自体脂肪颗粒及微粒皮混合移植修复烧伤患者深度创面

目的 了解自体脂肪颗粒及微粒皮混合移植修复大面积烧伤深度创面的效果. 方法选择20例重度烧伤患者,采用自身同体对照法,将患者双侧肢体或躯干对称部位创面分为脂肪颗粒+微粒皮组和微粒皮组,分别行自体脂肪颗粒+微粒皮(体积比1:1)混合移植和自体微粒皮移植.术后30、45、60 d计算2组创面愈合率;术后7、14、21、28 d取创面组织,行HE染色和增殖细胞核抗原(PCNA)免疫组织化学观察. 结果移植术后30、45、60 d,脂肪颗粒+微粒皮组创面愈合率分别为(56.3±3.1)%、(76.4±6.1)%、(96.2±1.5)%,均明显高于微粒皮组的(28.3±2.0)%、(47.3±4.8)%、(85.4±2.2)%(P<0.01).HE染色显示脂肪颗粒+微粒皮组创面上皮化早于微粒皮组,胶原纤维排列较整齐.脂肪颗粒+微粒皮组PCNA阳性细胞较微粒皮组多,主要分布于表皮基底层. 结论自体脂肪颗粒+微粒皮混合移植可促进创面愈合.     

自异体微粒皮昆合移植的优化比例研究

目的观察不同比例自异体微粒皮混合移植后创面愈合的效果. 方法以雄性Wistar大鼠为供体,在雌性SD大鼠背部建立全层皮肤缺损创面模型.将SD大鼠随机分为4组,每组10只(1)异体皮组,移植面积扩张比为103的异体微粒皮.(2)自体皮组,移植面积扩张比为101的自体微粒皮.(3)混合1组,自异体微粒皮移植面积扩张比各为101.(4)混合2组,自异体微粒皮移植面积扩张比分别为101和103.于移植术后2、3、4周对各组大鼠创面进行外观和组织学观察,数码相机照相后运用图像分析软件测定创面愈合率和创面收缩率,并进行各组间的比较.结果(1)异体皮组大鼠创面随着排斥反应发生,除创缘有新生表皮向内爬行外均为肉芽创面;自体皮组因微粒皮数量偏少,术后2周仍有部分为肉芽创面;两个混合移植组术后2周创面基本上皮化.(2)移植后各组创面真皮内有不同程度的血管扩张和单个核细胞浸润,在异体皮组和混合2组中更加明显,自体皮组及混合1、2组大鼠创面的表皮层明显增厚.(3)异体皮组移植后2～4周,随着排斥反应的发生,其创面愈合率明显下降.移植后3周,自体皮组创面愈合率为(55±26)%,明显低于混合1、2组的(88±6)%和(76±10)%(P《0.05或0.01).(4)移植后3周,混合2组创面收缩率为(69±7)%,高于异体皮组[(58±11)%],其余各组之间比较差异无统计学意义(P》0.05).结论适当比例的自异体微粒皮混合移植,可以促进创面愈合;当两者移植面积扩张比均为101时,具有较好的促创面愈合效果.     

整合素β1在微粒皮混合移植中的异位表达及定量分析

目的 了解自、异体微粒皮混合移植促进创面愈合的机制. 方法 建立自、异体微粒皮混合移植大鼠模型.第1部分实验分为3组,每组9只大鼠:(1)自体皮组,移植面积扩张比为10:1的自体微粒皮;(2)混合1组,移植自、异体微粒皮,面积扩张比均为10:1;(3)混合2组,移植自、异体微粒皮,面积扩张比分别为10:1和10:3.第2部分实验亦分为3组,每组6只大鼠:(1)自体皮组,移植面积扩张比为20:1的自体微粒皮;(2)混合1组,移植自、异体微粒皮,面积扩张比分别为20:1、20:3;(3)混合2组,移植自、异体微粒皮,面积扩张比分别为20:1和20:6.术后从各组大鼠愈合创面取样,第1部分实验于术后2、3、4周取样,第2部分实验于术后3、4周取样,每组大鼠各时相点检测3个样本.行常规组织学与免疫组织化学染色,测定整合素β1的表达.显微镜下测量表皮层厚度. 结果 (1)HE染色显示,术后各组大鼠创面的表皮层厚度明显增加,真皮内有不同程度的血管扩张和单个核细胞浸润.(2)术后2～4周,第1部分实验中2个混合组大鼠皮肤表皮层均明显厚于自体皮组(P＜0.05或P＜0.01);术后3、4周,第2部分实验中2个混合组大鼠皮肤表皮层厚度均明显厚于自体皮组(P＜0.05或P＜0.01).(3)免疫组织化学染色显示,术后各组新生表皮中均可见整合素β1阳性细胞,以棘层和颗粒层为主.术后2周,第1部分实验中混合组整合素β1的阳性表达明显强于自体皮组(P＜0.01),且混合1组的表达(10 982±2169)明显强于混合2组(4240±512,P＜0.01);术后3～4周,混合1组的表达仍明显强于自体皮组和混合2组(P＜0.01).第2部分实验仅在术后3周时混合2组整合素β1的阳性表达(1618±171)明显高于自体皮组(1060±146,P＜0.05). 结论 自、异体微粒皮混合移植中,整合素β1的异位表达和表达增强与表皮细胞的增殖分化、创面冉上皮化以及表皮层增厚有密切关系,在促进创面愈合过程中,整合素β1阳性表达细胞很有可能发挥了重要作用.     

