口腔修复膜植入预防腮腺手术后Frey综合征

目的：观察口腔修复膜（异种脱细胞真皮基质）植入对腮腺术后Frey综合征的预防作用。方法：我科近五年来施行的腮腺手术病人共75例,其中35例选择在皮瓣与腮腺床之间植入口腔修复膜,术后随访1-2年,以患者主观症状判断是否存在Frey综合征。结果：在未使用口腔修复膜的患者中,有29例（72．5％）出现Frey综合征的症状,在使用修复膜的患者中只有1例（2．9％）出现症状。两组之间有显著性差异（P〈0．01）。结论：口腔修复膜（异种脱细胞真皮基质）能有效预防腮腺手术后Frey综合征的发生。     

改良手术方法在腮腺肿瘤手术中的运用

目的:改良腮腺肿瘤手术方法,以期最大程度恢复术后患者美容及功能。方法:采用以下改良术式:①采用隐蔽的面部除皱切口,避免了常规术式的颈部切口;②采用总干法解剖面神经,减少了面神经周围支损伤的机率;③保留耳大神经,避免术后耳垂麻木;④采用口腔修复膜,减少了术后Frey综合征的发生;⑤采用蒂在上方的胸锁乳突肌肌瓣填塞腮腺切除后的凹陷区,避免了常规术式后的面部畸形。结果:采用该方法对36例患者行腮腺切除术,术后随访6月～4年,患者面部疤痕不明显,外形恢复良好,无面瘫,无Frey综合征出现。结论:改良的腮腺切除术克服了传统术式的缺陷,值得进一步推广和普及。     

改良手术方法在腮腺肿瘤手术中的运用

目的：改良腮腺肿瘤手术方法,以期最大程度恢复术后患者美容及功能。方法：采用以下改良术式：①采用隐蔽的面部除皱切口,避免了常规术式的颈部切口;②采用总干法解剖面神经,减少了面神经周围支损伤的机率;③保留耳大神经,避免术后耳垂麻木;④采用口腔修复膜,减少了术后Frey综合征的发生;⑤采用蒂在上方的胸锁乳突肌肌瓣填塞腮腺切除后的凹陷区,避免了常规术式后的面部畸形。结果：采用该方法对36例患者行腮腺切除术,术后随访6月～4年,患者面部疤痕不明显,外形恢复良好,无面瘫,无Frey综合征出现。结论：改良的腮腺切除术克服了传统术式的缺陷,值得进一步推广和普及。     

深度烧伤创面异体脱细胞真皮基质与自体刃厚皮复合移植 的临床观察

目的:探讨深度创面修复的有效方法。方法:30例患者随机分为两组,治疗组采用异体脱细胞真皮基质和自体刃厚皮片移植,对照组单纯采用自体刃厚皮片移植。最后采用温哥华瘢痕量表对患者术后1个月、6个月、12个月进行评分。结果:术后1个月,两组间温哥华评分无统计学差异。术后6个月、12个月,治疗组的温哥华评分低于对照组,差异有统计学意义(P<0.05)。结论:异体脱细胞真皮基质和自体刃厚皮移植是深度烧伤创面修复的一种有效方法。     

人工骨表面覆盖口腔修复膜对颌骨囊性缺损人工骨植入术患者植入腔感染的预防作用

目的:探讨人工骨表面覆盖口腔修复膜对颌骨囊性缺损人工骨植入术患者植入腔感染的预防作用。方法:将我院2012年4月～2016年2月收治的78例颌骨囊性缺损患者按治疗时间分为对照组38例与观察组40例,均行开窗人工骨植入术,其中对照组采取常规抗感染,观察组采取人工骨表面覆盖口腔修复膜。比较两组的囊腔体积、面积缩减率、人工骨植入量、骨厚度及植入腔感染率。结果:两组的囊腔体积、面积缩减率及人工骨植入量比较差异无统计学意义(P0.05)。但观察组的骨厚度明显大于对照组(P0.05),植入腔感染率明显低于对照组(P0.05)。结论:在开窗人工骨植入术的基础上使用口腔修复膜不仅能引导骨组织再生,而且能够显著降低植入腔的感染率。     

