自体富血小板血浆联合Meek微型皮片修复严重烧伤患者四肢创面的效果及其机制的前瞻性研究

郑健生; 刘胜利; 彭晓菁; 刘小飞; 禹乐; 梁声强

doi:10.3760/cma.j.cn501120-20200427-00241

自体富血小板血浆联合Meek微型皮片修复严重烧伤患者四肢创面的效果及其机制的前瞻性研究

doi: 10.3760/cma.j.cn501120-20200427-00241

1.
解放军联勤保障部队第909医院（厦门大学附属东南医院）烧伤整形科，漳州　　　　363000
2.
解放军联勤保障部队第909医院（厦门大学附属东南医院）病理科，漳州　　363000
3.
解放军联勤保障部队第909医院（厦门大学附属东南医院）输血科，漳州　　363000

基金项目:

南京军区医学科技创新课题 11MA079

福建省自然科学基金 2019J01143

详细信息

通讯作者:
郑健生，Email：asheng175@163.com

计量
- 文章访问数: 346
- HTML全文浏览量: 142
- PDF下载量: 57
- 被引次数: 0
出版历程
- 收稿日期: 2020-04-27

A prospective study of the effect and mechanism of autologous platelet-rich plasma combined with Meek microskin grafts in repairing the wounds of limbs in severely burned patients

1.
Department of Burns and Plastic Surgery, the 909th Hospital of the Joint Logistic Support Force of PLA (Affiliated Southeast Hospital of Xiamen University), Zhangzhou 363000, China
2.
Department of Pathology, the 909th Hospital of the Joint Logistic Support Force of PLA (Affiliated Southeast Hospital of Xiamen University), Zhangzhou 363000, China
3.
Department of Blood Transfusion, the 909th Hospital of the Joint Logistic Support Force of PLA (Affiliated Southeast Hospital of Xiamen University), Zhangzhou 363000, China

Funds:

Medical Science and Technology Innovation Project of Nanjing Military Region of China 11MA079

