骨桥蛋白促创面愈合的实验研究

目的　探讨骨桥蛋白 (OPN)在创面愈合中的作用和意义 ,为筛选促进伤口愈合的外用药物提供实验依据和理论基础。方法　建立创伤实验性模型 ,将其分为OPN组、血清组、EGF组。采用免疫组织化学染色 ,Westernblot分析等方法检测Ⅰ型胶原和羟脯氨酸含量。结果　 (1)形态学改变 :术后第 1天 ,OPN组创面可见有少量的渗出物。术后第 2～ 3天 ,血清组虽有肉芽组织增生 ,但没有充满伤口底层 ;而OPN组、EGF组的创面肉芽组织增生明显。术后第 4～ 7天 ,OPN组肉芽组织层明显较血清组、EGF组薄。 (2 )免疫组织化学染色显示 ,术后第 7天 ,在OPN处理的肉芽组织中Ⅰ型胶原含量略少于EGF组 ,但比血清组高 ,其Westernblot结果与免疫组织化学基本一致。 (3 )羟脯氨酸含量 :各实验组肉芽组织中羟脯氨酸含量差异无显著性 (P >0 .0 5 )。结论　OPN是一种促炎因子 ,具有诱导创伤早期炎症反应的和愈合后期抑制肉芽组织过度增生的功能。     

Acticoat™ stimulates inflammation,but does not delay healing,in acute full‐thickness excisional wounds

Acticoat? has antimicrobial and anti‐inflammatory effects which aid wound healing. However, in vitro studies indicate that Acticoat? is cytotoxic and clinical and in vivo studies suggest that it may delay healing in acute wounds. Therefore, this study investigated the effects of Acticoat? on healing in acute full‐thickness excisional wounds. Using a porcine model, healing was assessed on days 3, 6, 9 and 15 post‐wounding. Five wounds dressed with Acticoat? and five wounds dressed with polyurethane film (control) were assessed per day (n = 40 wounds). The rate of healing, inflammatory response, restoration of the epithelium and blood vessel and collagen formation were evaluated. No difference was found in the rate of healing between wounds treated with Acticoat? and the control wounds. Inflammation was increased in Acticoat?‐treated wounds on day 3 post‐wounding compared to the control wounds. However, by day 15 post‐wounding, the epithelium of the Acticoat?‐treated wounds closely resembled normal epithelium. Acticoat?‐treated wounds also contained a higher proportion of mature blood vessels, and differences in collagen deposition were apparent. Despite inducing an inflammatory response, Acticoat? did not delay healing in acute wounds. Conversely, the improved quality of the epithelium and blood vessels within Acticoat?‐treated wounds indicates that Acticoat? has a beneficial effect on healing.     

人唾液对创面愈合影响的实验研究

目的通过与云南白药比较,观察人唾液对创面愈合的作用,以期初步阐明作用机制。方法 3月龄雄性日本大耳白兔6只,体重2.0～2.5 kg;于每只兔脊柱两侧制备深至皮下、大小为2.5 cm×2.5 cm的创面6个。根据处理方法不同,将36个创面随机分为3组(n=12):空白对照组每天涂抹0.4 mL生理盐水;云南白药组每天涂抹0.5 g云南白药粉,唾液组每天涂抹0.4 mL人唾液,连续15 d。观察创面愈合情况,伤后3、5、8、11、15 d测量创面面积,计算创面愈合率;伤后15 d处死动物取创面组织行组织学观察,计数炎性细胞及微血管密度。结果唾液组和云南白药组创面愈合速度明显快于空白对照组,渗液量少,结痂快。伤后5、8、11 d,唾液组创面愈合率均显著高于空白对照组及云南白药组,差异有统计学意义(P<0.05)。组织学观察显示术后15 d,唾液组创面未见明显出血、坏死,创面基本由表皮覆盖,再生表皮向创面中心覆盖生长,唾液组炎性细胞计数及微血管密度均显著低于云南白药组及空白对照组,差异有统计学意义(P<0.05)。结论唾液可明显促进创面愈合,作用机制可能与其减少炎性细胞浸润、防止伤口感染、加速胶原纤维增生及促进创面血管重建有关。     

The role of hyaluronan in wound healing

The polysaccharide hyaluronan (HA) (synonyms – hyaluronic acid, hyaluronate) is a versatile, polymorphic, glycosoaminoglycan with vast biological functions. HA is found throughout the body, primarily residing in skin, thus playing an important role in wound healing. Research regarding HA's function has changed over the years, primarily focussing on a particular aspect or function. The contribution of HA in each stage of normal wound healing as well as its clinical wound dressing applications will be examined.     

