热休克蛋白60诱导小鼠皮肤移植耐受的实验研究

目的探讨热休克蛋白60（heat shock protein60，HSP60）对小鼠移植皮片成活的影响及其机制。方法选用60只C57BL／6（H．2b）小鼠为受体，45只BALB／C（H．2d）小鼠、15只CBA／N（H-2^k）为供体，均为8～12周龄近交系雌性小鼠。受体小鼠剪下1cm×1cm全层皮肤，干纱布清创，即为植床：随机分为4组，每组15只。A组：无菌取供体BALB／C（H．2d）小鼠背部1cm×1cm全层皮片，刮去皮下组织后移植至受体小鼠背部；B组：受体小鼠背部皮下注射0．1mL不完全弗氏佐剂（imcompleted Freund’s adjuvant，IFA），2周后行BALB／C（H-2d）小鼠皮肤移植：C组：受体小鼠背部皮下注射经0．1mLIFA乳化后的50gtgHSP60，2周后行BALB／C（H-2^d）小鼠皮肤移植：D组：受体小鼠背部皮下注射经0．1mL IFA乳化后的50μg HSP60，2周后行CBA／N（H-2^k）小鼠皮肤移植。B、C、D组供体皮肤移植方法同A组。术后观察移植皮片成活时间；移植术后7、25d行单向混合淋巴细胞反应及混合淋巴细胞培养上清液细胞因子检测；术后7d行迟发型超敏反应测定。结果A、B、C、D组移植皮片成活时间分别为（12．4±0．5）、（11．6±0.8）、（29.3±2．6）及（27．6±2．1）d：A、B组与C、D组比较，差异有统计学意义（P〈0．05），A、B组间及C、D组间比较，差异无统计学意义（P〉0．05）。皮肤移植术后7d，A、B、C、D组混合淋巴细胞反应每分钟放射脉冲数（counts of perminute impulse，cmp）值分别为12836±1357、11876±1265、6581±573及6843±612；A、B组与C、D组比较，差异有统计学意义（JP〈0．05）：A、B组间及C、D组间比较差异无统计学意义（JP〉0．05）；术后25d，各组cpm值分别为13286±1498、12960±1376、11936±1265及12374±1269，各组间差异无统计学意义（P〉0．05）。皮肤移植术后7d，C、D组混合淋巴细胞培养上清液IL-10高于A、B组，IL-2、干扰素γ（interferonl，，IFN-γ）低于A、B组（JP〈0．05），A、B组间及C、D组间差异均无统计学意义（JP〉0．05）：术后25d，各组IL-2、IL-10及IFN-γ差异无统计学意义（P〉0．05）。皮肤移植术后7d，A、B、C、D组受体小鼠对供体小鼠脾细胞的迟发型超敏反应为（0．84±0．09）、（0.81±0．07）、（0．43±0．05）及（0．46±0．03）mm：A、B组与C、D组比较，差异有统计学意义（P〈0．05），A、B组间及C、D组间差异无统计学意义（P〉0．05）。结论HSP60对免疫耐受的诱导和维持有一定作用。     

大鼠微粒皮移植创面中角蛋白19及整合素β1的异位表达

目的了解大鼠微粒皮移植后创面角蛋白19、整合素β1表达特征的变化，初步探讨微粒皮移植创面的愈合机制。方法取20只大鼠制成全层皮肤缺损创面模型，分为自体皮组：创面移植占缺损皮肤表皮质量10％的自体微粒皮；混合皮组：创面混合移植自、异体微粒皮，其用量分别为缺损皮肤表皮质量的10％、40％。比较移植后2、3、4周2组大鼠创面的愈合率、收缩率，观察2、4周时角蛋白19、整合素β1的表达与分布特征。结果移植后2、3周，混合皮组大鼠创面愈合率分别为（85±5）％、（84±8）％，明显高于自体皮组的（53±10）％、（65±9）％（P〈0．01）。2组创面收缩率在移植后各时相点差异无统计学意义（P〉0．05）。移植后2、4周，2组大鼠创面新生表皮的颗粒层和棘层均可见角蛋白19、整合素β1阳性细胞；此期间未见角蛋白19在基底层有所表达。移植后2周，2组创面基底层未见整合素β1阳性细胞；4周时，部分创面标本中有整合素β1阳性细胞在基底层间断出现。结论自、异体微粒皮混合移植有助于创面愈合。自体微粒皮和自、异体微粒皮混合移植创面中，均存在角蛋白19和整合素β1阳性细胞的异位表达。     

