• 第四軍醫(yī)大學(xué)唐都醫(yī)院燒傷整形科（西安，710038）;

【摘 要】 目的 探討脫細(xì)胞同種異體真皮與自體刃厚皮復(fù)合移植修復(fù)深度燒傷功能部位創(chuàng)面的療效。 方
法 2002 年6 月－ 2008 年12 月，收治30 例燒傷及瘢痕整形患者共42 個(gè)創(chuàng)面。男25 例，女5 例；年齡3 ～ 52 歲，中位
年齡31 歲。燒傷24 例35 個(gè)創(chuàng)面，其中深Ⅱ度23 個(gè)創(chuàng)面，Ⅲ度12 個(gè)創(chuàng)面；病程3 ～ 45 d，平均24 d。瘢痕整形6 例7 個(gè)
創(chuàng)面；病程9 ～ 21 d，平均16 d。42 個(gè)創(chuàng)面分別位于頸部2 個(gè)，手部4 個(gè)，前臂及肘部8 個(gè)，肩部3 個(gè)，腘窩6 個(gè)，膝部4 個(gè)，小腿及足踝部15 個(gè)。徹底清創(chuàng)、削痂及切除瘢痕后，創(chuàng)面范圍為10 cm × 10 cm ～ 30 cm × 20 cm。采用一步法將脫細(xì)胞同種異體真皮與自體刃厚皮復(fù)合移植修復(fù)創(chuàng)面。 結(jié)果 術(shù)后27 例39 個(gè)（92.9%）創(chuàng)面復(fù)合皮移植完全成活；3 例3 個(gè)
（7.1%）創(chuàng)面復(fù)合皮部分壞死，分別經(jīng)換藥和自體皮片移植術(shù)后愈合?；颊呔@隨訪，隨訪時(shí)間30 ～ 34 個(gè)月，平均32 個(gè)月。復(fù)合皮有輕度色素沉著，外觀平整，質(zhì)地柔軟，彈性好，皮膚耐磨；復(fù)合皮無(wú)攣縮及瘢痕增生，功能部位活動(dòng)正常。刃厚皮供皮區(qū)未見(jiàn)瘢痕增生。 結(jié)論 脫細(xì)胞同種異體真皮與自體刃厚皮復(fù)合移植修復(fù)功能部位深度燒傷及瘢痕整形創(chuàng)面，可
獲得良好外形及功能。

引用本文： 孟祥海,王曉琳,李學(xué)擁,李望舟,呂小星,蔣立,袁琰琴,李躍軍. 復(fù)合皮移植修復(fù)燒傷功能部位創(chuàng)面療效評(píng)價(jià). 中國(guó)修復(fù)重建外科雜志, 2012, 26(2): 219-222. doi: 復(fù)制

1. Heck EL, Bergstresser PR, Baxter CR. Composite skin graft: frozen dermal allografts support the engraftment and expansion of autologous epidermis. J Trauma, 1985, 25(2): 106-112.
2. Wainwright DJ. Use of an acellular allograft dermal matrix (AlloDerm) in the management of full-thickness burns. Burns, 1995, 21(4): 243-248.
3. 孫維國(guó), 樊星. 脫細(xì)胞異體真皮修復(fù)燒傷瘢痕的臨床觀察. 中國(guó)美容醫(yī)學(xué), 2008, 17(7): 974-975.
4. Wang HJ, Chou TD, Tsou TL, et al. The application of new biosynthetic artificial skin for long-term temporary wound coverage. Burns, 2005, 31(8): 991-997.
5. Patton JH Jr, Berry S, Kralovich KA. Use of human acellular dermal matrix in complex and contaminated abdominal wall reconstructions. Am J Surg, 2007, 193(3): 360-363.
6. Zhang X, Deng Z, Wang H, et al. Expansion and delivery of human fibroblasts on micronized acellular dermal matrix for skin regeneration. Biomaterials, 2009, 30(14): 2666-2674.