脱细胞真皮基质治疗对糖尿病足综合征合并下肢动脉硬化闭塞患者神经病变和对足部功能的影响

目的:探究脱细胞真皮基质治疗对糖尿病足综合征合并下肢动脉硬化闭塞患者神经病变的缓解作用和对足部功能的影响。方法:选择本院2017.5-2020.5收治的80例糖尿病足综合征合并下肢动脉硬化闭塞患者平均分为观察组和对照组2组,其中对照组患者给与常规干预结合下肢动脉腔内治疗,观察组则在对照组的基础上实施脱细胞真皮基质治疗。分析两组患者治疗前后TCSS评分、神经传导速度、足部功能、治疗效果、创面感染发生率、治疗费用以及并发症发生率的差异。结果:治疗后观察组患者TCSS评分和足部功能评分均较对照组低,神经传导速度较对照组快,差异有统计学意义(P<0.05);观察组患者治疗总有效率、患者创面感染发生率和并发症发生率分别为100.00%、2.50%和2.50%,对照组患者则分别为80.00%、17.50%和55.00%,且对照组住院费用较观察组高,差异有统计学意义(P<0.05)。结论:脱细胞真皮基质治疗对糖尿病足综合征合并下肢动脉硬化闭塞患者神经病变具有确切的缓解作用,尤其对足部功能效果显著,值得临床广泛推广使用。     

深度烧伤创面异体脱细胞真皮基质与自体刃厚皮复合移植的临床观察

目的：探讨深度创面修复的有效方法。方法：30例患者随机分为两组,治疗组采用异体脱细胞真皮基质和自体刃厚皮片移植,对照组单纯采用自体刃厚皮片移植。最后采用温哥华瘢痕量表对患者术后1个月、6个月、12个月进行评分。结果：术后1个月,两组间温哥华评分无统计学差异。术后6个月、12个月,治疗组的温哥华评分低于对照组,差异有统计学意义（P〈0．05）。结论：异体脱细胞真皮基质和自体刃厚皮移植是深度烧伤创面修复的一种有效方法。     

瑞诺口腔组织补片修复口腔黏膜缺损患者的护理

口腔黏膜缺损修复主要采用局部转移黏膜瓣及断层皮片等自体组织修复,尽管易于成活,但存在的缺点是不容忽视的,如对自体的供区和受区的功能与外形的影响,增加病人痛苦和病程等问题。随着组织工程学的发展,一种新型的真皮替代物———脱细胞异体真皮基质已经在烧伤和整形领域中皮肤的移植上成功应用。2005年1~12月,我们应用瑞诺口腔组织补片修复口腔黏膜缺损20例,获得较好的效果。现将相关的护理措施介绍如下。1临床资料1·1一般资料20例中,男12例,女8例,平均年龄35岁。其中腭部肿物切除8例,口腔黏膜外伤5例,下唇肿瘤切除2例,颊部病变切除3例,…     

三种猪源性细胞外基质体内降解规律的实验研究

目的:研究本实验以小鼠腹壁缺损为模型,通过对三种猪源性细胞外基质(ECM)—猪脱细胞小肠粘膜下层(P-SIS)、猪脱细胞心包(P-PC)以及猪脱细胞真皮(P-ADM),进行体内弹性纤维和葡糖氨基聚糖类(GAGs)的含量测定,然后通过三组材料中弹性纤维和GAGs在术后第4周、第8周时再生或降解的数量,来对比研究三种生物材料植入体内后的降解规律,从而为寻找性能优良的生物补片提供理论依据,为生物补片的临床应用以及避免术后并发症方面提供指导方向。方法:BALB/c小鼠60只,体重18~20 g,手术造成1 cm×1 cm的腹壁全层缺损,随机分为3组(n=20),分别以等面积的P-ADM、P-PC以及P-SIS进行修复,于术后4周、8周进行取材评估。结果:术后P-SIS组的腹腔内粘连评分均低于同时期内的其余两组。术后4、8周比较:P-ADM组,GAGs含量减少(P0.01);P-PC组,弹性纤维(P0.01)、GAGs(P0.05)含量均有所增加;P-SIS组,弹性纤维(P0.001)、GAGs(P0.05)含量均增加。结论:P-SIS材料中,弹性纤维和GAGs的再生状况优于其他两组,且P-SIS材料不易引起腹腔内粘连,故P-SIS能够更好的应用于组织缺损的治疗,P-SIS在组织工程学领域相对而言是更加理想的修复材料。     