烧伤残余创面的序贯性治疗

目的寻找烧伤残余创面序贯性治疗的有效方法。方法选择烧伤残余创面患者25例，采取自身对照，分别以凡士林油纱（A组）、组织工程全层皮肤（HTAS，B组）覆盖创面，用含氧液冲洗、负压引流后覆盖HTAS（C组）。取创面标本检测细菌量、肿瘤坏死因子（TNF）α含量及基质金属蛋白酶（MMP）13mRNA表达水平，计算创面愈合率。结果治疗后第3、6、9、12天，患者C组创面细菌量分别为（5．30±1．60）、（1．30±0．80）、（1．70±0．60）和（0．60±0.10）集落形成单位（CFU）／ml，显著低于A、B组（P＜0．01）。C组创面经治疗后6d，TNF-α．含量和MMP-13mRNA表达水平分别为（0．650±0．040）ng／mg、0．210±0．010，明显低于A组[（1．550±0．370）ng／mg、1．040±0．050，P＜0．01]和B组[（0．810±0，080）ng／mg、0．640±0．030，P＜0．01]；B组肉芽组织TNF-α含量和MMP-13mRNA表达量显著低于A组（P＜0．01）。治疗后15、30d，C组创面愈合率明显高于A、B组（P＜0．01）。结论应用含氧液冲洗、负压引流后覆盖HTAS，可显著促进创面愈合，是一种有效的烧伤残余创面序贯性治疗方法。     

脱细胞真皮移植部位血管细胞黏附分子1的表达

目的探讨血管细胞黏附分子1（vascular cell adhesion molecule 1,VCAM-1）在脱细胞真皮移植部位的表达变化和意义。方法取近交系小型香猪15只建立猪实验模型,分别于每只猪脊背两侧制作6cm×6cm各3处6个创面。随机分为三组,每组5只。A组为对照组,猪刃厚自体皮移植;B组异体脱细胞真皮与猪刃厚自体皮复合移植;C组J-1型（人）脱细胞真皮与猪刃厚皮复合移植。分别于移植术后3、9、21及30d观察移植皮片成活情况和面积,于移植后3、6、9、12、21及30d各时间点取移植组织标本,流式细胞仪检测VCAM-1的表达变化。结果移植术后3d各组移植皮片基底分离;9dA组皮片转红润基底粘连较紧密,揭开皮片可见渗血,B、C组皮片颜色次之,基底粘连不紧密;21d,A、B、C组移植皮片成活面积分别为94%±12%、92%±9%和91%±11%;术后30d各组移植皮片均愈合良好。各组VCAM-1表达,移植术后3d无明显差别;6dA组表达明显高于B、C组有统计学意义（P〈0.05）;9、12dB、C组明显高于A组有统计学意义（P〈0.05）;30d,各组VCAM-1表达均低于3d有统计学意义（P〈0.01）。结论同种和异种真皮基质移植部位VCAM-1表达高峰迟滞于自体皮移植;提示VCAM-1表达可能与脱细胞真皮活化、血管再生有关。同种和异种真皮移植物VCAM-1表达无差别。     

自体表皮细胞悬液移植修复全层皮肤缺损创面的动物实验研究

目的探讨自体表皮细胞悬液移植技术用于全层皮肤缺损创面修复的适宜密度。方法取健康清洁级成年SD大鼠40只,雌雄不限,体质量210~230 g;根据细胞移植密度不同,随机分为高、中、低细胞密度及空白组(分别为A、B、C、D组,n=10)。取大鼠背部皮肤培养表皮细胞,并制作大鼠全层皮肤缺损创面抗挛缩模型。其中A、B、C组分别将0.2 mL密度为1×10~6、1×10~5、1×10~4个/cm~2的自体表皮细胞悬液移植至创面处,D组给予等量限制性角质形成细胞无血清培养基;取成年Wistar大鼠背部皮肤制备同种异体皮,覆盖各组创面。术后观察大鼠存活情况,于术后7、14、21 d大体观察同种异体皮成活、脱落及创面愈合情况,同种异体皮脱落后计算创面愈合率;21 d时取材行组织学及免疫组织化学染色,观察创面修复情况。结果术后大鼠均存活至实验完成。各组大鼠同种异体皮随时间延长逐渐成活,干燥并开始脱痂;至21 d同种异体皮基本脱落后A、B组创面可见成片上皮,C组创面可见少量菲薄上皮,D组创面无上皮形成。术后21 d同种异体皮脱落后,A、B、C、D组创面愈合率分别为62.9%±9.6%、64.2%±9.1%、38.5%±5.7%、22.7%±5.5%,A、B组创面愈合率显著高于C、D组(P0.05),C组高于D组(P0.05),A、B组间比较差异无统计学意义(P0.05)。组织学观察示,A、B、C组愈合的创面上皮层可见鳞状上皮细胞,A、B组表皮分层明显,C组表皮层薄、可见炎性细胞浸润,D组为肉芽组织。免疫组织化学染色观察示,A、B、C组表皮-真皮连接层Ⅳ型胶原和Ⅶ型胶原表达呈阳性,D组无表皮层呈阴性;A、B组Ⅳ、Ⅶ型胶原表达阳性细胞百分比显著高于C组(P0.05),A、B组间比较差异无统计学意义(P0.05)。结论自体表皮细胞悬液移植技术在大鼠全层皮肤缺损创面修复中可重构皮肤,1.0×10~5个/mL为创面修复的适宜移植密度。     

