异体脱细胞真皮在手部深度烧伤创面治疗中的应用
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摘要
目的探讨异体脱细胞真皮在手部深度烧伤创面治疗中的应用效果。方法将2005年5月至2017年3月间解放军联勤保障部队第九〇六医院(原113医院)烧伤整形科收治的符合入选标准的62例(124只手)手部深度烧伤患者,按随机数字表法分为复合皮组和单纯自体刃厚皮组,每组各31例、62只手。复合皮组采用异体脱细胞真皮支架加自体大张刃厚皮片移植,单纯自体刃厚皮组采用单纯自体刃厚皮片大张移植,观察术后皮片成活、手部功能、瘢痕增生及外观恢复情况,电话、微信随访0. 5~1. 0年。数据比较采用Fisher确切概率法。结果复合皮组31例(62只手)患者术后整体手部外形平整、丰满、耐压、抗磨擦,全部未行二次瘢痕整形手术。单纯自体刃厚皮组31例(62只手)患者,术后整体手部外观平整度差,不丰满、弹性差、不耐压、抗磨擦差,舒展性差。复合皮组患者术后瘢痕轻度增生60只手,重度增生2只手;单纯自体刃厚皮组瘢痕轻度增生12只手,重度增生50只手,2组比较差异有统计学意义(P值均小于0. 05);复合皮组患者术后手部功能恢复良好62只手,恢复差0只手,单纯自体刃厚皮组患者手部功能恢复良好4只手,恢复差58只手,2组比较差异有统计学意义(P值均小于0. 05)。单纯自体刃厚皮组16例(32只手)患者再次作整形修复手术,修复后10例关节活动没有彻底恢复正常。另外13例(26只手)也有不同程度关节活动障碍,但未作整形修复手术。结论异体脱细胞真皮作支架可以有效地保证修复创面植皮外观(平整度、丰满度、耐压、抗磨擦、弹性、舒展性),最大限度恢复手部活动功能,疗效确切,并且供皮区恢复好,有好的临床应用价值,值得推广应用。
Objective To investigate the effect of allogeneic acellular dermis on the treatment of deep burn wounds in the hand. Methods From May 2005 to March 2017,62 cases( 124 hands) of patients with deep burns who met the inclusion criteria in the Department of Burns and Plastic Surgery,906 th Hospital of the People's Liberation Army Joint Service Support Unit( formerly 113 Hospital) were selected.According to the random number table method,patients were divided into a composite skin group and a simple autologous blade thick skin group,each group had 31 cases and 62 hands. The composite skin group was treated with allogeneic acellular dermal scaffold plus autologous large blade thick skin graft. The autologous blade thick skin group was transplanted with autologous blade thick skin graft. The postoperative skin survival,hand function,scar hyperplasia and appearance recovery were observed. The telephone and We Chat were followed up for 0. 5 to 1. 0 years. Data were compared with Fisher's exact probability method.Results In 31 patients( 62 hands) of the composite skin group,the overall hand shape was flat,full,pressure-resistant and anti-friction. All of them didn't undergo secondary scar plastic surgery. In 31 patients( 62 hands) with simple autologous blade thick skin group,the overall hand appearance was poor in flatness,not fullness,poor elasticity,no pressure resistance,poor abrasion resistance and poor stretchability. In the composite skin group, 60 patients with mild hyperplasia after operation and 2 patients with severe hyperplasia; 12 patients with mild hyperplasia of scar and 50 patients with severe hyperplasia in the simple autologous blade thick skin group,the difference between the two groups was statistically significant( with P values below 0. 05). In the composite skin group,the hand function recovered well in 62 hands,and the recovery was 0 hands. The hand function of the simple autologous blade thick skin group recovered well in4 hands,and the functional recovery was poor in 58 hands. the difference between the two groups was statistically significant( with P values below 0. 05). Sixteen patients( 32 hands) in the simple autologous blade thick skin group underwent plastic surgery again,and 10 cases' joint activities did not completely return to normal. In addition,13 patients( 26 hands) also had different degrees of joint movement disorder,but no plastic surgery was performed. Conclusion Allogeneic acellular dermal scaffold can effectively guarantee the appearance of skin grafting for wound repair( flatness,fullness,pressure resistance,abrasion resistance,elasticity,extensibility),and restore the function of hand movement to the maximum extent. The therapeutic effect is exact,and the donor skin area is recovered well,which has good clinical application value and is worth popularizing.
