[生物保护性敷料在兔微粒皮移植中的作用]

Zhang Wei-dong, Xie Wei-guo, Zhao Chao-li, Wang Hui, Liu Shu-hua, Ye Zi-qing

Institute of Burns, Wuhan City Hospital No.3 & Tongren Hospital of Wuhan University, Wuhan 430060, China.

Zhonghua Shao Shang Za Zhi. 2012 Oct;28(5):336-40.

OBJECTIVE

To study the effect of biological protective dressing made from porcine peritoneum in covering wounds with microskin grafts.

METHODS

Twenty New Zealand rabbits were divided into ten couples according to the random number table. Rabbits in each couple underwent surgery at the same time. A piece of full-thickness skin of 5 cm in diameter was removed symmetrically from the left and right sides of the back of each rabbit, thus forming two wounds with full-thickness skin defect. One fifth of one piece of skin of one rabbit was cut into tiny pieces of 0.2-0.5 mm in size (microskin). Then the microskin pieces were spread on the two wounds of the donor rabbit with the microskin/wound area ratio 1:10. The two wounds of each rabbit covered with microskin were divided into two groups according to the random number table. One wound was covered with biological protective dressing prepared with porcine peritoneum as experiment group, and the other was covered with the rest allograft in full size obtained from the other rabbit of each couple as control group. The general condition of wound was observed at post operation week (POW) 1-4. Wound healing rate was calculated at POW 3 and 4. Wound healing time was recorded. Specimens were harvested from wounds for histological observation at POW 1-4. Data were processed with paired t test.

RESULTS

(1) At POW 1, the biological protective dressings were found to attach firmly to the wounds in experiment group without obvious inflammatory response; the allografts survived well on the wounds in control group. At POW 2, the coverings attached well to the wounds of both groups, but became drier and darker as compared with those at POW 1. At POW 3, some wounds of the two groups healed when the coverings desiccated and separated. At POW 4, all the wounds of both groups healed without obvious difference in appearance. (2) The wound healing rates of the experiment and control groups were respectively (92.8 ± 6.2)% and (91.3 ± 7.3)% (t = 0.54, P > 0.05) at POW 3 and (98.1 ± 2.3)% and (97.0 ± 4.6)% (t = 0.38, P > 0.05) at POW 4. (3) The wound healing time was (25.0 ± 3.9) d in experiment group and (24.8 ± 2.3) d in control group. The difference between them was not statistically significant (t = 0.82, P > 0.05). (4) Histological observation showed that wounds of the two groups were all infiltrated by inflammatory cells, and new blood vessels were observed at POW 1 and 2. The survived microskin proliferated under the coverings. At POW 3 and 4, the coverings on the wounds of two groups were gradually degenerated and became necrotic and separated from the wound beds, while the wounds underneath were re-epithelialized.

CONCLUSIONS

The effect of biological protective dressing in covering wounds grafted with microskin is as good as that of the allograft, as they both help the auto-microskin proliferate and repair the wound. It could be considered to be new biological material for clinical application.

目的

研究猪腹膜生物防护敷料覆盖微小皮片移植创面的效果。

方法

将20只新西兰兔按随机数字表分为10对，每对兔同时手术。在每只兔背部左右两侧对称切除直径5 cm的一块全层皮肤，形成两个全层皮肤缺损创面。将1只兔的1/5皮肤剪成0.2～0.5 mm大小的微小皮片（微小皮）。然后将微小皮片以微小皮/创面面积比1∶10铺于供皮兔的两个创面上。将每只兔覆盖微小皮的两个创面按随机数字表分为两组。一个创面覆盖用猪腹膜制备的生物防护敷料作为实验组，另一个创面覆盖取自每对中另一只兔的整块异体皮作为对照组。术后1～4周观察创面一般情况。术后3、4周计算创面愈合率。记录创面愈合时间。术后1～4周取创面标本进行组织学观察。数据采用配对t检验处理。

结果

（1）术后1周，实验组生物防护敷料与创面贴附牢固，无明显炎症反应；对照组异体皮在创面上存活良好。术后2周，两组覆盖物与创面贴附良好，但与术后1周相比变干、变黑。术后3周，两组部分创面在覆盖物干燥、分离时愈合。术后4周，两组创面均愈合，外观无明显差异。（2）术后3周，实验组和对照组创面愈合率分别为（92.8±6.2）%和（91.3±7.3）%（t = 0.54，P＞0.05）；术后4周分别为（98.1±2.3）%和（97.0±4.6）%（t = 0.38，P＞0.05）。（3）实验组创面愈合时间为（25.0±3.9）d，对照组为（24.8±2.3）d，两者差异无统计学意义（t = 0.82，P＞0.05）。（4）组织学观察显示，两组创面均有炎性细胞浸润，术后1、2周可见新生血管。存活的微小皮在覆盖物下增殖。术后3、4周，两组创面覆盖物逐渐退变、坏死，与创面床分离，其下创面重新上皮化。