体外构建复合皮移植后对大鼠创面愈合的影响

目的：观察角质形成细胞和成纤维细胞与无细胞异种真皮基质构成的复合皮移植于全层皮肤缺损创面后的效果,寻找一种新的创面覆盖物。方法：54只SD大鼠作背部全层皮肤缺损创面后分为A、B、C三组,分别以A型复合皮（角质形成细胞＋成纤维细胞＋无细胞异种真皮基质）、B型复合皮（角质形成细胞＋无细胞异种真皮基质）和普通敷料进行移植,术后定期观察创面愈合情况并进行创面收缩率的计算,同时切取创面组织进行组织学检测。结果：三组中,A组的创面愈合及外观情况最好;A组创面收缩率明显低于B、C两组（P（0．05）;组织学检测提示A组复合皮上皮分化充分,胶原增生有序,表皮一真皮连接结构重建明显,未见明显的急性期免疫排斥反应。结论：角质形成细胞和成纤维细胞与无细胞异种真皮基质构成的复合皮移植后能改善创面愈合质量,是一种较理想的、可探索的皮肤替代物。     

大黄素对大鼠肝移植后肝细胞凋亡的影响

目的：探讨大黄素对大鼠肝移植后肝细胞凋亡的影响。方法：建立LEW→BN大鼠肝移植动物模型,随机分为A组（排斥反应组）、B组（CsA组）、C组（大黄素组）、D组（CsA＋大黄素组）4组,每组6只。术后每天分别腹腔注射生理盐水0.5mL/d、环孢素A（CsA）10.0mg/（kg·d）、大黄素50.0mg/（kg·d）、大黄素50.0mg/（kg·d）＋CsA10.0mg/（kg·d）。连续用药8d,停药后处死动物取肝脏组织观察肝细胞凋亡指数（AI）和排斥活动指数（RAI）。结果：A、B、C、D组AI分别是35.83±2.32、15.83±1.33、16.50±2.35、11.50±1.05,RAI分别是7.67±0.98、5.17±0.40、5.83±0.75、3.83±0.75。B、C、D组的AI、RAI较A组均明显降低（P〈0.01）,而D组较B、C组也均有明显降低（P〈0.05）,B、C组间差别均无意义（P〉0.05）。结论：大黄素能有效减少大鼠移植肝术后肝细胞凋亡,抑制排斥反应。     