脱细胞异体真皮在烧伤后爪型手畸形中的应用

目的探讨脱细胞异体真皮联合自体刃厚皮移植在治疗烧伤后爪型手畸形中的应用。方法对11例烧伤后爪型手畸形行瘢痕切除,松解粘连后,行脱细胞异体真皮联合自体刃厚皮移植术。结果 11例患者(18只手)均植皮成活(成活率100%),畸形矫正,功能恢复理想。结论烧伤后爪型手瘢痕切除脱细胞异体真皮联合自体刃厚皮移植效果理想。     

Vascularized acellular dermal matrix island flaps for the repair of abdominal muscle defects

The potential widespread use of tissue-engineered matrices in soft-tissue reconstruction has been limited by the difficulty in fabricating and confirming a functional microcirculation. Acellular dermal matrix placed in a soft-tissue pocket acts as a scaffold to be incorporated by the host's fibrovascular tissue. A new method for noninvasive real-time observation of functional microvascular networks using orthogonal polarization spectral (OPS) imaging has recently been reported. Arterioles, venules, and capillaries can be directly visualized, and the movement of individual blood cells through them can be observed. The present study was performed to investigate the use of prefabricated acellular dermal matrix with an arteriovenous unit for the repair of abdominal muscle defects. OPS imaging was used to determine the presence of a functional microcirculation in the neovascularized matrix. In Sprague-Dawley rats, vascularized matrix was prefabricated by placing the superficial epigastric artery and vein on a 2-cm x 2-cm implant-type acellular dermal matrix in the thigh. Three weeks after implantation, the matrix-arteriovenous unit was elevated as an axial-type flap and a 2-cm x 2-cm full-thickness block of abdominal muscle immediately superior to the inguinal ligament was resected. Additional procedures were performed according to group: no repair (group 1, n = 20); repair with nonvascularized acellular dermal matrix (group 2, n = 20); repair with devascularized acellular dermal matrix (group 3, = 20); and repair with vascularized acellular dermal matrix (group 4, n = 20). OPS imaging (field of view, 1 mm in diameter; scan depth range, 0.2 mm) was performed on both sides of each flap on a total of 10 random distal regions before and after pedicle transection in group 3 and with the pedicle preserved in group 4. Hernia rate and duration of survival were compared for 21 days. OPS imaging showed directional blood cell movement through the capillary network in all areas scanned in group 4. No microvascular perfusion was observed after pedicle transection in group 3. Hernia rates of 100, 80, 90, and 0 percent were seen in groups 1, 2, 3, and 4, respectively. Median survival times of 9, 11.5, 9, and 21 postoperative days were noted in groups 1, 2, 3, and 4, respectively. Histopathologic analysis with factor VIII revealed full-thickness infiltration of the matrix by endothelial cells, signifying newly formed blood vessels. Repair of abdominal muscle defects using vascularized acellular dermal matrix resulted in no hernia and survival of all animals for the duration of study. However, repairs using avascular or devascularized matrix resulted in significant rates of hernia and decreased survival. Acellular dermal matrix can be prefabricated into vascularized tissue using an arteriovenous unit and used successfully to repair abdominal muscle defects. OPS imaging allowed for high-contrast direct visualization of microcirculation in previously acellular tissue following prefabrication with an arteriovenous unit.     

Microporous acellular extracellular matrix combined with adipose-derived stem cell sheets as a promising tissue patch promoting articular cartilage regeneration and interface integration

BackgroundAcute or chronic injury of articular cartilage leads to localized destruction. Difficulties with interface integration between the implant and native cartilage tissue can lead to an undesirable outcome. To improve cartilage repair and interface integration, we explored the therapeutic efficacy of microporous acellular extracellular matrix (ECM) combined with adipose-derived stem cell (ASC) sheets.MethodsMethods for fabricating ASC sheets and microporous acellular ECM were explored before transplanting the constructed ASC sheet/matrix in vivo and in vitro, respectively. After the operation, distal femur samples were collected at 6 and 12 weeks for further analysis.ResultsThe decellularization process removed 90% of the DNA but retained 82.4% of glycosaminoglycans (GAGs) and 82.8% of collagen, which are the primary components of cartilage matrix. The acellular matrix/ASC sheet construct treatment in vivo showed better interface integration, cartilage regeneration, and collagenous fiber arrangement, which resembles the native structure. There was a significant increase in GAG and collagen accumulation at the zone of regeneration and integration compared to other groups. Gene expression analysis showed that the mRNA level associated with cartilage formation significantly increased in the acellular matrix/ASC sheet group (p<0.05), which is consistent with the histological analysis.DiscussionASC sheets promote interface integration between the implant and native tissue. This effect, together with the acellular matrix as a graft, is beneficial for cartilage defect repair, which suggests that acellular matrix/ASC sheet bioengineered cartilage implants may be a better approach for cartilage repair due to their enhanced integration.     

