摘要
目的:观察和探讨使用脱细胞异体真皮基质(acellular allogeneicdermal matrix,Allo-ADM)移植修复深度烧伤和瘢痕整形病人关节功能部位处创面的临床应用效果。
方法:选择24例,关节处有深度烧伤或瘢痕增生的患者。将脱细胞异体真皮基质(Allo-ADM)与自体刃厚皮片组成复合皮(Compositeskin,CS),移植于这些病人的共30处位于关节部位的创面上,并在CS移植区周边或附近予单纯刃厚皮移植为对照。作定期随访,观察其成活及外观功能情况等。
结果:30处创面CS移植物及对照组植皮全部愈合。在术后6-18个月的随访期内,未观测到明显的排异反应,瘢痕增生不明显,CS移植区皮肤外观和质地较单纯刃厚皮移植优良,关节功能良好。
结论:脱细胞异体真皮基质作为一种优良的真皮替代物在修复烧伤、瘢痕整形关节部位创面的应用中取得了令人满意的效果。其成活率高,术后效果与中厚皮移植效果相似,是一种较理想的关节功能区植皮方法,可以作为全厚皮和中厚皮移植的良好替代和补充。
Objective:To observe and investigate the effect of acellular allogeneic dermal matrix(Allo—ADM)on cograft in joint functional positions of patients with excision of eschar and post-burn plastic operation.
Methods:24 patients with hypertrophic scar and severe burns on joint were used,30 reticulated Allo—ADM were overlapped with autogenous thin split-thickness skins grafts to constitute the CS(composite skin),and were transplanted to the eschar-cutting and scar-cutting wounds in the joints of those patients.The neighbouling autogenous thin split-thickness skins were used as control.After 12-14 days,the dressings were changed,and the long-term follow-up studies and observations were carried out.
Results:The 30 composit skin grafts as well as the controls were all survived.Dring the 6～18 months follow-up studies,the rejection was not found;hypertrophic scars were rare;the appearance of composit skin grafts were better than the controls and near to normal skins;function of the jiont were well.
Conclusion:the Allo—ADM could be used to Transplant in joint functional positions of patients with excision of eschar and post-burn hypertrophic scars and could produce satisfactory results as dermal substitute,survival rate was high and the results was likeness with the intermediate split-thickness skins transplantation.So we recommend it to be a good complement of intermediate split-thickness skin graft and full-thickness skin graft for transplantation.
引文
1 张余光,王文正,郭思覃。混合表皮细胞培养及其组合皮移植研究。中华整形烧伤外科杂志。1993,9(1):37-40
2 姜笃银,杨银辉,陈璧。无细胞异体真皮基质的研究进展[J]。中国临床康复 2002,6(22):3416-3417
3 姜笃银,孙同柱,张玮,等.无细胞异种真皮基质降解因素的实验研究[J].中华实验外科杂志,2003,23(4):360-361。
4 陈孝平 石应康 邱贵兴。外科学[M]。第一版,北京,人民卫生出版社,2005,902-918。
5 陈锦河,郑亦庆,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,2002,24:27-28。
6 Wainwright DJ,Use of an acellular allograft dermal matrices (Allo-Derm)in the management of full thickness burns[J].Burns,1995,21:243—248.
7 贾生贤,廖镇江,黄伯高,等。脱细胞真皮基质与自体刃厚皮片复合移植的临床应用[J]。中华整形外科杂志,2001,17:227-229。
8 Walter RJ,Matsuda T,Reyea HM,et al.Characterization of acellular dermal matrices(ADMs)prepared by two different methods[J].Burns,1998,24:104-113.
9 陈壁,姜笃银,贾赤宇,等.复合皮移植的实验研究与临床应用[J]。中华烧伤杂志,2004,20(6):347-350.
10 姜笃银,陈壁,贾赤字,等。无细胞异种真皮基质临床应用的免疫 反应特征[J],江苏医学杂志,2004,30(8):578-580。
11 张立海,胡敏。异体脱细胞真皮基质的研究进展[J]。国外医学生物医学工程分册 2005,28(4):241-244
12 杜庆安,张茂红,章冠东,等。自体大张中厚皮片修复功能部位创面的应用研究[J]。东南国防医药 2007,9(5):334-336。
13 姜笃银,陈壁,史颖辉等。复合皮真皮—表皮连接区结构再生机制与功能重建[J]。临床与实验病理学杂志,2000,16(11);524-526。
14 Kitamura N,OtaY,Mimura K.Effects of diisopropylamine dichloroacetate on proliferation and differentiation of normal human keratinocytes in vitro[J].Skin Pharmacol And Skin Physiol,1999,12(6):317-325.
15 Vicanova J,Weerheim AM,Kempenaar JA,et al.Incorporation of linoleic acid by cultured human keratinocytes[J].J Arch Dermatol Res,1999,291(7-8):405-412.
[1]Wainwright DJ,Madden M,Luterman A,et al.Clinical evaluation of an acellular allograft dermal matrix in full-thickness burns[J].J Burn Care Rehab,1996,17:124-136.
