创面比例为 1∶5～ 1∶8。结果 18块脱细胞异体真皮基质复合移植皮肤成活率 94 % ,随访 3～ 13个月皮肤弹性及色泽好、瘢痕轻、耐磨 ,愈合质量优于对照部位创面。术后 3个月组织切片表皮真皮连接紧密 ,可见钉突样结构 ,胶原纤维排列较规整 ;单纯皮浆移植皮肤为瘢痕皮肤结构。结论 应用脱细胞真皮基质与自体皮浆复合移植 ,明显优于单纯的皮浆移植 ,具有较好的临床应用前景。

Objective To present the clinical application of composite graft of acellular allo-dermis matrix(ADM) with thin auto-microskin on burn wound. Methods 8 inpatients with 18 full thickness skin burn wounds were transplanted with allo-ADM after eschar was excised, then the auto-microskin and allo-human skin were covered on the area of the matrix, the wound where no allo-ADM grafting were covered as control groups only with auto-microskin and allo-human skin. The area of donor to wound is 1∶5～1∶8. Results Survived rate of 18 pieces composite skin that allo-ADM with auto-microskin were grafted were 94%. After following up for 3 to 13 months, the skins of complex grifting had well elastic and smooth texture compared to auto-microskin grafted, they appeared less cicatrisation and ulceration. 3 months after operation, it was indicated by histological examination that tightknit the epithelial-dermal conjunction and epidermal papilla structure could be identified in the allo-ADM skin and there were orderly collagenous fibres,but scar skin structure was observed in that auto-microskin grifted area. Conclusion The graft effectiveness of allo-ADM and auto-microskin was better than that of auto-microskin, and this method could be used on major deep burn wound healing.