Mobilised bone marrow‐derived cells accelerate wound healing

Massive skin defects caused by severe burn and trauma are a clinical challenge to surgeons. Timely and effective wound closure is often hindered by the lack of skin donor site. Bone marrow‐derived cells (BMDCs) have been shown to ‘differentiate’ into multiple tissue cells. In this study we focused on the direct manipulation of endogenous BMDCs, avoiding the immunocompatibility issues and complicated cell isolation, purification, identification and amplification procedures in vitro on wound repair. We found that mobilisation of the BMDCs into the circulation significantly increased the amount of BMDCs at the injury site which in turn accelerated healing of large open wound. We used a chimeric green fluorescent protein (GFP) mouse model to track BMDCs and to investigate their role in full‐thickness skin excisional wounds. We have shown that bone marrow mobilisation by granulocyte colony stimulating factor (G‐CSF) exerted multiple beneficial effects on skin repair, both by increasing the engraftment of BMDCs into the skin to differentiate into multiple skin cell types and by upregulating essential cytokine mRNAs critical to wound repair. The potential trophic effects of G‐CSF on bone marrow stem cells to accelerate wound healing could have a significant clinical impact.     

不同浓度法舒地尔促进皮肤创面愈合作用的研究

目的：观察法舒地尔（HA1077）促进创面愈合的效果,并探讨HA1077与创面愈合的量效关系,寻找出促进创面愈合的最佳剂量。方法：18只Wistar大鼠背部左右两侧致直径为2cm的圆形皮肤缺损。随机3只动物6个创面为一组,分为6组,分别给予10、20、40、80和160μmol/L盐酸法舒地尔和生理盐水（对照组）创面喷洒,每个创面0.5ml,隔日创面追加喷洒。实验3、7、10d计算伤口面积,实验10d取创面组织,观察组织学变化。结果：各组大鼠创面面积随伤后时间延长而逐渐缩小,20μmol/L组创面面积明显小于同时间点其他各组,除实验7d与80μmol/L组创面面积比较差异无显著性外,其余各时间点差异均有显著性（P〈0.05）。病理学变化显示,创伤后10d,应用20μmol/L法舒地尔组创面新生肉芽组织生长及新生表皮生长速度明显优于其他各组。结论：HA1077可促进皮肤缺损创面愈合,以20μmol/LHA1077效果更为明显。     

创面治疗中心建设的实践

The construction of wound healing or wound care center in China is necessary for patients and about 10 wound healing or care centers have already been established during the past years. In this paper, we summarize their experience and expect their development in the future.     

Telemedicine in wound healing

Better care for patients and improved health care depends on the availability of good information which is accessible when and where it is needed. The development of technology, more specifically the Internet, has expanded the means whereby information can be acquired and transmitted over large distances enabling the concept of telemedicine to become a reality. Telemedicine, defined as the practise of medicine at a distance, encompasses diagnosis, education and treatment. It is a technology that many thought would expand rapidly and change the face of medicine. However, this has not happened and during the last decade although certain telemedicine applications, such as video-consulting and teleradiology, have matured to become essential health care services in some countries, others, such as telepathology, remain the subject of intensive research effort. Telemedicine can be used in almost any medical specialty although the specialties best suited are those with a high visual component. Wound healing and wound management is thus a prime candidate for telemedicine. Development of a suitable telemedical system in this field could have a significant effect on wound care in the community, tertiary referral patterns and hospital admission rates.     

单核细胞集落刺激因子缺失对小鼠创面愈合与新生血管化的影响

目的观察单核细胞集落刺激因子(GMCSF)缺失对创面愈合率和创面愈合过程中新生血管化程度的影响,并分析其机理。方法取GMCSF基因缺失小鼠(GMCSF-/-)和野生小鼠(WT)各30只,麻醉后背部致创(0.8cm×0.8cm),伤后在不同时相点摄像并取创面标本。通过计算机图像处理系统计算创面愈合率,用免疫组织化学方法通过测定创面CD31的阳性表达来计算新生血管数目。结果GMCSF基因缺失的小鼠创面愈合率从伤后3d起就明显低于野生小鼠。伤后第7天起,GMCSF-KO组小鼠CD31的阳性率明显低于WT组。结论GMCSF基因缺失影响创面的新生血管化能力,进而影响创面的愈合。     

Effects of immunosuppressive therapy on wound healing

Immunosuppressive therapy is increasingly being used in clinical practice and has been shown to affect wound healing to varying degrees. This article looks at the effects of the newer immunosuppressive agents on wound healing. It is shown that wound healing is impaired via different mechanisms. Some of the animal and human studies are reviewed in more detail. It is shown that some of the newer agents affect wound healing to such an extent that reduction or avoidance of these drugs until complete wound healing is achieved is advocated. More research is required for these newer agents to determine the most appropriate time to introduce them.     