大鼠肝移植后早期血清一氧化氮的变化及其意义

目的探讨大鼠肝移植后早期血清一氧化氮（NO）的变化情况及其意义。方法将SD大鼠随机分成A、B、C三组，进行肝移植．供、受者均为SD大鼠。A组于移植肝恢复血流2h、B组于移植肝恢复血流4h、C组于移植肝恢复血流6h时采取受者的下腔静脉血和左肝叶组织．测定血清丙氨酸转氨酶（ALT）和NO含量．免疫组化法测定移植肝组织中核因子．κB p65亚单位（NF-κB p65）的表达，并观察肝组织病理学变化；每组均于移植肝恢复血流时收集5min的胆汁，测量5min胆汁分泌量。结果A组的5min胆汁分泌量为（3．73±1．11）μl．明显高于B组的（2．35±0．92）μ和C组的（2．23±0．81）μl（P〈0．05）。A组血清ALT含量为（468±36）IU／L．B组为（619±49）IU／L．C组为（820±65）IU／L，A组明显低于B、C组（P〈0．05），B组明显低于C组（P〈0．05）。A组血清NO含量为（14．2±1．5）μmol／L，明显高于B组的（10．5±1．2）μmol／L和C组的（10．3±1．1）μmol／L（P〈0．05）。A组肝组织中NF-κB p65表达阳性细胞百分率为（23．5±1．9）％．B组为（43．8±3．8）％，C组为（48．6±5．1）％．A组明显低于B、C组（P〈0．05）。病理学观察显示．随着移植肝脏再灌注时间的延长，肝组织损伤呈进行性加重。Pearson相关性分析提示．NO与血清ALT水平及NF-κB p65表达呈明显的负相关（r值分别为-0．74和-0．77，P〈0．01）。结论移植肝脏再灌注早期．血清NO下降，NF-κB的活性逐渐增强．移植肝脏的功能和组织损伤呈加重趋势。     

大鼠自体异体表皮细胞悬液混合移植的实验研究

目的　探讨自、异体表皮细胞悬液混合移植技术在创面修复中的应用。　方法　 30只大鼠随机配成 15对后 ,分成细胞悬液移植组 (A组 ,10对 )和细胞膜片移植组 (B组 ,5对 )。取每只大鼠全厚皮 ,分离表皮细胞 ,并根据配对情况按 1∶1的细胞比例混合 ,体外常规培养。 4d后收获A组混合细胞悬液 ,14d后收获B组混合细胞膜片。将此细胞悬液和膜片分别转移至A、B组相应供体大鼠的去全厚皮创面。随后A组每对大鼠的创面交叉覆盖配对方的异体全厚皮 ;B组创面覆盖胶原膜及“优妥”敷料。比较移植后 2～ 3周两组的创面修复情况。　结果　术后 2～ 3周 ,A组创面大多愈合 ,表面光滑 ,与皮下连接紧密。术后第 5天 ,B组创面部分细胞膜片脱落 ,部分成活 ,膜片成活的创面后期再次出现小创面 ,经久不愈。　结论　自、异体表皮细胞悬液混合移植是一种可行的、体内构建皮肤、修复创面的方法。     

A型肉毒毒素对兔植皮后皮片收缩相关因素的影响

／目的研究A型肉毒毒素对兔植皮术后皮片收缩的相关因素影响。方法于兔背部沿脊柱两侧对称地制备两排共4个2cm×2cm正方形供皮区,切取全厚皮片,共形成20个创面。每只兔背部随机选取2个创面皮下注射A型肉毒毒素5U,此为A组,共10个创面;其余未注射A型肉毒毒素的创面为B组。术后12d,大体观察切口愈合及植皮成活情况。观察组织的HE染色标本中炎症细胞、成纤维细胞、胶原纤维的变化及免疫组织化学染色标本中α-SMA表达;测量每张图片α-SMA的积分光密度值。结果大体观察A组与B组切口愈合及皮片成活无明显差异。光镜下,观察A组较B组真皮中炎症细胞减少,胶原纤维相对细小、致密度下降,排列较规则,大体走向一致;成纤维细胞数量减少,较分散。A组与B组α-SMA的积分光密度值组间差异具有统计学意义（P=0．003）,A组α-SMA的表达较B组明显减少。结论A型肉毒毒素的注射不影响植皮的正常成活及切口愈合。可通过减少收缩过程中的成纤维细胞的数量、胶原的合成与沉积及炎症细胞的生成,以减少肌成纤维细胞中α-SMA的表达,达到抑制皮片收缩的目的。     

明胶/聚己内酯电纺复合纳米纤维支架促进创面愈合的实验研究

目的 了解明胶/聚己内酯(Gt/PCL)电纺复合纳米纤维支架对家兔全层皮肤缺损创面愈合的影响. 方法 将16只家兔背部制作全层皮肤缺损创面,其中8只行同体对照实验,分别以Gt/PCL纳米纤维膜覆盖(Gt/PCL组)、PCL纤维膜覆盖(PCL组);余下8只家兔创面用凡士林纱布覆盖(对照组),各组创面数均为8个.记录创面愈合时间;于伤后3、7、10 d计算创面愈合率,并取创面及创周组织行组织病理学观察. 结果 Gt/PCL组创面愈合时间为(18.2±1.3)d、PCL组(20.3±1.1)d、对照组为(22.0±0.6)d,组间差异有统计学意义(P＜0.05);Gt/PCL组伤后各时相点创面愈合率均高于其他2组(P＜0.05).与其余2组比较,Gt/PCL组真皮层肉芽组织增生少,上皮细胞移行速度明显增快,胶原排列规则. 结论 Gt/PCL电纺复合纳米纤维支架能明显促进家兔全层皮肤缺损创面的愈合,是目前可供选择的效果比较确切的组织工程支架材料.     

