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目的探讨脱细胞(猪)真皮支架在深度烧伤创面及切瘢创面修复中的临床应用。方法应用脱细胞(猪)真皮支架与大张自体刃厚皮复合移植治疗15例切(削)痂后的深度烧伤创面和47例切除瘢痕后的创面,术后于复合移植区和对照区(单纯移植大张自体刃厚皮)切取标本行光镜及电镜观察,并记录随访结果。结果 15例深度烧伤创面和47例切瘢创面复合移植后未发现明显排斥反应。与对照创面部位相比,复合移植创面愈合后大体观察见创面光滑、平整,无明显瘢痕挛缩,皮肤弹性良好,尤其关节部位功能恢复良好。组织切片光镜观察见复合移植60d后基底膜清晰、连续,皮肤结构逐渐融合为一体,角质层连续而成熟,钉突下伸,真皮胶原纤维粗细基本一致,排列较为规则,毛细血管数量较前减少,而对照区域表、真皮易分离,连接不紧密,基底膜不清晰。电镜下见复合移植区棘细胞间桥粒清晰,基底膜清晰连续。随访观察5个月～7年,复合移植后外形和功能恢复均比单纯大张自体刃厚皮移植好。结论深度烧伤创面和切瘢创面行脱细胞(猪)真皮支架与大张自体刃厚皮复合移植可发挥诱导组织再生的真皮引导作用,移植后外形和功能恢复好,具有广泛的临床应用价值。
Objective To investigate the clinical application of decellularized (porcine) dermal scaffolds in the repair of deep burn wounds and cut scar wounds. Methods A total of 15 deep scald wounds after scab (scab) and 47 wounds after resection of scars were treated with acellular porcine dermal scaffold and large autologous blade combined with grafting. After operation, Pure transplants large autologous blade thick skin) cut the specimens under light and electron microscopy, and record the follow-up results. Results No significant rejection was found in 15 cases of deep burn wounds and 47 cases of cut scar wounds. Compared with the control wound site, the healing of the composite graft wound showed that the wound was smooth and smooth, with no obvious scar contracture and good skin elasticity, especially the function recovery of the joint was good. Tissue sections were observed by light microscopy 60 days after compound transplantation, the basement membrane was clear, continuous, the skin structure gradually integrated as a whole, the stratum corneum continuous and mature, nail extension, the thickness of dermal collagen fibers are basically the same, arranged more rules, the capillary number Reduce, while the control area table, easy separation of the dermis, the connection is not close, the basement membrane is not clear. Under electron microscope, the dendritic cells in the composite graft area were clear and the basement membrane was clear and continuous. Follow-up observation of 5 months to 7 years after the composite grafts and functional recovery than the large autologous blade thick skin graft good. Conclusion The combination of decellularized (porcine) dermal scaffolds with autologous blade and thick skin grafts in deep burn wounds and scar scar wounds can play the role of dermal guidance for inducing tissue regeneration. It has good shape and function recovery after transplantation, and has a wide range of clinical application value.