Natural Science Foundation of Fujian Province of China 2019J01143

More Information

Corresponding author: Zheng Jiansheng, Email: asheng175@163.com

摘要

摘要: 目的观察自体富血小板血浆（PRP）联合Meek微型皮片修复严重烧伤患者四肢创面的效果，并探讨其机制。方法采用前瞻性对照研究方法。解放军联勤保障部队第909医院烧伤整形科2016年9月—2020年1月收治16例符合入选标准的大面积深度烧伤患者（男9例、女7例，年龄18~69岁）。8例患者两侧患肢损伤程度相近，按随机数字表法将患肢分为Meek植皮+PRP组和单纯Meek植皮组；将另8例患者损伤较重一侧患肢纳入Meek植皮+PRP组，另一侧患肢纳入单纯Meek植皮组。2组患肢创面进行相应治疗。术后10 d，观察Meek微型皮片成活和融合情况，并计算皮片成活率和融合率，苏木精-伊红染色观察Meek微型皮片基底组织形态，免疫组织化学染色观察Meek微型皮片基底组织微血管增生情况并计数。对数据进行配对样本t 检验。结果术后10 d，Meek植皮+PRP组患肢创面较干燥，绝大部分Meek微型皮片与基底贴合牢固；单纯Meek植皮组患肢创面可见少量分泌物，小部分Meek微型皮片脱落或与基底贴合不牢固。术后10 d，Meek植皮+PRP组患肢创面皮片成活率、融合率分别为（94±3）%、（86±4）%，明显高于单纯Meek植皮组的（89±4）%、（79±4）%（t=3.633、4.229，P<0.01）。术后10 d，Meek植皮+PRP组患肢创面Meek微型皮片基底表皮与真皮连接紧密，有较多炎症细胞浸润，微血管增生活跃；单纯Meek植皮组患肢创面Meek微型皮片基底表皮与真皮连接欠紧密，真皮层下胶原纤维变性明显，炎症细胞浸润较少，微血管增生情况欠佳。术后10 d，Meek植皮+PRP组患肢创面Meek微型皮片基底组织微血管呈簇状密集分布，单纯Meek植皮组患肢创面皮片基底组织微血管呈散在、稀疏、点状分布；Meek植皮+PRP组患肢创面Meek微型皮片基底每400倍视野下的微血管数为（36±6）条，明显多于单纯Meek植皮组的（29±7）条（t=2.671，P<0.05）。结论自体PRP可能通过促进皮片基底微血管新生，提高严重烧伤患者四肢创面削痂后移植的Meek微型皮片的成活率和融合率。
- 烧伤 /
- 富血小板血浆 /
- Meek微型皮片
Abstract: Objective To observe the effect of autologous platelet-rich plasma (PRP) combined with Meek microskin grafts in repairing the wounds of limbs in severely burned patients, and to explore the mechanism. Methods The prospective controlled research method was used. From September 2016 to January 2020, 16 patients aged 18-69 years, with extensive deep burns, including 9 males and 7 females, who met the selection criteria were admitted to the Department of Burns and Plastic Surgery of the 909th Hospital of the Joint Logistic Support Force of PLA. The bilateral limbs with similar injury in 8 patients were divided into Meek skin grafting+PRP group and Meek skin grafting alone group according to the random number table; in the other 8 patients, the limbs with severer injury were included in Meek skin grafting+PRP group, and the limbs on the other side were included in Meek skin grafting alone group. The wounds of affected limbs in the two groups were treated correspondingly. On post surgery day (PSD) 10, the survival and fusion of Meek microskin grafts were observed and the survival rate and fusion rate were calculated; the histological morphology and the angiogenesis of the basal tissue of Meek microskin graft were observed by hematoxylin-eosin staining and immunohistochemical staining, respectively, with the microvessels being counted. Data were statistically analyzed with paired sample t test. Results On PSD 10, the wounds of affected limbs in Meek skin grafting+PRP group were dry, and most of the transplanted skin grafts were closely adhered to the basal tissue; while a small amount of exudate could be found in the wounds of affected limbs in Meek skin grafting alone group, and a small part of the transplanted microskin grafts fell off or poorly attached to the basal tissue. On PSD 10, the survival rate and the fusion rate of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group were (94±3)% and (86±4)%, which were significantly higher than (89±4)% and (79±4)% of Meek skin grafting alone group, respectively (t=3.633, 4.229, P<0.01). On PSD 10, the basal epidermis was closely connected with dermis of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group, with more inflammatory cell infiltration and active microvascular hyperplasia, while the basal epidermis was less closely connected with dermis of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting alone group, with obvious degeneration of collagen fibers under the dermis, less inflammatory cell infiltration, and slightly poor microvascular hyperplasia. On PSD 10, the distribution of microvessels in basal tissue of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group were densely clustered, while the distribution of microvessels in Meek skin grafting alone group were scattered, sparse, and dotted. On PSD 10, the number of microvessels in basal tissue of Meek microskin grafts in the wounds of affected limbs in Meek skin grafting+PRP group was 36±6 in each 400-fold visual field, which was significantly more than 29±7 of Meek skin grafting alone group (t=2.671, P<0.05). Conclusions Autologous PRP can effectively promote the survival rate and fusion rate of Meek microskin grafts in the wounds of limbs after escharectomy in severely burned patients by promoting angiogenesis at the base of Meek microskin grafts.
- Burns /
- Platelet-rich plasma /
- Meek microskin grafts
所有作者均声明不存在利益冲突

HTML全文

参考文献(35)