Evaluation of Dermal Substitute in a Novel Co-Transplantation Model with Autologous Epidermal Sheet

The development of more and more new dermal substitutes requires a reliable and effective animal model to evaluate their safety and efficacy. In this study we constructed a novel animal model using co-transplantation of autologous epidermal sheets with dermal substitutes to repair full-thickness skin defects. Autologous epidermal sheets were obtained by digesting the basement membrane (BM) and dermal components from rat split-thickness skins in Dispase II solution (1.2 u/ml) at 4°C for 8, 10 and 12 h. H&E, immunohistochemical and live/dead staining showed that the epidermal sheet preserved an intact epidermis without any BM or dermal components, and a high percentage of viable cells (92.10±4.19%) and P63 positive cells (67.43±4.21%) under an optimized condition. Porcine acellular dermal matrixes were co-transplanted with the autologous epidermal sheets to repair full-thickness skin defects in Sprague-Dawley rats. The epidermal sheets survived and completely re-covered the wounds within 3 weeks. Histological staining showed that the newly formed stratified epidermis attached directly onto the dermal matrix. Inflammatory cell infiltration and vascularization of the dermal matrix were not significantly different from those in the subcutaneous implantation model. Collagen IV and laminin distributed continuously at the epidermis and dermal matrix junction 4 weeks after transplantation. Transmission electron microscopy further confirmed the presence of continuous lamina densa and hemidesmosome structures. This novel animal model can be used not only to observe the biocompatibility of dermal substitutes, but also to evaluate their effects on new epidermis and BM formation. Therefore, it is a simple and reliable model for evaluating the safety and efficacy of dermal substitutes.     

Evaluation of human acellular dermis versus porcine acellular dermis in an in vivo model for incisional hernia repair

Incisional hernias commonly occur following abdominal wall surgery. Human acellular dermal matrices (HADM) are widely used in abdominal wall defect repair. Xenograft acellular dermal matrices, particularly those made from porcine tissues (PADM), have recently experienced increased usage. The purpose of this study was to compare the effectiveness of HADM and PADM in the repair of incisional abdominal wall hernias in a rabbit model. A review from earlier work of differences between human allograft acellular dermal matrices (HADM) and porcine xenograft acellular dermal matrices (PADM) demonstrated significant differences (P < 0.05) in mechanical properties: Tensile strength 15.7 MPa vs. 7.7 MPa for HADM and PADM, respectively. Cellular (fibroblast) infiltration was significantly greater for HADM vs. PADM (Armour). The HADM exhibited a more natural, less degraded collagen by electrophoresis as compared to PADM. The rabbit model surgically established an incisional hernia, which was repaired with one of the two acellular dermal matrices 3 weeks after the creation of the abdominal hernia. The animals were euthanized at 4 and 20 weeks and the wounds evaluated. Tissue ingrowth into the implant was significantly faster for the HADM as compared to PADM, 54 vs. 16% at 4 weeks, and 58 vs. 20% for HADM and PADM, respectively at 20 weeks. The original, induced hernia defect (6 cm²) was healed to a greater extent for HADM vs. PADM: 2.7 cm² unremodeled area for PADM vs. 1.0 cm2 for HADM at 20 weeks. The inherent uniformity of tissue ingrowth and remodeling over time was very different for the HADM relative to the PADM. No differences were observed at the 4-week end point. However, the 20-week data exhibited a statistically different level of variability in the remodeling rate with the mean standard deviation of 0.96 for HADM as contrasted to a mean standard deviation of 2.69 for PADM. This was significant with P < 0.05 using a one tail F test for the inherent variability of the standard deviation. No significant differences between the PADM and HADM for adhesion, inflammation, fibrous tissue or neovascularization were noted.     