自体表皮细胞-纤维蛋白膜创面移植治疗大鼠烧伤

目的：观察自体表皮细胞-纤维蛋白膜移植到大鼠烧伤创面治疗皮肤缺损的效果。方法：健康Wistar大鼠20只,随机分成烧伤皮肤缺损造模组和自体表皮细胞-纤维蛋白膜移植治疗组,治疗后计算表皮细胞在纤维蛋白膜上最佳接种密度,观察移植后的各组创面愈合情况、创面伤口的收缩比例等。结果：在纤维蛋白膜上接种表皮细胞的最佳密度为5×10^4／cm2,烧伤皮肤缺损造模组创面完全愈合时间平均22．3d,自体表皮细胞-纤维蛋白膜移植治疗组为18．1d,造模组创面收缩率为（70±5）％,移植组为（20±5）％（均P〈0．05）。结论：自体表皮细胞-纤维蛋白膜可用于覆盖大面积烧伤造成的皮肤缺损,预防创面伤口瘢痕化的形成,减轻创面收缩率,加速皮肤缺损创面的愈合速度。     

重组人表皮生长因子促进大鼠皮肤创面愈合的研究

目的观察重组人表皮生长因子(rhEGF)对皮肤创面愈合的作用。方法制作大鼠背部创伤模型,采用自身平行对照,将34只大鼠背部的68个创面分成rhEGF治疗组与盐水对照组,观察大体形态和组织学改变、创面愈合时间和愈合率,测定伤后不同时间创面羟脯氨酸(OHP)含量和Ⅰ型Ⅲ型胶原比例,进行细胞DNA周期分析。结果经rhEGF治疗的创面愈合速度较盐水对照明显加快,2组平均愈合时间为(17.2±1.3)d和(20.5±1.6)d(P<0.01);外用rhEGF使创面肉芽组织生成增多,再上皮化明显,显著增加创面中OHP含量,降低Ⅰ型Ⅲ型胶原比例,加速细胞DNA复制。结论外用rhEGF可缩短创面愈合时间,增加肉芽组织及OHP含量,降低Ⅰ型Ⅲ型胶原比例,加速细胞DNA复制,明显促进皮肤创面的修复。     

人组织工程全层皮肤在烧伤创面中厚供皮区的应用

目的观察人组织工程全层皮肤(ActivSkin)在中厚供皮区临床应用效果.方法 9例患者,年龄17～43岁.其中5例1%～6%总体表面积烧伤,深Ⅱ度～Ⅲ度;4例烧伤后瘢痕.每例患者2个部位创面,均使用自体中厚皮片修复.切取皮片后供区遗留创面随机分为试验组和对照组,行自体对照观察.试验组创面采用ActivSkin修复,对照组创面采用凡士林油纱覆盖.术后观察创面疼痛、愈合时间及治愈率;术后7～30 d每日观察创面愈合情况,1、3、6个月定期随访.结果试验组创面术后疼痛明显减轻,愈合时间为9.67±2.92 d,比对照组16.56±2.96 d提前,差异有统计学意义(P＜0.05);治愈率均为100%.术后随访试验组创面供皮区愈合后未见水疱、残余创面发生,瘢痕形成减轻;对照组创面4例于术后3个月内有水泡形成,残余创面发生. 结论ActivSkin可减轻中厚供皮区创面疼痛,加速愈合,并能预防供皮区愈合后水疱、残余创面发生,降低瘢痕形成.     

Microskin grafting. I. Animal experiments

This article reports a new grafting technique—microskin grafting. These experiments were carried out in rabbits, and used a small amount of autograft minced into tiny pieces and then spread on a piece of homograft. The combined autograft plus homograft was then transplanted onto the wound of a rabbit. In 12 rabbits, the microskin grafts took well and covered the wound completely in 8 rabbits. The expansion ratios of the micrografts were from 7:1 to 15:1. The healing time of the wound was from 19 to 35 days. The operation failed in 4 rabbits because of the homograft moving. Histological sections revealed that microskin grafts orientated upwards can grow well and those orientated in a lateral or downward direction can grow too. This technique is an effective procedure for repairing extensive wounds with smaller donor sites.     

