摘要
目的探讨脱细胞异体真皮基质与自体薄皮片复合移植修复烧伤后不稳定性瘢痕的临床疗效,并行病理学观察,旨在为脱细胞异体真皮基质的临床应用奠定理论基础。方法 2007年1月-2008年6月,收治19例24个部位不稳定性瘢痕。男16例20个部位,女3例4个部位;年龄3～58岁,中位年龄27岁。致伤原因:火焰烧伤14例18个部位,电击伤4例5个部位,烫伤1例1个部位。瘢痕位于手部8例,前臂2例,大腿3例,小腿2例,足部2例,胸部1例,腹部1例。瘢痕遗留3个月～1年。术中瘢痕切除后缺损范围为7cm×5cm～22cm×15cm,采用脱细胞异体真皮基质复合自体薄皮片修复缺损。于一期术后6～18个月二期行局部瘢痕修复时,取复合移植区域全层皮肤组织样本进行病理学检查。结果术后创面均Ⅰ期愈合。其中18例瘢痕溃疡完全去除,移植皮片成活;1例移植皮片表皮局部出现水疱,经换药后愈合。患者均获随访,随访时间10个月～2年,平均18个月。移植皮片外观、质地、弹性等与周围正常皮肤相似,均未再次出现不稳定性瘢痕,功能恢复可。供皮区呈色素沉着或表浅瘢痕。病理学检查示表皮细胞层、基底膜结构完整,形态与正常皮肤相似,真皮层内胶原纤维排列规则,无慢性炎性细胞浸润,毛细血管生长良好。结论脱细胞异体真皮基质与自体薄皮片复合移植能有效修复不稳定性瘢痕切除后创面,术后外观及功能恢复良好,组织结构与正常皮肤相似。
Objective To evaluate the clinical effect and the pathological characteristics of acellular allogeneic dermal matrix in repairing unstable burn scar.Methods From January 2007 to June 2008,19 cases of unstable burn scars（24 parts） were treated,including 16 males（20 parts） and 3 females（4 parts） with a median age of 27 years（range,3-58 years）.The injury was caused by flame（14 cases,18 parts）,electricity（4 cases,5 parts）,and hot water（1 case,1 part）.The unstable burn scars located on hands（8 cases）,forearms（2 cases）,thighs（3 cases）,legs（2 cases）,feet（2 cases）,chest（1 case）,and abdomen（1 case）.Scar formed for 3 months to 1 year.The area of defect varied from 7 cm × 5 cm to 22 cm × 15 cm after scar removal.Defects were covered with acellular allogeneic dermal matrix and autogenous split-thickness skin graft.At 6-18 months after operation,the pathological observations of the epidermis,the basal membrane,and structural components of the dermis were done.Results All wounds healed by first intention.Scar ulcer disappeared completely in 18 cases and the composite skin grafts all survived.Some blisters occurred in 1 case and were cured after dressing changing.All patients were followed up 10 months to 2 years（18 months on average）.The grafted-skin was excellent in the appearance,texture,and elasticity.The function recovered well.Only superficial scar was observed at skin donor sites.Pathological observation showed that the epidermis and the basal membrane of the skin grafts were similar to that of normal skin,and no significant difference was found in newly capillaries between them.Collagen fibers arranged regularly,and there were few inflammatory cells in the matrix.Conclusion Acellular allogeneic dermal matrix with autogenous split-thickness skin graft may effectivly repair the wound after removing the unstable burn scar,and its structure is similar to that of normal skin.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2010年第6期653-656,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
不稳定性瘢痕
脱细胞异体真皮基质
自体皮片
复合移植
病理学特征
Unstable scar Acellular allogeneic dermal matrix Autogenous skin Composite transplantation Pathological characteristics