Microporous Dermal-Mimetic Electrospun Scaffolds Pre-Seeded with Fibroblasts Promote Tissue Regeneration in Full-Thickness Skin Wounds

Electrospun scaffolds serve as promising substrates for tissue repair due to their nanofibrous architecture and amenability to tailoring of chemical composition. In this study, the regenerative potential of a microporous electrospun scaffold pre-seeded with dermal fibroblasts was evaluated. Previously we reported that a 70% collagen I and 30% poly(Ɛ-caprolactone) electrospun scaffold (70:30 col/PCL) containing 160 μm diameter pores had favorable mechanical properties, supported fibroblast infiltration and subsequent cell-mediated deposition of extracellular matrix (ECM), and promoted more rapid and effective in vivo skin regeneration when compared to scaffolds lacking micropores. In the current study we tested the hypothesis that the efficacy of the 70:30 col/PCL microporous scaffolds could be further enhanced by seeding scaffolds with dermal fibroblasts prior to implantation into skin wounds. To address this hypothesis, a Fischer 344 (F344) rat syngeneic model was employed. In vitro studies showed that dermal fibroblasts isolated from F344 rat skin were able to adhere and proliferate on 70:30 col/PCL microporous scaffolds, and the cells also filled the 160 μm pores with native ECM proteins such as collagen I and fibronectin. Additionally, scaffolds seeded with F344 fibroblasts exhibited a low rate of contraction (~14%) over a 21 day time frame. To assess regenerative potential, scaffolds with or without seeded F344 dermal fibroblasts were implanted into full thickness, critical size defects created in F344 hosts. Specifically, we compared: microporous scaffolds containing fibroblasts seeded for 4 days; scaffolds containing fibroblasts seeded for only 1 day; acellular microporous scaffolds; and a sham wound (no scaffold). Scaffolds containing fibroblasts seeded for 4 days had the best response of all treatment groups with respect to accelerated wound healing, a more normal-appearing dermal matrix structure, and hair follicle regeneration. Collectively these results suggest that microporous electrospun scaffolds pre-seeded with fibroblasts promote greater wound-healing than acellular scaffolds.     

Cytotoxicity testing of scaffolds potentially suitable for the preparation of three-dimensional skin substitutes

The preparation and study of three-dimensional functional skin substitutes has been the focus of intense research for several decades. Dermal substitutes are now commonly used in medical practice for a variety of applications. Here, we assess the toxicity of seven selected acellular dermal matrix materials to establish their potential for use in future three-dimensional skin substitute studies. The cytotoxicity of acellular dermis (of Allo- and Xenograft origin) prepared in our lab and biomaterials based on collagen and hyaluronic acid (Coladerm H and Coladerm H–L) were compared to that seen in three commercially available products (Xe-Derma, AlloDerm and Xeno-Impl). Murine fibroblasts NIH-3T3 and human dermal fibroblasts were used in cytotoxicity tests, with any resultant cytotoxic effects caused by the seven tested dermal scaffolds visualised using an inverted microscope system and confirmed in parallel using colorimetric MTT cell proliferation assays. While most of the dermal substitutes did not demonstrate a cytotoxic effect on our two cell types, Xeno and Xeno-Impl scaffolds clearly did. The cytotoxic effect of acellular Xeno dermal matrix could essentially be removed through a regime of multiple washes, but we were unable to remove the cytotoxic effect of Xeno-Impl. Thus, Xeno-Impl alone has been excluded from our future work on preparation of 3D skin substitutes.     

Full incorporation of Strattice(TM) Reconstructive Tissue Matrix in a reinforced hiatal hernia repair: a case report

ABSTRACT: INTRODUCTION: A non-cross-linked porcine acellular dermal matrix was used to reinforce an esophageal hiatal hernia repair. A second surgery was required 11 months later to repair a slipped Nissen; this allowed for examination of the hiatal hernia repair and showed the graft to be well vascularized and fully incorporated. CASE PRESENTATION: A 71-year-old Caucasian woman presented with substernal burning and significant dysphagia. An upper GI series revealed a type III complex paraesophageal hiatal hernia. She underwent laparoscopic surgery to repair a hiatal hernia that was reinforced with a xenograft (StratticeTM Reconstructive Tissue Matrix, LifeCell, Branchburg, NJ, USA) along with a Nissen fundoplication. A second surgery was required to repair a slipped Nissen; this allowed for examination of the hiatal repair and graft incorporation 11 months after the initial surgery. CONCLUSION: In this case, a porcine acellular dermal matrix was an effective tool to reinforce the crural hiatal hernia repair. The placement of the mesh and method of fixation are believed to be crucial to the success of the graft. It was found to be well vascularized 11 months after the original placement with no signs of erosion, stricture, or infection. Further studies and longterm follow-up are required to support the findings of this case report.