目的 探讨保留变性真皮厚度对深Ⅱ度烧伤猪植皮成活率的影响. 方法 将7只中国家猪脊柱两侧各造成4个深Ⅱ度烧伤创面,将其中6只猪的创面按照随机数字表法分为0.25、0.50、0.75、1.00 mm组,每组12个创面,分别接受相应厚度削痂自体皮移植术.削痂前在每个创面中心部位采集活检组织样本测量烧伤组织厚度及行组织学观察,削痂后在每个创面中心附近采集活检组织样本测量保留变性真皮厚度及行组织学观察.余1只猪的8个创面设为对照组,不行削痂植皮术,同前取标本后行暴露疗法.伤后即刻到伤后3个月,观察5组创面大体情况.伤后8d,计算0.25、0.50、0.75、1.00 mm组创面植皮成活率(以中位数表示).记录5组创面愈合时间.伤后3个月,再次获取5组创面标本,透射电镜下观察超微结构变化.对数据行成组设计多样本比较的秩和检验、单因素方差分析、LSD检验. 结果 本实验中烧伤组织厚度为(1.120±0.211) mm.0.25、0.50、0.75、1.00 mm组创面保留变性真皮厚度分别为(0.830±0.031)、(0.701±0.010)、(0.382±0.031)、(0.141±0.040)mm.伤后8d,0.25、0.50 mm组创面所植皮片全部坏死；0.75 mm组创面所植皮片大部分坏死；1.00 mm组创面所植皮片大部分成活,少部分溶脱；对照组创面逐渐溶痂.伤后15d,0.25、0.50、0.75 mm组创面未成活皮片逐渐脱落,表层有渗出物结痂,1.00 mm组创面完全愈合,对照组创面渗出结痂面积最大.伤后3个月,0.25、0.50、0.75 mm组和对照组愈合创面因瘢痕收缩而缩小,1.00 mm组创面未见明显瘢痕.0.25、0.50、0.75、1.00 mm组创面植皮成活率差异有统计学意义(x2 =19.421,P＜0.001).1.00 mm组创面植皮成活率最高为70％(60％,80％),0.75 mm组创面植皮成活率为20％(0,30％),0.25、0.50 mm组创面植皮成活率均为0(0,0).5组创面愈合时间差异有统计学意义(F =41.450,P＜0.001).0.25、0.50 mm组创面愈合时间分别为(18.2±1.5)、(18.7±2.3)d,与对照组相近[(18.4±1.7)d,P值均大于0.05]；0.75 mm组创面愈合时间为(14.9±2.6)d,与0.25、0.50 mm组及对照组比较差异有统计学意义(P值均小于0.01)；1.00 mm组创面愈合时间为(9.5±1.2)d,较另4组创面愈合时间均明显缩短(P值均小于0.01).削痂前,5组创面真皮深层可见炎性细胞浸润带；削痂后植皮前,0.25、0.50、0.75、1.00 mm组创面断层表面至炎性细胞浸润带厚度各不相同,对照组创面可见较多炎性细胞.伤后3个月透射电镜下观察示,1.00 mm组创面真皮内可见较多Fb,其粗面内质网丰富,细胞器结构较完善. 结论 伤及真皮深层的深Ⅱ度烧伤,保留烧伤变性真皮0.10 mm左右行自体薄皮片移植术,有利于真皮功能重建,减轻瘢痕生长.