7. 張瑋, 姜篤銀, 楊定文, 等. 無(wú)細(xì)胞異體真皮基質(zhì)在關(guān)節(jié)功能部位整復(fù)中的應(yīng)用. 實(shí)用全科醫(yī)學(xué), 2004, 2(2): 101-102.
8. Soejima K, Chen X, Nozaki M, et al. Novel application method of artificial dermis: one-step grafting procedure of artificial dermis and skin, rat experimental study. Burns, 2006, 32(3): 312-318.
9. 姜篤銀, 付小兵. 無(wú)細(xì)胞異種真皮基質(zhì)降解因素的研究. 中華實(shí)驗(yàn)外科雜志, 2003, 20(4): 360-361.
10. Feng X, Tan J, Pan Y, et al. Control of hypertrophic scar from inception by using xenogenic (porcine) acellular dermal matrix (ADM) to cover deep second degree burn. Burns, 2006, 32(3): 293-298.
11. Atherton DD, Tang R, Jones I, et al. Early excision and application of matriderm with simultaneous autologous skin grafting in facial burns. Plast Reconstr Surg, 2010, 125(2): 60e-61e.
12. Loss M, Wedler V, Künzi W, et al. Artificial skin, split-thickness autograft and cultured autologous keratinocytes combined to treat a severe burn injury of 93% of TBSA. Burns, 2000, 26(7): 644-652.
13. 張建超, 沈國(guó)良, 趙小瑜, 等. 網(wǎng)狀中厚皮片移植聯(lián)合負(fù)壓封閉引流修復(fù)皮膚軟組織缺損. 中國(guó)誤診學(xué)雜志, 2009, 9(34): 8317-8319.
14. Sun Y, Pan Y, Chen S, et al. Clinical application of microskin grafting to repair granulation or decrustation wounds. J Burn Care Res, 2006, 27(4): 515-519.
15. 潘云川, 徐家欽, 袁素, 等. 異體脫細(xì)胞真皮基質(zhì)加自體刃厚皮復(fù)合移植遠(yuǎn)期隨訪評(píng)價(jià). 中華燒傷雜志, 2010, 26(6): 439-443.
16. Bellemare J, Roberge CJ, Bergeron D, et al. Epidermis promotes dermal fibrosis: role in the pathogenesis of hypertrophic scars. J Pathol, 2005, 206(1): 1-8.
17. 陳璧, 姜篤銀, 賈赤宇, 等. 復(fù)合皮移植的實(shí)驗(yàn)研究與臨床應(yīng)用. 中華燒傷雜志, 2004, 20(6): 347-350.
18. Wainwright DJ, Bury SB. Acellular dermal matrix in the management of the burn patient. Aesthet Surg J, 2011, 31(7 Suppl): 13S-23S.
19. 李東杰, 宋慧鋒, 賈曉明, 等. 脫細(xì)胞異體真皮基質(zhì)修復(fù)燒傷后不穩(wěn)定性瘢痕的臨床應(yīng)用及病理學(xué)觀察. 中國(guó)修復(fù)重建外科雜志, 2010, 24(6): 653-656.
20. Tang B, Zhu B, Liang YY, et al. Early escharectomy and concurrent composite skin grafting over human acellular dermal matrix scaffold for covering deep facial burns. Plast Reconstr Surg, 2011, 127(4): 1533-1538.
  1. 1. Heck EL, Bergstresser PR, Baxter CR. Composite skin graft: frozen dermal allografts support the engraftment and expansion of autologous epidermis. J Trauma, 1985, 25(2): 106-112.
  2. 2. Wainwright DJ. Use of an acellular allograft dermal matrix (AlloDerm) in the management of full-thickness burns. Burns, 1995, 21(4): 243-248.
  3. 3. 孫維國(guó), 樊星. 脫細(xì)胞異體真皮修復(fù)燒傷瘢痕的臨床觀察. 中國(guó)美容醫(yī)學(xué), 2008, 17(7): 974-975.
  4. 4. Wang HJ, Chou TD, Tsou TL, et al. The application of new biosynthetic artificial skin for long-term temporary wound coverage. Burns, 2005, 31(8): 991-997.