Autologous skin transplantation: comparison of minced skin to other techniques

BACKGROUND: Skin grafting may be necessary to close nonhealing skin wounds. This report describes a fast and minimally invasive method to produce minced skin suitable for transplantation to skin wounds. The technique was evaluated in an established porcine skin wound healing model and was compared to split-thickness skin grafts and suspensions of cultured and noncultured keratinocytes. MATERIALS AND METHODS: The study included 90 wounds on 3 pigs. Fluid-treated full-thickness skin wounds were grafted with minced skin, split-thickness skin grafts, noncultured keratinocytes, or cultured keratinocytes. Controls received either fluid or dry treatment. The wound healing process was analyzed in histologies collected at Days 8 to 43 postwounding. Wound contraction was quantified by photoplanimetry. RESULTS: Wounds transplanted with minced skin and keratinocyte suspension contained several colonies of keratinocytes in the newly formed granulation tissue. During the healing phase, the colonies progressed upward and reepithelialization was accelerated. Minced skin and split-thickness skin grafts reduced contraction as compared to keratinocyte suspensions and saline controls. Granulation tissue formation was also reduced in split-thickness skin-grafted wounds. CONCLUSIONS: Minced skin grafting accelerates reepithelialization of fluid-treated skin wounds. The technique is faster and less expensive than split-thickness skin grafting and keratinocyte suspension transplantation. Minced skin grafting may have implications for the treatment of chronic wounds.     

胶原-壳聚糖真皮支架原位诱导修复猪全层皮肤缺损的研究

目的 观察胶原-壳聚糖真皮支架移植于猪皮肤缺损创面后支架的血管化及血管化支架上皮肤移植的成活情况.方法 将双层人工皮肤支架移植于10只猪全层皮肤缺损创面,在植入后1、2、3周对真皮支架血管化、创面、血管化支架上皮肤移植愈合情况进行观察;同时用免疫组织化学方法,对CD34阳性信号(新生血管数目)进行检测.结果 支架植入后1周支架内可见细胞浸润和少量新生微血管形成;植入后2周,垂直于创面的新生微血管明显增多;植入后3周,大部分支架被血管化.CD34阳性信号在支架植入后3周比植入后2周明显增多,植入后2周比植入后1周明显增多.在支架植入后1、2、3周创面植中厚皮,植皮2周后皮片存活率分别为10%、70%和100%.在支架植入后1周和2周创面植表皮,1周和2周后移植表皮存活良好.结论 胶原-壳聚糖真皮支架可以诱导血管长入,明显促进创面愈合.在支架上移植表皮,可较好修复创面,在皮肤移植中有良好的应用前景.     

Thrombin peptide TP508 accelerates closure of dermal excisions in animal tissue with surgically induced ischemia.

TP508 is a synthetic peptide corresponding to amino acids 508 through 530 of human prothrombin. We previously demonstrated that a single topical application of TP508 stimulates revascularization and healing of acute incisional and excisional wounds in normal, healthy rat skin. To determine if TP508 would enhance wound healing in ischemic skin, we used bipedicle flaps, cranially based flaps, and free grafts to surgically create ischemic regions on the backs of rats. Full-thickness, circular excisions were made within the flaps or grafts and immediately treated with a single application of saline +/- TP508 (0.1 microg/wound). Compared to wound closure in normal skin, ischemic skin wounds exhibited delayed closure, and the length of delay correlated with the degree of surgically induced ischemia. TP508 significantly accelerated closure in both normal and ischemic skin, resulting in closure rates that were increased within the first 7 days of wounding by 30% in normal tissue and bipedicle flaps, 50% in cranially based flaps, and 225% in free grafts. Moreover, in both flap models, TP508 restored the rate of closure to a rate approximating the control rate observed in normal skin. Histological comparisons of wound tissue from normal skin and cranially based flaps showed that ischemia reduced early recruitment of inflammatory cells at day 1 but increased inflammatory cell numbers in wound beds at day 14. TP508 treatment of ischemic flap wounds significantly increased early inflammatory cell recruitment and restored the normal rapid resolution of the inflammatory phase. In addition, at day 7, TP508-treated wounds appeared to have an increased number of large functional blood vessels compared to saline controls. These studies support the potential efficacy of TP508 in treating ischemic wounds in humans.     

