Rhee P H, Friedman C D, Ridge J A, Kusiak J
Craniofacial Tissue Engineering, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
Arch Otolaryngol Head Neck Surg. 1998 Nov;124(11):1201-4. doi: 10.1001/archotol.124.11.1201.
The standard reconstruction of significant mucosal defects in head and neck surgery has been split-thickness skin grafting (STSG).
To examine the use of a commercially available acellular dermal matrix as an alternative to STSG to reduce the scarring and contracture inherent to meshed split-thickness autografting and avoid the additional donor site morbidity.
Twenty-nine patients with full-thickness defects of the oral cavity were included in this retrospective chart review. Candidate patients had their operative procedure performed at a tertiary care center during a 24-month period. Allograft dermal matrix, an acellular tissue-processed biomaterial, was applied to these intraoral defects. The defects were reconstructed with an acellular dermal graft matrix in the same technical fashion as with an autologous skin graft. Patients were evaluated for rate of "take," functional return time to reepithelialization, average surface area of graft, associated pain and discomfort, evidence of restrictive graft contracture, patient diagnosis, and graft location within the oral cavity. Any evidence of incomplete graft reepithelialization was considered grounds for graft failure, either complete or incomplete. Epithelialization and contracture were assessed during outpatient clinical examinations. Patient complaints with regard to discomfort at the graft bed were considered evidence of pain.
Graft locations included 9 in the tongue (32%), 5 in the maxillary oral vestibule (17%), 4 in the mandible (14%), 4 in the floor of mouth (14%), 3 in the hard and/or soft palate (10%), 3 in the tonsil (10%), and 1 in the lip (3%). The overall rate of take was 90% with complete epithelialization noted on clinical evaluation within 4 weeks. Patients were followed up for an average of 8.6 months. The average grafted surface area was 25 cm2. Pain or discomfort was noted in 3 patients (12%). One patient (4%) was noted to have clinical evidence of graft contracture.
Allograft dermal matrix was successful as a substitute to autologous STSG for resurfacing of intraoral defects. Allograft dermal matrix may be considered a useful reconstructive option for patients with oral mucosal defects.
头颈部手术中显著黏膜缺损的标准重建方法一直是断层皮片移植（STSG）。
研究使用市售脱细胞真皮基质替代断层皮片移植，以减少网状断层自体皮移植固有的瘢痕形成和挛缩，并避免额外的供区并发症。
本回顾性病历研究纳入了29例口腔全层缺损患者。候选患者在一家三级医疗中心于24个月期间接受了手术。同种异体真皮基质，一种经过脱细胞处理的生物材料，被应用于这些口腔内缺损。这些缺损采用与自体皮肤移植相同的技术方式用脱细胞真皮移植基质进行重建。对患者进行了“成活”率、重新上皮化的功能恢复时间、移植平均表面积、相关疼痛和不适、移植挛缩受限的证据、患者诊断以及移植在口腔内的位置等方面的评估。任何移植不完全重新上皮化的证据都被视为移植失败的依据，无论是完全失败还是部分失败。在门诊临床检查期间评估上皮化和挛缩情况。患者关于移植床不适的主诉被视为疼痛的证据。
移植部位包括舌部9例（32%）、上颌口腔前庭5例（17%）、下颌4例（14%）、口底4例（14%）、硬腭和/或软腭3例（10%）、扁桃体3例（10%）以及唇部1例（3%）。总体成活成功率为90%，临床评估显示在4周内实现了完全上皮化。患者平均随访8.6个月。平均移植表面积为25平方厘米。3例患者（12%）出现疼痛或不适。1例患者（4%）有移植挛缩的临床证据。
同种异体真皮基质作为自体断层皮片移植的替代物成功用于口腔内缺损的修复。同种异体真皮基质可被视为口腔黏膜缺损患者的一种有用的重建选择。