[1]	中华医学会烧伤外科学分会MEEK植皮技术中心协作组,海军军医大学第一附属医院烧伤外科,全军烧伤研究所.MEEK微型皮片移植技术临床操作规范[J/CD].中华损伤与修复杂志:电子版,2019,14(4):311-313.DOI: 10.3877/cma.j.issn.1673-9450.2019.04.015.
[2]	林陆添.影响Meek植皮术治疗大面积深度烧伤疗效的多因素分析[J].中国现代手术学杂志,2018,22(6):454-457.DOI: 10.16260/j.cnki.1009-2188.2018.06.011.
[3]	Fernandez-MoureJS,Van EpsJL,CabreraFJ,et al.Platelet-rich plasma: a biomimetic approach to enhancement of surgical wound healing[J].J Surg Res,2017,207:33-44.DOI: 10.1016/j.jss.2016.08.063.
[4]	郑健生,胡君玲,陈文,等.富血小板血浆对猪自体移植皮片成活和生长的影响[J].中华烧伤杂志,2016,32(2):112-116.DOI: 10.3760/cma.j.issn.1009-2587.2016.02.011.
[5]	WangB,GengQ,HuJ,et al.Platelet-rich plasma reduces skin flap inflammatory cells infiltration and improves survival rates through induction of angiogenesis: an experiment in rabbits[J].J Plast Surg Hand Surg,2016,50(4):239-245.DOI: 10.3109/2000656X.2016.1159216.
[6]	郑健生,王彪,耿秋华,等.富血小板血浆局部应用对皮瓣成活的影响[J].中华医学美学美容杂志,2017,23(2):129-132.DOI: 10.3760/cma.j.issn.1671-0290.2017.02.017.
[7]	李洋,郑健生,王彪,等.自体富血小板血浆对游离皮瓣修复兔软组织缺损的影响[J].中华烧伤杂志,2019,35(9):683-689.DOI: 10.3760/cma.j.issn.1009-2587.2019.09.007.
[8]	EppleyBL,PietrzakWS,BlantonM.Platelet-rich plasma: a review of biology and applications in plastic surgery[J].Plast Reconstr Surg,2006,118(6):147e-159e.DOI: 10.1097/01.prs.0000239606.92676.cf.
[9]	LubkowskaA,DolegowskaB,BanfiG.Growth factor content in PRP and their applicability in medicine[J].J Biol Regul Homeost Agents,2012,26(2 Suppl 1):S3-22.
[10]	ChenL,DingY,ChengG,et al.Use of platelet-rich fibrin in the treatment of periodontal intrabony defects: a systematic review and meta-analysis[J].Biomed Res Int,2021,2021:6669168.DOI: 10.1155/2021/6669168.
[11]	AlsousouJ,ThompsonM,HulleyP,et al.The biology of platelet-rich plasma and its application in trauma and orthopaedic surgery: a review of the literature[J].J Bone Joint Surg Br,2009,91(8):987-996.DOI: 10.1302/0301-620X.91B8.22546.
[12]	KnightonDR,CiresiKF,FiegelVD,et al.Classification and treatment of chronic nonhealing wounds. Successful treatment with autologous platelet-derived wound healing factors (PDWHF)[J].Ann Surg,1986,204(3):322-330.DOI: 10.1097/00000658-198609000-00011.
[13]	EmerJ.Platelet-rich plasma (PRP): current applications in dermatology[J].Skin Therapy Lett,2019,24(5):1-6.
[14]	EvertsP,OnishiK,JayaramP,et al.Platelet-rich plasma: new performance understandings and therapeutic considerations in 2020[J].Int J Mol Sci,2020,21(20):7794.DOI: 10.3390/ijms21207794.
[15]	PengGL.Platelet-rich plasma for skin rejuvenation: facts, fiction, and pearls for practice[J].Facial Plast Surg Clin North Am,2019,27(3):405-411.DOI: 10.1016/j.fsc.2019.04.006.
[16]	CroiséB,ParéA,JolyA,et al.Optimized centrifugation preparation of the platelet rich plasma: literature review[J].J Stomatol Oral Maxillofac Surg,2020,121(2):150-154.DOI: 10.1016/j.jormas.2019.07.001.
[17]	GentileP,CalabreseC,De AngelisB,et al.Impact of the different preparation methods to obtain autologous non-activated platelet-rich plasma (A-PRP) and activated platelet-rich plasma (AA-PRP) in plastic surgery: wound healing and hair regrowth evaluation[J].Int J Mol Sci,2020,21(2):431. DOI: 10.3390/ijms21020431.
[18]	KesyL,KopczyńskiP,BaszczukA,et al.Methods of preparation of the platelet-rich plasma used in medicine as an accelerator of tissue regeneration[J].Pol Merkur Lekarski,2014,36(214):283-286.
[19]	DavisVL,AbukabdaAB,RadioNM,et al.Platelet-rich preparations to improve healing. Part Ⅱ: platelet activation and enrichment, leukocyte inclusion, and other selection criteria[J].J Oral Implantol,2014,40(4):511-521.DOI: 10.1563/AAID-JOI-D-12-00106.
[20]	AmablePR,CariasRB,TeixeiraMV,et al.Platelet-rich plasma preparation for regenerative medicine: optimization and quantification of cytokines and growth factors[J].Stem Cell Res Ther,2013,4(3):67.DOI: 10.1186/scrt218.
[21]	GiraldoCE,ÁlvarezME,CarmonaJU.Effects of sodium citrate and acid citrate dextrose solutions on cell counts and growth factor release from equine pure-platelet rich plasma and pure-platelet rich gel[J].BMC Vet Res,2015,11:60.DOI: 10.1186/s12917-015-0370-4.
[22]	FukudaK,KuwanoA,KurodaT,et al.Optimal double-spin method for maximizing the concentration of platelets in equine platelet-rich plasma[J].J Equine Sci,2020,31(4):105-111.DOI: 10.1294/jes.31.105.
[23]	OzerK,KankayaY,ColakO,et al.The impact of duration and force of centrifugation on platelet content and mass in the preparation of platelet-rich plasma[J].Aesthetic Plast Surg,2019,43(4):1078-1084.DOI: 10.1007/s00266-019-01375-9.
[24]	NiuW,WangP,GeS,et al.Effects of platelet concentrates used in alveolar ridge preservation: a systematic review[J].Implant Dent,2018,27(4):498-506.DOI: 10.1097/ID.0000000000000797.
[25]	van der MeerPF.PAS or plasma for storage of platelets? A concise review[J].Transfus Med,2016,26(5):339-342.DOI: 10.1111/tme.12325.
[26]	XuP,WuY,ZhouL,et al.Platelet-rich plasma accelerates skin wound healing by promoting re-epithelialization[J/OL].Burns Trauma,2020,8:tkaa028[2021-07-01]. https://pubmed.ncbi.nlm.nih.gov/32821743/.DOI: 10.1093/burnst/tkaa028.
[27]	KazakosK,LyrasDN,VerettasD,et al.The use of autologous PRP gel as an aid in the management of acute trauma wounds[J].Injury,2009,40(8):801-805.DOI: 10.1016/j.injury.2008.05.002.
[28]	QuinteroEC,MachadoJFE,RoblesRAD.Meek micrografting history, indications, technique, physiology and experience: a review article[J].J Wound Care,2018,27(Suppl 2):S12-18.DOI: 10.12968/jowc.2018.27.Sup2.S12.
[29]	KlosováH,Němečková CrkvenjašZ,ŠtětinskýJ.MEEK micrografting technique and its use in the treatment of severe burn injuries at the University Hospital Ostrava Burn Center[J].Acta Chir Plast,2017,59(1):11-17.
[30]	栗申,郭素娟.邮票皮、meek微型皮与微粒皮三种植皮方式在修复大面积皮肤缺损创面中的疗效对比研究[J].四川解剖学杂志,2018,26(2):81-83.DOI: 10.3969/j.issn.1005-1457.2018.02.030.
[31]	张鹏, 原莉莉, 罗佳, 等. 严重烧伤患者Meek植皮术后皮片存活情况的影响因素及其预测价值 [J] . 中华烧伤杂志, 2021, 37(3) : 243-249. DOI: 10.3760/cma.j.cn501120-20201127-00503.
[32]	RodeH,MartinezR,PotgieterD,et al.Experience and outcomes of micrografting for major paediatric burns[J].Burns,2017,43(5):1103-1110.DOI: 10.1016/j.burns.2017.02.008.
[33]	李兴照, 蔡晨, 徐庆连, 等. 重度烧伤患儿Meek微型皮片移植失败的原因及治疗措施 [J] . 中华烧伤杂志,2019,35 (7): 525-531. DOI: 10.3760/cma.j.issn.1009-2587.2019.07.009.
[34]	ChoukrounJ,DissA,SimonpieriA,et al.Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part Ⅳ: clinical effects on tissue healing[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2006,101(3):e56-60.DOI: 10.1016/j.tripleo.2005.07.011.
[35]	OzerK,ColakO.Leucocyte- and platelet-rich fibrin as a rescue therapy for small-to-medium-sized complex wounds of the lower extremities[J/OL].Burns Trauma,2019,7:11[2020-04-27].https://pubmed.ncbi.nlm.nih.gov/31080838/. DOI: 10.1186/s41038-019-0149-0.

