中国组织工程研究

中国组织工程研究 ›› 2014, Vol. 18 ›› Issue (46): 7417-7421.doi: 10.3969/j.issn.2095-4344.2014.46.008

• 皮肤粘膜组织构建 skin and mucosal tissue construction • 上一篇    下一篇

异种皮覆盖薄中厚与刃厚微粒皮皮浆移植修复烧伤创面的对比

张明珠1，王建华1，历 虎1，董运凤2，齐长春1，郭宝文2，王永岭3，刘晓岩1，李云峰1，张晓慧1，刘 颖1，李兴华1，王鸿风4，郁 强4   

  1. 1河北钢铁集团唐山钢铁有限责任公司医院烧伤科，河北省唐山市 063020；2唐山市工人医院烧伤科，河北省唐山市 063000；3解放军第二五五部队医院烧伤科，河北省唐山市 063000；4唐山市丰润区第二人民医院普外科，河北省唐山市 063000
  • 修回日期:2014-09-09 出版日期:2014-11-12 发布日期:2014-11-12
  • 通讯作者: 齐长春，主任医师，河北钢铁集团唐山钢铁有限责任公司医院烧伤科，河北省唐山市 063020
  • 作者简介:张明珠，男，1966年生，吉林省白山市人，汉族，1993年河北联合大学(原华北煤炭医学院)毕业，主任医师，主要从事烧伤整形专业的临床医疗、教学及科研工作。
  • 基金资助:

    河北省卫生厅，重点科技研究计划自筹基金项目(20130663)

Thin-thickness versus blade-thickness micro-skin pulping covered with heterogeneous skin for repair of burn wounds  

Zhang Ming-zhu1, Wang Jian-hua1, Li Hu1, Dong Yun-feng2, Qi Chang-chun1, Guo Bao-wen2, Wang Yong-ling3, Liu Xiao-yan1, Li Yun-feng1, Zhang Xiao-hui1, Liu Ying1, Li Xing-hua1, Wang Hong-feng4, Yu Qiang4   

  1. 1Department of Burns, Hospital of Tangshan Steel and Iron Co., Ltd., Tangshan 063020, Hebei Province, China; 2Department of Burns, Tangshan Worker’s Hospital, Tangshan 063000, Hebei Province, China; 3Department of Burns, Hospital of Troop 255 of Chinese PLA, Tangshan 063000, Hebei Province, China; 4Department of General Surgery, the Second People’s Hospital of Fengrun Area, Tangshan 063000, Hebei Province, China
  • Revised:2014-09-09 Online:2014-11-12 Published:2014-11-12
  • Contact: Qi Chang-chun, Chief physician, Department of Burns, Hospital of Tangshan Steel and Iron Co., Ltd., Tangshan 063020, Hebei Province, China
  • About author:Zhang Ming-zhu, Chief physician, Department of Burns, Hospital of Tangshan Steel and Iron Co., Ltd., Tangshan 063020, Hebei Province, China
  • Supported by:

    the Self-raised Major Scientific Research Plan of Hebei Health Bureau, No. 20130663

PDF

495

被引次数

19

摘要：

背景：采用自体微粒皮移植异体皮覆盖已成为近来修复特重度烧伤患者创面的主要手段。由于异体皮来源极为困难，因此，临床上采用异种皮(猪皮)或人工皮作为载体来覆盖创面。

目的：观察薄中厚微粒皮皮浆移植异种皮覆盖修复烧伤创面的疗效及创面愈合后的皮肤质量，并与刃厚微粒皮皮浆移植异种皮覆盖的临床疗效进行对比。
方法：选取特重度具有双侧肢体烧伤的患者36例，采用自身对照的方法，选择可供对比的创面42对，其中关节部位32对。每例患者选取1至2对肢体烧伤程度较为相同的Ⅲ度切痂创面进行对比。在异种皮覆盖下，试验组采用薄中厚微粒皮皮浆涂抹移植修复烧伤创面，对照组采用刃厚微粒皮皮浆涂抹移植修复烧伤创面，两组供皮区与受皮区面积之比相同(所有患者扩张比控制在1∶8-1∶12)。观察创面愈合时间、移植后半年至2年创面愈合后的瘢痕增生程度、关节部位需整复手术的比率，对手术切除的瘢痕按温哥华瘢痕量表总评分进行对比分析。

结果与结论：试验组创面平均愈合时间(44.7±1.24) d，明显短于对照组创面平均愈合时间(49.6±1.41) d (P < 0.05)。试验组移植后半年至2年创面愈合后的瘢痕增生程度轻于对照组：重度瘢痕增生的比率明显小于对照组(P < 0.05)，轻度瘢痕增生的比率明显大于对照组(P < 0.01)，两组中度瘢痕增生的比率相近(P > 0.05)。试验组关节部位需整复手术的比率为38%，明显低于对照组59%(P < 0.01)。试验组手术切取瘢痕的温哥华瘢痕量表总评分明显低于对照组(P < 0.05)。提示在异种皮覆盖下，通过增加微粒皮厚度，采用薄中厚微粒皮浆移植是修复大面积全层皮肤烧伤的较好方法，可获得较好的创面愈合质量。



中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程


全文链接：

关键词: 组织构建, 移植, 微粒皮, 皮浆, 组织移植, 三度烧伤, 创面愈合, 疗效, 瘢痕增生

Abstract:

BACKGROUND: Autologous micro-skin graft covered with allogeneic skin has become a major means for repair of extremely severe burn wounds. Due to the limitation of the source of allogeneic skin, heterogeneous skin (pigskin) or artificial skin serves as a vector to cover the wound on the clinical use.

OBJECTIVE: To observe the curative effect of thin-thickness micro-skin pulping covered with heterogeneous skin for repair of burn wounds in comparison with blade-thickness micro-skin pulping covered with heterogeneous skin.
METHODS: A self-control study was performed in 36 patients with severe burns of bilateral limbs. There were 42 pairs of wounds, 32 of which were at joint sites. One or two pairs of III-degree burns treated with escharectomy were selected from each patient for self-control comparison. Covered with heterogeneous skin, thin-thickness micro-skin pulping and blade-thickness micro-skin pulping were used in the trial and control groups, respectively. The expansion ratio was controlled at 1:8-1:12 in all patients. Wound healing time, degree of scar hyperplasia within 6 months to 2 years after transplantation, and ratio of reconstruction surgery at joint sites were observed and compared. The removed scars by surgery were analyzed based on the total score of the Vancouver Scar Scale.
RESULTS AND CONCLUSION: The average wound healing time was (44.7±1.24) days in the trial group and (49.6±1.41) days in the control group, and there was a significant difference between the two groups (P < 0.05). The trial group exhibited less scar hyperplasia than the control group at 6 months to 2 years after transplantation. Compared with the control group, the ratio of severe scar hyperplasia was significantly less in the trial group (P < 0.05), while the ratio of mild scar hyperplasia was obviously greater in the trial group (P < 0.01). However, there was no difference in the ratio of moderate scar hyperplasia between the two groups (P > 0.05). The reconstructive surgery ratio of the trial group was 38%, significantly lower than that of the control group (59.38%; P < 0.01). The total score on the Vancouver Scar Scale was less in the trial group than the control group (P < 0.05). These findings suggest that the thin-thickness micro-skin covered with heterogeneous skin is likely to be a better treatment to repair large full-thickness skin burn by increasing the thickness of micro-skin, and it can obtain better wound healing quality.


中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程


全文链接：

Key words: skin transplantation, transplantation, heterologous, burns, cicatrix

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