Objective To investigate the effect of allogeneic acellular dermis on the treatment of deep burn wounds in the hand. Methods From May 2005 to March 2017,62 cases( 124 hands) of patients with deep burns who met the inclusion criteria in the Department of Burns and Plastic Surgery,906 th Hospital of the People's Liberation Army Joint Service Support Unit( formerly 113 Hospital) were selected.According to the random number table method,patients were divided into a composite skin group and a simple autologous blade thick skin group,each group had 31 cases and 62 hands. The composite skin group was treated with allogeneic acellular dermal scaffold plus autologous large blade thick skin graft. The autologous blade thick skin group was transplanted with autologous blade thick skin graft. The postoperative skin survival,hand function,scar hyperplasia and appearance recovery were observed. The telephone and We Chat were followed up for 0. 5 to 1. 0 years. Data were compared with Fisher's exact probability method.Results In 31 patients( 62 hands) of the composite skin group,the overall hand shape was flat,full,pressure-resistant and anti-friction. All of them didn't undergo secondary scar plastic surgery. In 31 patients( 62 hands) with simple autologous blade thick skin group,the overall hand appearance was poor in flatness,not fullness,poor elasticity,no pressure resistance,poor abrasion resistance and poor stretchability. In the composite skin group, 60 patients with mild hyperplasia after operation and 2 patients with severe hyperplasia; 12 patients with mild hyperplasia of scar and 50 patients with severe hyperplasia in the simple autologous blade thick skin group,the difference between the two groups was statistically significant( with P values below 0. 05). In the composite skin group,the hand function recovered well in 62 hands,and the recovery was 0 hands. The hand function of the simple autologous blade thick skin group recovered well in4 hands,and the functional recovery was poor in 58 hands. the difference between the two groups was statistically significant( with P values below 0. 05). Sixteen patients( 32 hands) in the simple autologous blade thick skin group underwent plastic surgery again,and 10 cases' joint activities did not completely return to normal. In addition,13 patients( 26 hands) also had different degrees of joint movement disorder,but no plastic surgery was performed. Conclusion Allogeneic acellular dermal scaffold can effectively guarantee the appearance of skin grafting for wound repair( flatness,fullness,pressure resistance,abrasion resistance,elasticity,extensibility),and restore the function of hand movement to the maximum extent. The therapeutic effect is exact,and the donor skin area is recovered well,which has good clinical application value and is worth popularizing.
引文
[1] Yu G,Ye L,Tan W,et al. A novel dermal matrix generated from burned skin as a promising substitute for deep degree burns therapy[J]. Mol Med Rep,2016,13(4):2570-2582.
[2]于庆平,李航,于海霞,等.磨削痂术治疗手部深Ⅱ度烧伤的临床疗效观察[J].中国麻风皮肤病杂志,2017,33(3):142-144.
[3] Shilo S,Roth S,Amzel T,et al. Cutaneous wound healing after treatment with plant-derived human recombinant collagen flowable gel[J]. Tissue Eng part A,2013,19(13-14):1519-1526.
[4] Andonovska D,Dzokic G,Spasevska L,et al. The advantages of the application of amnion membrane in the treatment of burns[J]. Prilozi,2008,29(1):183-198.
[5] Cuono CB,Langdon R,Birchall N,et al. Composite antologousallogenie skin replacement:development and dinical application[J]. Plast Recoustr Surg,1987,80(4):626-637.
[6]王炜.整形外科学[M].浙江:浙江科学技术出版社,1999:486.
[7]谢玉国,范智凌,曾庆湖.保痂肉芽创面植皮及切痂微粒皮植皮在大面积深度烧伤患者的疗效对比研究[J].临床医学工程,2013,20(5):575-576.
[8] Perkins BA, Ficociello LH, Ostander BE, et al.Micoroalbuminuria and the risk for early progressive renal function decline in type 1 diaetes[J]. J Am Soc Nephrol,2007,18(4):1353-1361.
[9]陈锦河,郑庆亦,郭毅斌,等.早期削痂治疗Ⅱ度创面为主的大面积烧伤14例[J].福建医药杂志,2002,24(5):27-28.
[10]邓立柱,谭军强.脱细胞异体真皮联合自体薄皮混合移植在深度烧伤治疗中的应用效果分析[J].临床医学工程,2016,23(1):27-28
[11]刘坡,祁少海,舒斌,等.异体脱细胞真皮基质作为组织工程皮肤真皮支架的可行性[J].中国组织工程研究,2012,16(21):3864-3868.
[12] Livesey SA,Herndon DN,Hollyoak MA,et al. Transplanted acellular allograft dermal matrix. Potential as a template for the reconstruction of viable dermis[J]. Transplantation,1995,60(1):1-9.
[13] Ge L,Zheng S,Wei H. Comparison of histologial structure and biocompatibility between human acellular dermal matrix(ADM)and porcine ADM[J]. Burns,2009,35(1):46-50.
[14] Zhong SP,Zhang YZ,Lim CT. Tissue scaffolds for skin wound healing and dermal reconsreuction[J]. Wiley Interdiscip Rev Nanomed Nanobiotechnol,2010,2(5):510-525.