  5. 5. Patton JH Jr, Berry S, Kralovich KA. Use of human acellular dermal matrix in complex and contaminated abdominal wall reconstructions. Am J Surg, 2007, 193(3): 360-363.
  6. 6. Zhang X, Deng Z, Wang H, et al. Expansion and delivery of human fibroblasts on micronized acellular dermal matrix for skin regeneration. Biomaterials, 2009, 30(14): 2666-2674.
  7. 7. 張瑋, 姜篤銀, 楊定文, 等. 無(wú)細(xì)胞異體真皮基質(zhì)在關(guān)節(jié)功能部位整復(fù)中的應(yīng)用. 實(shí)用全科醫(yī)學(xué), 2004, 2(2): 101-102.
  8. 8. Soejima K, Chen X, Nozaki M, et al. Novel application method of artificial dermis: one-step grafting procedure of artificial dermis and skin, rat experimental study. Burns, 2006, 32(3): 312-318.
  9. 9. 姜篤銀, 付小兵. 無(wú)細(xì)胞異種真皮基質(zhì)降解因素的研究. 中華實(shí)驗(yàn)外科雜志, 2003, 20(4): 360-361.
  10. 10. Feng X, Tan J, Pan Y, et al. Control of hypertrophic scar from inception by using xenogenic (porcine) acellular dermal matrix (ADM) to cover deep second degree burn. Burns, 2006, 32(3): 293-298.
  11. 11. Atherton DD, Tang R, Jones I, et al. Early excision and application of matriderm with simultaneous autologous skin grafting in facial burns. Plast Reconstr Surg, 2010, 125(2): 60e-61e.
  12. 12. Loss M, Wedler V, Künzi W, et al. Artificial skin, split-thickness autograft and cultured autologous keratinocytes combined to treat a severe burn injury of 93% of TBSA. Burns, 2000, 26(7): 644-652.
  13. 13. 張建超, 沈國(guó)良, 趙小瑜, 等. 網(wǎng)狀中厚皮片移植聯(lián)合負(fù)壓封閉引流修復(fù)皮膚軟組織缺損. 中國(guó)誤診學(xué)雜志, 2009, 9(34): 8317-8319.
  14. 14. Sun Y, Pan Y, Chen S, et al. Clinical application of microskin grafting to repair granulation or decrustation wounds. J Burn Care Res, 2006, 27(4): 515-519.
  15. 15. 潘云川, 徐家欽, 袁素, 等. 異體脫細(xì)胞真皮基質(zhì)加自體刃厚皮復(fù)合移植遠(yuǎn)期隨訪評(píng)價(jià). 中華燒傷雜志, 2010, 26(6): 439-443.
  16. 16. Bellemare J, Roberge CJ, Bergeron D, et al. Epidermis promotes dermal fibrosis: role in the pathogenesis of hypertrophic scars. J Pathol, 2005, 206(1): 1-8.
  17. 17. 陳璧, 姜篤銀, 賈赤宇, 等. 復(fù)合皮移植的實(shí)驗(yàn)研究與臨床應(yīng)用. 中華燒傷雜志, 2004, 20(6): 347-350.
  18. 18. Wainwright DJ, Bury SB. Acellular dermal matrix in the management of the burn patient. Aesthet Surg J, 2011, 31(7 Suppl): 13S-23S.
  19. 19. 李東杰, 宋慧鋒, 賈曉明, 等. 脫細(xì)胞異體真皮基質(zhì)修復(fù)燒傷后不穩(wěn)定性瘢痕的臨床應(yīng)用及病理學(xué)觀察. 中國(guó)修復(fù)重建外科雜志, 2010, 24(6): 653-656.
  20. 20. Tang B, Zhu B, Liang YY, et al. Early escharectomy and concurrent composite skin grafting over human acellular dermal matrix scaffold for covering deep facial burns. Plast Reconstr Surg, 2011, 127(4): 1533-1538.