中国组织工程研究 ›› 2016, Vol. 20 ›› Issue (11): 1551-1557.doi: 10.3969/j.issn.2095-4344.2016.11.005

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

移植异种(猪)去细胞真皮基质修复深度烧伤创面的可行性:12个月随访

曾  明,魏迪南,支  燕,汪  虹,陈宗华   

  1. 昆明医科大学第二附属医院,云南省昆明市 650101
  • 收稿日期:2016-01-19 出版日期:2016-03-11 发布日期:2016-03-11
  • 通讯作者: 魏迪南,主任医师,昆明医科大学第二附属医院,云南省昆明市 650101
  • 作者简介:曾明,1968年生,男,云南省昆明市人,副主任医师,硕士。
  • 基金资助:
    国家自然科学基金资助项目(81071552)

Feasibility of different xenogeneic (porcine) acellular dermal matrices in the repair of deep burn wounds: a 12-month follow-up

Zeng Ming, Wei Di-nan, Zhi Yan, Wang Hong, Chen Zong-hua   

  1. Second Affiliated Hospital of Kunmng Medical University, Kunming 650101, Yunnan Province, China
  • Received:2016-01-19 Online:2016-03-11 Published:2016-03-11
  • Contact: Wei Di-nan, Chief physician, Second Affiliated Hospital of Kunmng Medical University, Kunming 650101, Yunnan Province, China
  • About author:Zeng Ming, Master, Associate chief physician, Second Affiliated Hospital of Kunmng Medical University, Kunming 650101, Yunnan Province, China
  • Supported by:

    the National Natural Science Foundation of China, No. 81071552

摘要:

 文章快速阅读:

文题释义:

去细胞真皮基质:是一种新型的组织材料,制备过程中去除同种皮表皮,对真皮进行脱细胞处理,仅保留真皮的细胞外基质结构与形态,最终获得所需的网状支架结构,具有良好的组织相容性,被广泛应用于整形外科和烧伤外科等。
深度烧伤:创面自行愈合需要21 d以上的烧伤。包括较深或伴感染的深Ⅱ度烧伤、Ⅲ度和Ⅳ度烧伤,通常需要手术治疗。深Ⅱ度烧伤表皮发白或棕黄,去除坏死皮后,创面微湿或红白相间,感觉迟钝,可见粟粒大小的红色小点,一般需三四周愈合,Ⅲ度烧伤局部表现可为苍白、黄褐色、焦黄,严重者呈焦灼状或炭化,皮肤失去弹性,触之硬入皮革,干燥无渗液,感觉差,需要手术植皮治疗,愈合后有瘢痕。

 

背景:深度烧伤患者需要进行植皮治疗,以往的自体皮移植存在皮源不足的问题。
目的:探讨异种(猪)去细胞真皮基质修复深度烧伤创面的可行性。
方法:纳入41例深度烧伤患者,按照患者意愿分为2组,对照组21例,实施自体刃厚皮移植治疗,观察组20例,实施自体刃厚皮联合异种(猪)去细胞真皮基质移植治疗。移植后随访12个月,观察患者移植后1,2,3,4周的植皮成功率和移植后3,6,9,12个月的植皮收缩率以及创面修复情况,以及移植后1,2,3个月的炎性因子水平,并进行比较。
结果与结论:(1)植皮成功率:对两组患者移植后1,2,3,4周的植皮成功率进行差异无显著性意义     (P > 0.05);(2)植皮收缩率:移植后3,6,9,12个月植皮收缩率比较差异无显著性意义(P > 0.05);(3)炎性因子水平:移植后1,2,3个月对两组的炎性因子水平进行检测,不同时间点均无明显改变,且各时间点两组相关炎症检测各项指标水平差异无显著性意义(P > 0.05);(4)随访结果:对两组患者进行12个月的随访观察,对照组创面部位未出现严重的瘢痕增生,触之质地柔软;观察组3例早期出现局部色素沉着现象,随时间延长逐渐消退;均未出现明显的瘢痕,仅存在细小、点状瘢痕,修复创面触之柔软;(5)不良事件:两组治疗过程中均未出现不良事件,无死亡病例;(6)结果表明:自体刃厚皮联合异种(猪)去细胞真皮基质移植治疗深度烧伤患者可获得理想的创面修复效果,可改善创面愈合质量,是一种安全有效的修复方案。  ORCID: 0000-0002-4749-2845(曾明)

关键词: 组织构建, 组织工程, 烧伤, 深度烧伤, 创面, 创面修复, 移植, 自体刃厚皮, 真皮, 替代物, 去细胞真皮基质, 异种(猪)去细胞真皮基质, 国家自然科学基金

Abstract:

BACKGROUND: Skin grafting is crucial for patients with deep burns, but limited source of autologous skin grafts is an existing difficulty.
OBJECTIVE: To investigate the effect of xenogeneic (porcine) acellular dermal matrix in the treatment of deep burn wounds and the feasibility of its application.
METHODS: Forty-one patients with deep burn were divided into two groups according to the intention of the patients, 21 cases in control group and 20 cases in observational group, followed by autologous split-thickness skin grafting alone or combined with different (porcine) acellular dermal matrix, respectively. After 12 months of follow-up, the graft success rate at postoperative 1, 2, 3, 4 weeks and skin graft contraction rate and wound repair at postoperative 3, 6, 9, 12 months were observed and compared between two groups. Moreover, levels of inflammatory factors were detected and compared between two groups at postoperative 1, 2, 3 months.
RESULTS AND CONCLUSION: The skin graft success rates showed no difference between two groups at postoperative 1, 2, 3, 4 weeks (P > 0.05). The skin graft contraction rates also showed no difference between two groups at postoperative 3, 6, 9, 12 months (P > 0.05). After 12 months of follow-up, no serious scar hyperplasia, but soft texture appeared in the control group. In the observational group, three cases presented with local pigmentation at the early stage, but it gradually subsided with time; no obvious scar, but only small, point-like scar, was visible, and the repaired wound exhibited soft touch. No adverse events and death occurred in both two groups. Experimental results show that the treatment of deep burns with autologous split-thickness skin grafting combined with xenogeneic (porcine) acellular dermal matrix is safe and effective, which can improve the quality of wound healing.