异体脱细胞真皮联合自体皮复合移植在创面修复中应用及远期疗效观察.docVIP

异体脱细胞真皮联合自体皮复合移植在创面修复中应用及远期疗效观察【摘要】目的寻找功能部位深度烧伤创面与瘢痕畸形修复的理想覆盖材料。方法将功能部位的深度烧伤、瘢痕切除后创面或溃疡创面行脱细胞异体真皮+自体刃厚皮复合移植。结果30例患者复合皮全部成活,复合皮光滑柔软,局部弹性好,关节功能恢复良好。结论脱细胞异体真皮+自体皮是功能部位创面修复的理想覆盖材料。? 【关键词】 脱细胞异体真皮; 自体刃厚皮; 创面修复 ?? The long-term efficacy and clinical application of acellular allograft dermal with autogenous skin grafts in wound repair LU Da-lun,DUAN Long-sheng,WANG Yun-long,et al.Department of Burn,Yijishan Hospital,the Affiliated Hospital of Wannan Medical College,Wuhu 241000,China ? 【Abstract】ObjectiveTo find an ideal cover material for repairing of deep-burned functional part and scar deformity.MethodsThe wound of ulcer,scar and wound of the deep-burned functional part excised were covered with acellular allograft derma plus autogenous split-thickness skin graft.Results30 cases were included in this study.The survival rate of the composite skin grafts was 100%.All the composite skin grafts were smooth and soft,had good elasticity,and the joint functions were good.ConclusionAcellular allograft dermal with autologous skin is an ideal covering material for repairing wound of function parts? 【Key words】 Acellular allograft dermal; Autogenous split-thickness skin; Wound repair 在深度烧伤创面及瘢痕的手术治疗中,长期以来以自体皮移植为主,但由于自体全厚皮供区有限,而中厚皮、刃厚皮移植后不同程度存在不耐磨、易起水疱及瘢痕增生挛缩等问题。人们一直在寻求更加理想的皮肤替代物。在这一情况下,包含表皮和真皮的复合皮孕育而生。近年来,我们通过异体脱细胞真皮联合自体皮复合移植在创面修复的临床应用中取得较满意的效果,现介绍如下。? 1临床资料? 1.1一般资料本组病例共30例,其中男19例,女11例;成人20例,儿童10例;年龄3~73岁;溃疡创面10例,瘢痕8例,烧伤12例。移植部位颈胸部3例、上肢(肘)8例、下肢(大腿、膝关节、踝关节)13例,其中全左下肢1例,其他部位6例。? 1.2使用方法? 1.2.1创面处理①彻底清创并切(削)痂,或切除瘢痕至健康组织,创基血运良好;②可依情采用压迫、电凝或结扎等方法充分止血;③肉芽创面换药至新鲜。? 1.2.2自体皮片制备常规消毒供皮区,取自体薄层皮片;或自体刃厚皮片。? 1.2.3脱细胞异体真皮处理 打开外包装袋,将内包装袋置于无菌台上,使用时取出用无菌生理盐水冲洗3遍,即可。? 1.2.4手术要点①将脱细胞异体真皮基底膜面(光洁面)向上,真皮面(粗糙面)直接贴敷于创面,自体皮片的真皮面贴敷于脱细胞异体真皮基底膜面上;②脱细胞异体真皮与创面、自体皮片之间均不可存在气泡、渗血(液)、皱折和重叠;③脱细胞异体真皮与自体皮片之间对角缝合固定,防止皮片移动。也可将脱细胞异体真皮先间断缝合固定于创面上,再将自体皮贴敷于脱细胞异体真皮上,并缝合固定;④使用脱细胞异体真皮应自然展平,使网孔略拉开即可,如自体皮片拉网覆盖植皮,最好使自体皮网孔与脱细胞异体真皮网孔错开。? 1.2.5包扎 按植皮常规方法包扎即可。? 1.2.6术后处理 同常规植皮,