Jiang Duyin, Chen Bi, Xu Mingda, Hu Dahai, Tang Chaowu, Zhu Xiongxiang
Department of Burns, Xijing Hospital, The Fourth Military Medical University, Xian 710033 Shaanxi Province, P.R. China.
Zhonghua Shao Shang Za Zhi. 2002 Feb;18(1):15-8.
To lower down the antigenicity of heterogenous swine acellular dermal tissue, and to explore the feasibility of clinical using it as a composite graft for human patients.
Split-thickness skin was harvested from healthy swines and then processed by two methods. The swine acellular dermal matrix (sADM) was prepared by removing cells from the skin with trypsin and Triton X-100. Then the cross-linked sADM (sADM(1)) and non-cross-linked sADM (sADM(0)) were embedded subcutaneously in rabbits and also transplanted onto the burn wounds of patients. The histological changes and also transplantation results were observed.
(1) In animals with sADM(0) embedded subcutaneously, the grafted tissue was invaded immediately by host cells with obvious inflammatory reaction and tissue degradation. But there was less inflammatory reaction, and with no obvious skin degradation and contraction with sADM(1). (2) In ten burn patients with III degree burn wounds and one patient with wound in chest after scar removal, sADM and ultra-thin skin (UTS) composite graft were grafted on the wounds with autologous thin skin (ATS) and autologous razor-thin or UTS as the control. Nineteen pieces of composite skin of sADM with UTS were grafted on the wounds with survival rate of 78.9%, exhibiting no evident difference with that of ATS. When sADM(0) and UTS were grafed, there exhibited remarkable early inflammatory reaction and wound contraction with similar external appearance with that of UTS. Whereas when sADM(1) and UTS were grafted, there appeared less early inflammatory reaction and wound contraction, resulting in an even appearance and soft to touch similar to that with ATS. But ulceration occurred, with exposure of sADM(1), exposure and severe macrophage reaction to foreign body in 6 wounds of 3 cases 12.8 +/- 6.9 weeks after sADM(1) and UTS grafting.
Grafting of sADM as a dermal substitute of composite skin could alleviate early post-grafting immune reaction and improve UTS grafting results. But the delayed graft rejection couldn't be avoided.
降低异种猪脱细胞真皮组织的抗原性，探讨其作为复合移植物用于人类患者临床应用的可行性。
从健康猪身上取断层皮，然后用两种方法进行处理。用胰蛋白酶和曲拉通X-100去除皮肤细胞制备猪脱细胞真皮基质（sADM）。然后将交联的sADM（sADM(1)）和未交联的sADM（sADM(0)）皮下植入兔体内，并移植到患者烧伤创面。观察组织学变化及移植结果。
（1）皮下植入sADM(0)的动物，移植组织立即被宿主细胞侵入，有明显的炎症反应和组织降解。但sADM(1)的炎症反应较轻，无明显的皮肤降解和收缩。（2）在10例Ⅲ度烧伤患者和1例胸部瘢痕切除术后患者中，以自体薄皮（ATS）和自体超薄皮或超薄皮为对照，将sADM与超薄皮（UTS）复合移植物移植到创面。将19片sADM与UTS的复合皮移植到创面，成活率为78.9%，与ATS无明显差异。当sADM(0)与UTS移植时，早期炎症反应明显，创面收缩，外观与UTS相似。而当sADM(1)与UTS移植时，早期炎症反应和创面收缩较少，外观平整，触感柔软，与ATS相似。但出现溃疡，3例6个创面在sADM(1)与UTS移植后12.8±6.9周出现sADM(1)暴露、异物暴露及严重巨噬细胞反应。
sADM作为复合皮肤的真皮替代物移植可减轻移植后早期免疫反应，改善UTS移植效果。但移植后延迟排斥反应无法避免。