整合素表达对伤口愈合时成纤维细胞合成原胶原的影响

目的 研究伤口愈合时创面成纤维细胞整合素表达对成纤维细胞合成原胶原的影响。方法 以反义寡核苷酸阻断创面成纤维细胞表面相应整合素亚基的表达，用反转录多聚酶链式反应RT—PCR检测该整合素表达被抑制后创面成纤维细胞原胶原mRNA量的变化。结果 反义寡核苷酸能特异性抑制创面成纤维细胞相应整合素亚基的表达，该成纤维细胞合成原胶原α1(I)、α1(Ⅲ)mRNA的量显著降低。结论 降低创面成纤维细胞整合素的表达可从转录水平抑制成纤维细胞合成原胶原，为伤口愈合时减少瘢痕产生的研究提供实验依据。     

Effect of silver on burn wound infection control and healing: review of the literature

Silver compounds have been exploited for their medicinal properties for centuries. At present, silver is reemerging as a viable treatment option for infections encountered in burns, open wounds, and chronic ulcers. The gold standard in topical burn treatment is silver sulfadiazine (Ag-SD), a useful antibacterial agent for burn wound treatment. Recent findings, however, indicate that the compound delays the wound-healing process and that silver may have serious cytotoxic activity on various host cells. The present review aims at examining all available evidence about effects, often contradictory, of silver on wound infection control and on wound healing trying to determine the practical therapeutic balance between antimicrobial activity and cellular toxicity. The ultimate goal remains the choice of a product with a superior profile of infection control over host cell cytotoxicity.     

Effect of electrolyzed water on wound healing

Electrolyzed water accelerated the healing of full-thickness cutaneous wounds in rats, but only anode chamber water (acid pH or neutralized) was effective. Hypochlorous acid (HOCl), also produced by electrolysis, was ineffective, suggesting that these types of electrolyzed water enhance wound healing by a mechanism unrelated to the well-known antibacterial action of HOCl. One possibility is that reactive oxygen species, shown to be electron spin resonance spectra present in anode chamber water, might trigger early wound healing through fibroblast migration and proliferation.     

Validation of a laser‐assisted wound measurement device in a wound healing model

In the treatment and monitoring of a diabetic or chronic wound, accurate and repeatable measurement of the wound provides indispensable data for the patient's medical record. This study aims to measure the accuracy of the laser‐assisted wound measurement (LAWM) device against traditional methods in the measurement of area, depth and volume. We measured four ‘healing’ wounds in a Play‐Doh^®‐based model over five subsequent states of wound healing progression in which the model was irregularly filled in to replicate the healing process. We evaluated the LAWM device against traditional methods including digital photograph assessment with National Institutes of Health ImageJ software, measurements of depth with a ruler and weight‐to‐volume assessment with dental paste. Statistical analyses included analysis of variance (ANOVA) and paired t‐tests. We demonstrate that there are significantly different and nearly statistically significant differences between traditional ruler depth measurement and LAWM device measurement, but there are no statistically significant differences in area measurement. Volume measurements were found to be significantly different in two of the wounds. Rate of percentage change was analysed for volume and depth in the wound healing model, and the LAWM device was not significantly different than the traditional measurement technique. While occasionally inaccurate in its absolute measurement, the LAWM device is a useful tool in the clinician's arsenal as it reliably measures rate of percentage change in depth and volume and offers a potentially aseptic alternative to traditional measurement techniques.     

创面修复临床治疗机构现状与展望

It is essential for the development of modem clinical medicine to establish a professional facility and team for wound healing. There is some successful experience of constructing and running the wound healing center to be mirrored at home and abroad. The construction of the facility and team for wound healing will be promoted by guideline issuing, profession certificating, and others, which would push forward the clinical treatment and basic research of wound healing.     

Silver‐based wound dressings reduce bacterial burden and promote wound healing

Various types of wound dressings have been designed for different purposes and functions. Controlling bacterial burden in a wound during the early phase is important for successful wound repair. Once bacterial burden is under control, the active promotion of wound healing is another important factor for efficient wound healing. This study investigated the potential of three silver‐containing dressings, namely KoCarbonAg^®, Aquacel^® Ag and Acticoat 7, in reducing bacterial survival and promoting wound healing. The ability of these dressings to block the entry of bacteria from external environment and retain intrinsic bacteria was studied in vitro. In addition, the study used a rat model to compare the healing efficiencies of the three dressings and investigate the quantity of collagen synthesis in vivo. In vitro results indicated that the silver‐containing dressings prevented bacterial growth in wounds by blocking the entry of external bacteria and by retaining the bacteria in the dressing. In vivo study indicated that reduction in bacterial burden accelerated wound healing. Wounds treated by the silver‐containing dressings showed better healing than those treated with gauze. Moreover, KoCarbonAg^® further accelerated wound healing by promoting collagen synthesis and arrangement.     