The clinical application effects of artificial dermis scaffold and autologous split-thickness skin composite grafts combined with vacuum-assisted closure in refractory wounds

To investigate the clinical application effects of artificial dermis scaffold and autologous split-thickness skin composite grafts combined with vacuum-assisted closure (V.A.C) in refractory wounds. A retrospective analysis was performed on 70 patients with refractory wounds admitted to the First Affiliated Hospital of Soochow University from June 2019 to December 2021 (44 males and 25 females, with an average age of 49.3 ± 21.4 years). There were 26 patients with chronic ulcers; 3 patients with cancerous wounds; 16 patients with hot crush injuries; and 25 patients with traumatic wounds, including 21 cases of hands, 33 cases of feet, 6 cases of upper limbs, and 10 cases of lower limbs. The patients were divided into an artificial dermis scaffold group (35 patients, including 21 males and 14 females, aged 49.5 ± 21.3 years) and a skin graft group (35 patients, including 23 males and 11 females, aged 49.1 ± 21.5 years). In the artificial dermis scaffold group, after debridement, the artificial dermis scaffold was transplanted for approximately 2 weeks until the wound surface was well vascularized, after which the autologous split-thick skin graft was transplanted. Negative pressure wound therapy was performed throughout the treatment. In the skin grafting group, after debridement, the autologous split-thickness skin graft (aSTSG) was transplanted, and negative pressure wound therapy was performed continuously. The wound healing rate; skin graft survival rate; postoperative wound infection; exudative fluid volume; subcutaneous haematoma; hospitalisation time; hospitalisation cost; Vancouver Scar Scale (VSS) score, used to evaluate the scar of the recipient area at 6 months after the operation; and the sensory disorder grading method, used to evaluate the sensory recovery of the recipient area, were compared between the two groups. All 70 refractory wounds healed. In the artificial dermis scaffold group, the skin graft survival rate was 90% (86%–95%), the hospitalisation time was 38 (29–45) days, the hospitalisation cost was 148 102 (118242–192327) yuan, and the VSS score was 1.9 ± 1.3. There were significant differences in skin graft survival rate (70% [60%–80%]), length of hospital stay (21 [14–28] days), hospitalisation cost (76 201 [39228–135 919] yuan) and VSS score [6.1 ± 3.6] between the skin graft group and the artificial dermis scaffold group (P < .05). The skin graft survival rate, scar hyperplasia and sensory recovery of the recipient area in the artificial dermis scaffold group were better than those in the skin graft group, but the hospitalisation time was relatively longer, and the hospitalisation cost was relatively higher. Wound healing rate, postoperative wound infection, exudate volume, and subcutaneous haematoma of patients in the two groups were similar, and there were no significant differences (P > .05). The artificial dermis scaffold and composite transplantation of autologous aSTSG with V.A.C can promote painless wound healing and improve the skin survival rate, skin colour and lustre, and flexible smooth texture and is conducive to less scar hyperplasia and postoperative functional exercise and recovery. This method provides a reasonable and effective scheme for the treatment of clinical refractory wounds.     

重组人表皮生长因子促进兔创面愈合及其量效关系的实验研究

目的：观察重组人表皮生长因子（rh-EGF）对兔皮肤创面愈合的促进作用及其量效关系。方法：制作兔子背部创伤模型,20只兔子背部制作共100个创面,这些创面分为实验组和对照组,实验组包括：低剂量rh-EGF（0.5μg/g）组、中剂量rh-EGF（10μg/g）组、高剂量rh-EGF（100μg/g）组,对照组包括：生理盐水组和EGF基质组,观察五组的大体形态和组织学改变、创面愈合时间和愈合率,测定创面羟脯氨酸（OHP）含量。结果：rh-EGF低剂量组、中剂量组、高剂量组、盐水组和EGF基质组的愈合时间分别为（14.7±0.67）天,（12.9±0.92）天,（11.8±0.99）天,（15.8±0.90）天,（15.5±0.85）天,P〈0.05）。组织学检查可见经rh-EGF高剂量组作用的创面肉芽组织生长活跃,创面的再上皮化迅速。rh-EGF高剂量组的创面中羟脯氨酸含量也最高。结论：rh-EGF对皮肤创面愈合有促进作用,并存在一定的量效关系。以高剂量的rh-EGF（100μg/g）促进作用最大。