1 Meek微型皮片移植+富血小板血浆（PRP）和单纯Meek植皮分别治疗严重烧伤患者右、左上肢创面。1A、1B.分别为术中右、左上肢，呈深度烧伤征象，右前臂和右手背行焦痂切开减张后；1C、1D.分别为右、左上肢削痂后，多深达断层脂肪层，右上肢部分达深筋膜浅层并喷涂PRP，左上肢部分达断层真皮层；1E、1F.分别为右、左上肢术后10 d创面愈合情况，右上肢创面愈合比左上肢好；1G、1H.分别为术后1个月右、左上肢，均愈合良好

下载: 全尺寸图片幻灯片

2 严重烧伤患者行Meek植皮+富血小板血浆治疗的右上臂和行单纯Meek植皮的左上臂创面术后10 d皮片基底组织形态学观察苏木精-伊红×100，图中标尺为100 μm。2A.右上臂皮片基底表皮与真皮连接紧密，较多炎症细胞浸润，微血管增生活跃；2B.左上臂表皮与真皮连接欠紧密，胶原纤维变性明显，可见真皮浅层少量微血管

注：红色箭头示表皮与真皮连接处，黑色箭头示微血管，绿色箭头示炎症细胞浸润，蓝色箭头示胶原纤维

下载: 全尺寸图片幻灯片

3 严重烧伤患者行Meek植皮+富血小板血浆治疗的右上臂和行单纯Meek植皮的左上臂创面术后10 d皮片基底组织微血管（棕色或棕黄色）情况二氨基联苯胺-苏木精×100，图中标尺为200 μm。3A.右上臂微血管呈簇状密集分布；3B.左上臂微血管呈散在、稀疏、点状分布，数量明显少于图3A

注：图中箭头示微血管

下载: 全尺寸图片幻灯片