Effects of glutamine on wound healing

Studies reporting the need for replacing amino acids such as glutamine (Gln), hydroxymethyl butyrate (HMB) and arginine (Arg) to accelerate wound healing are available in the literature. The primary objective of this study was to present the effects of Gln on tissue hydroxyproline (OHP) levels in wound healing. This study was conducted on 30 female Sprague Dawley rats with a mean weight of 230 ± 20 g. Secondary wounds were formed by excising 2 × 1 cm skin subcutaneous tissue on the back of the rats. The rats were divided into three equal groups. Group C (Control): the group received 1 ml/day isotonic solution by gastric gavage after secondary wound was formed. Group A (Abound): the group received 0·3 g/kg/day/ml Gln, 0·052 g/kg/day/ml HMB and 0·3 g/kg/day/ml Arg by gastric gavage after secondary wound was formed. Group R (Resource): the group received 0·3 g/kg/day/ml Gln by gastric gavage after secondary wound was formed. The OHP levels of the tissues obtained from the upper half region on the 8th day and the lower half region on the 21st day from the same rats in the groups were examined. Statistical analysis was performed using the statistics program SPSS version 17.0. No statistically significant differences were reported with regard to the OHP measurements on the 8th and 21st days (8th day: F = 0·068, P = 0·935 > 0·05; 21st day: F = 0·018, P = 0·983 > 0·05). The increase in mean OHP levels on the 8th and 21st days within each group was found to be statistically significant (F = 1146·34, P = 0·000 < 0·001). We conclude that in adults who eat healthy food, who do not have any factor that can affect wound healing negatively and who do not have large tissue loss at critical level, Gln, Arg and HMB support would not be required to accelerate secondary wound healing.     

Potential role of statins on wound healing: review of the literature

Wound healing is a dynamic and complex biological process, which requires coordinated events including haemostasis, inflammation, proliferation, revascularisation and remodelling. Impaired wound healing is a common problem that occurs in both community and hospital settings. Various experimental and clinical studies have evaluated different modalities for the treatment of topical wounds, such as sugar, antibiotics, honey and phytotherapies; also statins have diverse pleiotropic effects that have been suggested to be useful to improve wound healing. Data derived from both animal and human studies showed that statins especially atorvastatin, simvastatin and pravastatin can accelerate the wound-healing process. However, further high-quality and evidence-based studies are needed to address the best statin drug, appropriate dose, the best administration route, duration of treatment and to determine correlation between pleiotropic effects of statins and their probable clinical benefits.     

甲鱼油对大鼠浅Ⅱ度烫伤创面愈合过程中组织修复的影响

目的:探讨甲鱼油治疗大鼠浅Ⅱ度烫伤的效果及其对创面愈合过程中组织修复的影响。方法:108只Wistar大鼠随机分为单纯烫伤组、银锌霜治疗组和甲鱼油治疗组,每组36只。采用将脱毛区置于70℃恒温水浴中15s的方法制成10%体表面积浅Ⅱ度烫伤模型,伤情经病理切片证实。各组创面分别用生理盐水纱布(1ml/cm2)、银锌霜纱布(1ml/cm2)、甲鱼油(1ml/cm2)纱布覆盖包扎固定后放回笼中分笼饲养,换药1次/d。观察创面愈合率及愈合时间。各组动物分别于伤后1、3、5、10、14d取创面组织,常规苏木精-伊红染色,观察病理组织学变化;免疫组织化学链霉素-卵白素-生物素-过氧化物酶复合物法检测创面组织增殖细胞核抗原的表达。结果:①创面愈合时间:单纯烫伤组为(15.33±0.82)d、银锌霜治疗组(12.57±0.54)d,甲鱼油治疗组(11.33±0.67)d,甲鱼油治疗组比单纯烫伤组明显缩短(P<0.01)。②创面愈合率:3组大鼠伤后10和14d的创面愈合率与伤后7d相比差异均具有显著性(P<0.01),甲鱼油治疗组和银锌霜治疗组两组大鼠的创面愈合率比单纯烫伤组在伤后7、10及14d均明显升高(P<0.01)。③病理学观察:甲鱼油能减轻烫伤创面早期的炎症反应,组织学分析显示甲鱼油可促进创面的再上皮化和表皮各层的分化。④增殖细胞核抗原在创面组织标本中的表达量:甲鱼油治疗组比单纯烫伤组、银锌霜治疗组明显升高(P<0.01)。结论:甲鱼油能加速大鼠烫伤创面组织修复细胞的增殖,加快创面再上皮化,促进创面愈合。