目的 探討保留變性真皮厚度對深Ⅱ度燒傷豬植皮成活率的影響. 方法 將7隻中國傢豬脊柱兩側各造成4箇深Ⅱ度燒傷創麵,將其中6隻豬的創麵按照隨機數字錶法分為0.25、0.50、0.75、1.00 mm組,每組12箇創麵,分彆接受相應厚度削痂自體皮移植術.削痂前在每箇創麵中心部位採集活檢組織樣本測量燒傷組織厚度及行組織學觀察,削痂後在每箇創麵中心附近採集活檢組織樣本測量保留變性真皮厚度及行組織學觀察.餘1隻豬的8箇創麵設為對照組,不行削痂植皮術,同前取標本後行暴露療法.傷後即刻到傷後3箇月,觀察5組創麵大體情況.傷後8d,計算0.25、0.50、0.75、1.00 mm組創麵植皮成活率(以中位數錶示).記錄5組創麵愈閤時間.傷後3箇月,再次穫取5組創麵標本,透射電鏡下觀察超微結構變化.對數據行成組設計多樣本比較的秩和檢驗、單因素方差分析、LSD檢驗. 結果 本實驗中燒傷組織厚度為(1.120±0.211) mm.0.25、0.50、0.75、1.00 mm組創麵保留變性真皮厚度分彆為(0.830±0.031)、(0.701±0.010)、(0.382±0.031)、(0.141±0.040)mm.傷後8d,0.25、0.50 mm組創麵所植皮片全部壞死；0.75 mm組創麵所植皮片大部分壞死；1.00 mm組創麵所植皮片大部分成活,少部分溶脫；對照組創麵逐漸溶痂.傷後15d,0.25、0.50、0.75 mm組創麵未成活皮片逐漸脫落,錶層有滲齣物結痂,1.00 mm組創麵完全愈閤,對照組創麵滲齣結痂麵積最大.傷後3箇月,0.25、0.50、0.75 mm組和對照組愈閤創麵因瘢痕收縮而縮小,1.00 mm組創麵未見明顯瘢痕.0.25、0.50、0.75、1.00 mm組創麵植皮成活率差異有統計學意義(x2 =19.421,P＜0.001).1.00 mm組創麵植皮成活率最高為70％(60％,80％),0.75 mm組創麵植皮成活率為20％(0,30％),0.25、0.50 mm組創麵植皮成活率均為0(0,0).5組創麵愈閤時間差異有統計學意義(F =41.450,P＜0.001).0.25、0.50 mm組創麵愈閤時間分彆為(18.2±1.5)、(18.7±2.3)d,與對照組相近[(18.4±1.7)d,P值均大于0.05]；0.75 mm組創麵愈閤時間為(14.9±2.6)d,與0.25、0.50 mm組及對照組比較差異有統計學意義(P值均小于0.01)；1.00 mm組創麵愈閤時間為(9.5±1.2)d,較另4組創麵愈閤時間均明顯縮短(P值均小于0.01).削痂前,5組創麵真皮深層可見炎性細胞浸潤帶；削痂後植皮前,0.25、0.50、0.75、1.00 mm組創麵斷層錶麵至炎性細胞浸潤帶厚度各不相同,對照組創麵可見較多炎性細胞.傷後3箇月透射電鏡下觀察示,1.00 mm組創麵真皮內可見較多Fb,其粗麵內質網豐富,細胞器結構較完善. 結論 傷及真皮深層的深Ⅱ度燒傷,保留燒傷變性真皮0.10 mm左右行自體薄皮片移植術,有利于真皮功能重建,減輕瘢痕生長.
목적 탐토보류변성진피후도대심Ⅱ도소상저식피성활솔적영향. 방법 장7지중국가저척주량측각조성4개심Ⅱ도소상창면,장기중6지저적창면안조수궤수자표법분위0.25、0.50、0.75、1.00 mm조,매조12개창면,분별접수상응후도삭가자체피이식술.삭가전재매개창면중심부위채집활검조직양본측량소상조직후도급행조직학관찰,삭가후재매개창면중심부근채집활검조직양본측량보류변성진피후도급행조직학관찰.여1지저적8개창면설위대조조,불행삭가식피술,동전취표본후행폭로요법.상후즉각도상후3개월,관찰5조창면대체정황.상후8d,계산0.25、0.50、0.75、1.00 mm조창면식피성활솔(이중위수표시).기록5조창면유합시간.상후3개월,재차획취5조창면표본,투사전경하관찰초미결구변화.대수거행성조설계다양본비교적질화검험、단인소방차분석、LSD검험. 결과 본실험중소상조직후도위(1.120±0.211) mm.0.25、0.50、0.75、1.00 mm조창면보류변성진피후도분별위(0.830±0.031)、(0.701±0.010)、(0.382±0.031)、(0.141±0.040)mm.상후8d,0.25、0.50 mm조창면소식피편전부배사；0.75 mm조창면소식피편대부분배사；1.00 mm조창면소식피편대부분성활,소부분용탈；대조조창면축점용가.상후15d,0.25、0.50、0.75 mm조창면미성활피편축점탈락,표층유삼출물결가,1.00 mm조창면완전유합,대조조창면삼출결가면적최대.상후3개월,0.25、0.50、0.75 mm조화대조조유합창면인반흔수축이축소,1.00 mm조창면미견명현반흔.0.25、0.50、0.75、1.00 mm조창면식피성활솔차이유통계학의의(x2 =19.421,P＜0.001).1.00 mm조창면식피성활솔최고위70％(60％,80％),0.75 mm조창면식피성활솔위20％(0,30％),0.25、0.50 mm조창면식피성활솔균위0(0,0).5조창면유합시간차이유통계학의의(F =41.450,P＜0.001).0.25、0.50 mm조창면유합시간분별위(18.2±1.5)、(18.7±2.3)d,여대조조상근[(18.4±1.7)d,P치균대우0.05]；0.75 mm조창면유합시간위(14.9±2.6)d,여0.25、0.50 mm조급대조조비교차이유통계학의의(P치균소우0.01)；1.00 mm조창면유합시간위(9.5±1.2)d,교령4조창면유합시간균명현축단(P치균소우0.01).삭가전,5조창면진피심층가견염성세포침윤대；삭가후식피전,0.25、0.50、0.75、1.00 mm조창면단층표면지염성세포침윤대후도각불상동,대조조창면가견교다염성세포.상후3개월투사전경하관찰시,1.00 mm조창면진피내가견교다Fb,기조면내질망봉부,세포기결구교완선. 결론 상급진피심층적심Ⅱ도소상,보류소상변성진피0.10 mm좌우행자체박피편이식술,유리우진피공능중건,감경반흔생장.