[15]孙红,冯光珍.真皮基质材料的研究进展[J].中国美容医学,2004,13(1):104-106.
[16]孙树,薛宝升,姜英令,等.大面积烧伤早期切痂微粒皮移植中功能部位不同方式复合皮移植的应用[J].中国医学工程,2013,21(3):28-29.
[17]孙永华,李迟,王春元,等.脱细胞异种真皮与自体薄皮片移植的研究与应用[J].中华整形烧伤外科杂志,1998,14(5):370-373,40.
[18]方向京,罗和源,孟宏,等.同种异体脱细胞真皮加自体刃厚皮片修复手部烧伤[J].临床和实验医学杂志,2006,5(5):484-485.
[19]覃秋海,黄运严,边建民,等.脱细胞异体真皮加自体刃厚皮复合移植在创面修复中的临床应用[J].中国临床新医学,2009,2(2):116-118.
[20]孙革,周长青,高春阳.关节周围皮肤缺损伤异体真皮网和自体皮片移植的临床应用[J].中国医药导报,2008,5(17):36-37.
[2]于庆平,李航,于海霞,等.磨削痂术治疗手部深Ⅱ度烧伤的临床疗效观察[J].中国麻风皮肤病杂志,2017,33(3):142-144.
[3] Shilo S,Roth S,Amzel T,et al. Cutaneous wound healing after treatment with plant-derived human recombinant collagen flowable gel[J]. Tissue Eng part A,2013,19(13-14):1519-1526.
[4] Andonovska D,Dzokic G,Spasevska L,et al. The advantages of the application of amnion membrane in the treatment of burns[J]. Prilozi,2008,29(1):183-198.
[5] Cuono CB,Langdon R,Birchall N,et al. Composite antologousallogenie skin replacement:development and dinical application[J]. Plast Recoustr Surg,1987,80(4):626-637.
[6]王炜.整形外科学[M].浙江:浙江科学技术出版社,1999:486.
[7]谢玉国,范智凌,曾庆湖.保痂肉芽创面植皮及切痂微粒皮植皮在大面积深度烧伤患者的疗效对比研究[J].临床医学工程,2013,20(5):575-576.
[8] Perkins BA, Ficociello LH, Ostander BE, et al.Micoroalbuminuria and the risk for early progressive renal function decline in type 1 diaetes[J]. J Am Soc Nephrol,2007,18(4):1353-1361.
[9]陈锦河,郑庆亦,郭毅斌,等.早期削痂治疗Ⅱ度创面为主的大面积烧伤14例[J].福建医药杂志,2002,24(5):27-28.
[10]邓立柱,谭军强.脱细胞异体真皮联合自体薄皮混合移植在深度烧伤治疗中的应用效果分析[J].临床医学工程,2016,23(1):27-28
[11]刘坡,祁少海,舒斌,等.异体脱细胞真皮基质作为组织工程皮肤真皮支架的可行性[J].中国组织工程研究,2012,16(21):3864-3868.
[12] Livesey SA,Herndon DN,Hollyoak MA,et al. Transplanted acellular allograft dermal matrix. Potential as a template for the reconstruction of viable dermis[J]. Transplantation,1995,60(1):1-9.
[13] Ge L,Zheng S,Wei H. Comparison of histologial structure and biocompatibility between human acellular dermal matrix(ADM)and porcine ADM[J]. Burns,2009,35(1):46-50.
[14] Zhong SP,Zhang YZ,Lim CT. Tissue scaffolds for skin wound healing and dermal reconsreuction[J]. Wiley Interdiscip Rev Nanomed Nanobiotechnol,2010,2(5):510-525.
[15]孙红,冯光珍.真皮基质材料的研究进展[J].中国美容医学,2004,13(1):104-106.
[16]孙树,薛宝升,姜英令,等.大面积烧伤早期切痂微粒皮移植中功能部位不同方式复合皮移植的应用[J].中国医学工程,2013,21(3):28-29.
[17]孙永华,李迟,王春元,等.脱细胞异种真皮与自体薄皮片移植的研究与应用[J].中华整形烧伤外科杂志,1998,14(5):370-373,40.
[18]方向京,罗和源,孟宏,等.同种异体脱细胞真皮加自体刃厚皮片修复手部烧伤[J].临床和实验医学杂志,2006,5(5):484-485.
[19]覃秋海,黄运严,边建民,等.脱细胞异体真皮加自体刃厚皮复合移植在创面修复中的临床应用[J].中国临床新医学,2009,2(2):116-118.
[20]孙革,周长青,高春阳.关节周围皮肤缺损伤异体真皮网和自体皮片移植的临床应用[J].中国医药导报,2008,5(17):36-37.