[2]MEDALIN DA,EMISG SA,TOMPKISS RG,et al.Valuation of Human Skin Reconstituted form Composite Grafts of Cultured Keratinocytes and Human Acellular Dermis Transplanted to Athymic Mice[J].J Invest Dermatol,1996,107(1):121-127.
[3]Takami Y,Matsuda T,Yoshitake M.Dispase/detergent treated dermal matrix as a dermal substitute[J].Burns.1996,22(3):182-190.
[4]Livesey SA.Herndern DN.Hollyoak MA.et al.Transplanted acellular allograft dermal matrix:Potential as atemplate for reconstruction of viable dermis[J].Transplantion.1995,60(1):11—9.
[5]孙红,一种新型的无细胞真皮基质的研制[J],解剖学杂志,2003,26(2):172-173.
[6]Lee Y,Chen MY,Kuo CY.et al.Preparation of porcine dermal matrix graft[M].Taibei:Global Chinese Symposium on Biomaterials and Controlled Release.1999,12:584-587.
[7]Ray-Neng Chen,Hsiu-O Ho,Yu-Ting Tsai.Process development of an acellular dermal matrix(ADM)for biomedical applications[J].Biomaterials.2004,25:2679-2686.
[8]Srivastava A,Lawrence J,Marend Hanumabass M,et al.Xenogeneie acellular dermal matrix as a dermal substitute in rats[J].J Burn Care Rehab.1999.20:383-390.
[9]Sclafani AP,Romo T.Jacono AA,et al.Evaluation of acellular dermal graft in sheet(Allo-Derm)and injectable(micronized Allo-Derm)forms for soft tissue augmentation:Clinical observations and histological analysis[J].Arch Facial Hast Surg,2000,2(2):130-136.
[10]Rohrich RJ,Reagan BJ,Jr Adams WP,et al.Early results of vermilion lip augmentation using acellular allogenic:An adjunct in facial rejuvenation[J].Plast Reconstr Surg,2000,205:409-416.
[11]MUNXSTER AM,SMITH MM,SHALOM A.Acellular allograft dermal matrix:immediate or delayed epidermal coverage[J].Burns,2001,27(2):150-153.
[12]姜笃银,陈璧,徐明达,等.异种脱细胞真皮基质的制作和临床应用观察[J].中华烧伤外科杂志,2002,18(1):15-18.
[13]JIANG DY,CHEX B,JIA CY,et al.Manufacture and clincal application of heterogeneous/allogeneic acellular dermal matrix cross-linked by glutaraldehyde[J].J The 4th Mil Med Univ,1999,20(5):371-374.
[14]Walter RJ,Matsuda T,Reyes HM,et al.Characterization of acellular dermal matrices(ADMs)prepared by two different methods[J].Burns,1998.24:104-113.
[15]Medalie DA,Eming SA,Collins ME,et al.Diferences in dermal analogs influence subsequent pigmentation,epidermal differentiation,basement membrane,and rete ridge formation of transplanted composite skin grafts[J].Transplantation,1997,64:454-456.
[16]GUSTAFSON CJ,KRATZ G.Cultured autologous keratinocytes on a cell-free dermis in the treatment of fall-thickness wounds [J].Burns,1999,25:331-335.
[17]崔正军,陈璧,施新猷,等.复合皮研究中去除真皮中上皮成分的方法和意义.中华整形烧伤杂志.1997,13(1):37-39.
[18]孙永华,李迟,王春元,等.脱细胞异体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.
[19]Jackson IT,Yavuzer R.Allo-Derm for dorsal nasal irregularities[J].Plast Reconstr Surg,2001,107(2):553-558.
[20]Gryskiewicz JM.Rohrich RJ,Reagan BJ.The use of Allo-derm for the corection of nasal contour deformities[J].Plast Reconstr Surg,2001,107(2):561-570.
[21]Castor SA,To WC,Papay FA.Lip augmentation with Allo-Derm acellular allogenic dermal graft and fat autograft:A comparison with autologous fat injection alone[J].Aesthetic Plast Surg,1999,23(3),218-223.
[22]Sclafani AP,Romo T,Jacono AA.Rejuvenation of the aging lip with an injectable acellular dermal graft(Cymetra)[J].Arch Facial Plast Surg,2002,4(4),252-257.
[23]Shor N,PerryJD,GoldbergRA,etal.The safetyand applications of acellular human dermal allograft in ophthalmic plastic and reconstructive surgery:A preliminary report[J].Oplthal Plast Reconstr surg,2000,16(3):223-230.
[24]Sclafani AP,Romo T,Jacono AA,et al.Evaluation of acellular dermal graft in sheet(AlloDerm)and injectable (micronized AlloDerm)forms for soft tissue augmentation:Clinical observations and histological analysis[J].Arch Facial Plast Surg,2000,2(2):130-136.
[25]ROEDER R,WOLFE J,LIANAKIS N,et al.Compliance,elastic modulus,and burst pressure of small-intestine submucosa(SIS),small-diameter vascular grafts[J].J Biomed Mater Res,1999,47:65-72.
[26]姜笃银,陈壁,贾赤字,等。无细胞异种真皮基质临床应用的免疫反应特征[J],江苏医学杂志,2004,30(8):578-580。