Objective To explore the influence of the thickness of retained denatured dermis on the survival rate of grafted skin in swine with deep partial-thickness burn.Methods Four deep partial-thickness wounds were reproduced respectively on both sides of spine in 7 Chinese domestic pigs.The wounds of 6 pigs were divided into 0.25,0.50,0.75,and 1.00 mm groups with 12 wounds in each group according to the random number table.Tangential excision and autoskin grafting were performed.Before the tangential excision,1 tissue specimen was harvested from the center of each remaining wound for the estimation of the depth of burn,and histological observation was done.After the tangential excision,1 tissue specimen was harvested from the area near the center of each wound for the measurement of the depth of retained denatured dermis with histological examination.The 8 wounds of one pig were set as the control group,and the operation was done,and then they were treated with exposure treatment after biopsy specimens were taken with above-mentioned method.The general condition of wounds in 5 groups was observed from immediately after injury to post injury month (PIM) 3.On post injury day (PID) 7,the survival rate of grafted skin was observed in 0.25,0.50,0.75,and 1.00 mm groups.Wound healing time was recorded.At PIM 3,the specimens were harvested from the wounds of 5 groups,and their ultra microstructures were observed by transmission electron microscope.Data were processed with rank-sum test,one-way analysis of variance,and LSD test.Results The depth of the burn tissue was (1.120 ± 0.211) mm.The depths of retained denatured dermis in0.25,0.50,0.75,and 1.00 mm groups were respectively (0.830±0.031),(0.701 ±0.010),(0.382 ±0.031),and (0.141±0.040) mm.At PID 8,all grafted skin in 0.25 and 0.50 mm groups became necrotic; most grafted skin in 0.75 mm group was necrotic; most grafted skin in 1.00 mm group survived with only a few became necrotic and separated from the wounds.The scabs were gradually separated from the wounds of control group.On PID 15,the grafted skin which did not survive in 0.25,0.50,and 0.75 mm groups was gradually separated from the wounds with exudate forming scab on the surface in varying degrees,while the wounds in 1.00 mm group were all healed,and the incidence of scabs formation was highest in control group.At PIM 3,scar contraction was found in 0.25,0.50,0.75 mm groups and control group,while no obvious scar was observed in 1.00 mm group.There were statistically significant differences in the survival rate of grafted skin in 0.25,0.50,0.75,and 1.00 mm groups (x 2 =19.421,P ＜ 0.001).The survival rate was the highest in 1.00 mm group [70％ (60％,80％)],while the survival rate was 20％ (0,30％) in 0.75 mm group,and it was in both 0.25 and 0.50 mm groups with non-survival of all the grafted skin.There were statistically significant differences in the wound healing time among 5 groups (F =41.450,P ＜ 0.001).The wound healing time in 0.25 and 0.50 mm groups were respectively (18.2 ± 1.5),and (18.7 ± 2.3) d,not statistically significant different from that of control group [(18.4 ±1.7) d,P values both above 0.05].The wound healing time in 0.75 mm group [(14.9 ± 2.6) d] was significantly different from those of 0.25,0.50 mm groups and control group (P values all below 0.01).The wound healing time in 1.00 mm group [(9.5 ± 1.2) d] was significantly shorter compared with that of the other 4 groups (P values all below 0.01).Before tangential excision,the zone of infiltration of the imflammatory cells was observed in the deep dermis of wounds in 5 groups.After tangential excision and before autoskin grafting,the depth from the fault surface to the zone of infiltration of the inflammatory cells varied in 0.25,0.50,0.75,and 1.00 mm groups while more inflammatory cells were observed in control group.At PIM 3,many fibroblasts were observed in the dermis of wounds in 1.00 mm group with abundant rough endoplsmic reticulum and basically intact organelles.Conclusions Performing autologous skin grafting on deep partial-thickness burn,in which the depth of retained denatured dermis was 0.10 mm,may help regenerate dermal function and alleviate scar formation.