不同比例自体微粒皮与异体脱细胞微粒真皮复合移植的研究

目的 观察阶梯比例自体微粒皮与异体脱细胞微粒真皮混合移植后创面的修复效果。方法 选雄性Wistar大鼠为移植供体,以60只雌性SD大鼠作为受体,制作全层皮肤创面,并按混合的比例不同分为混合皮A、B、C组、自体皮组(D组)、异体皮组(E组),移植扩张比为5:1。比较各组创而愈合率,微血管计数及基质金属蛋白酶(MMP)-1和MMP-2蛋白表达。结果 (1)移植后2、3周,混合皮组创面愈合效果明显高于D组和E组,混合皮组间B、C组创面愈合率(28.94±2.97)％、(30.62±1.94)％;(81.14±9.30)％、(88.00±5.71)％显著高于A组(28.36±2.11)％;(79.81±7.07)％ (P ＜0.05),而且A组有明显脱屑现象。(2)移植后2、3周,混合皮各组微血管数目明显高于D组、E组(P＜0.05);移植后2周混合皮组间A组微血管数目(30.00±1.83)明显少于B、C组( 34.30±1.70)、(35.10±1.79)。(3)MMP-1在创面形成后表达上调,而后下降,但混合皮组MMP-1的表达高于D组,尤以A、B组明显;MMP-2在移植后第3周达高峰,混合皮组表达高于D组(P＜0.05)。结论 自体微粒皮与异体脱细胞微粒真皮移植扩张比为4:1时,达到促进创面愈合的最佳比例,有利于微血管长入及MMP-1、2的适度表达。     

自体微粒皮与异体脱细胞微粒真皮混合移植对大鼠创面纤维连接蛋白和层粘连蛋白表达的影响

目的 探讨自体微粒皮与异体脱细胞微粒真皮混合移植对创面愈合的影响,并对有关机制做进一步研究.方法 Wistar大鼠作为供体,SD大鼠为受体,在SD大鼠背部建立全层皮肤损伤模型.90只SD大鼠分为5组,每组18只,第1组为自体微粒皮组;第2组为异体脱细胞微粒真皮移植组;第3、4、5组为混合移植组.混合移植组中自异体微粒皮的面积比例分别为:1∶1、1∶0.5、1∶0.25.术后第2、3、4周分别测量每组创面的愈合率,采集创面标本,做HE染色,检测纤维连接蛋白(FN)和层粘连蛋白(LN)、进行组间比较.结果 混合移植组与自体微粒皮移植组比较,混合移植组创面愈合率及FN、LN均高于自体微粒皮组,其中1∶0.25混合移植组最高,差异有统计学意义(P＜0.05或P＜0.01).结论 混合移植创面愈合率高于自体微粒皮移植,且自体微粒皮与异体脱细胞微粒真皮混合移植的面积比例按1∶0.25效果最佳,这可能与创面纤维连接蛋白和层粘连蛋白升高有关.     

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。     

大面积深度烧伤创面修复的新途径

大面积深度烧伤的创面修复贯穿烧伤治疗的全过程 ,是烧伤治疗的关键。只有及时、有效地覆盖创面 ,才能达到治疗的目的。由于大面积深度烧伤患者 (烧伤总面积 >90 %或Ⅲ度面积 >70 %TBSA)自体皮源缺乏 ,如何解决这一难题 ,多年来一直被人们所关注。196 6年上海第二医科大学瑞金医院烧伤科创建早期分批切痂自体皮与异体 (种 )皮混合移植法 ,将大张异体皮等距离开洞 ,嵌植断层自体小片皮 ,自体皮片的面积不小于 0 .3cm× 0 .3cm ,皮片间距不超过 1cm ,当自体皮片和异体皮片边缘吻合后 ,异体皮片出现脱屑现象 ,创面最终将随着自体皮片扩展而被…     

不同厚度异体皮制备的微粒皮混合自体微粒皮移植对创面愈合的影响

目的　观察不同厚度异体皮制备的微粒皮混合自体微粒皮移植于大鼠背部全层皮肤缺损后对创面愈合的影响。　方法　制作大鼠全层皮肤缺损创面模型。以移植面积扩张比为 5∶1的自体微粒皮为对照组 ( 10只 ) ,两种不同厚度异体皮制备的微粒皮与同样扩张比的自体微粒皮混合移植为实验组 ,其中实验 1组异体微粒皮厚度为 0 .3mm(10只 ) ,实验 2组 0 .6mm(6只 )。比较移植后 2、3、4周 3组大鼠创面愈合率、收缩率及组织学差异。　结果　创面愈合率 :移植后 2周实验 1组大鼠( 94 .5 8± 3.99) %和实验 2组 ( 95 .2 8± 1.93) %均高于对照组 ( 88.2 8± 6 .85 ) % (P <0.0 5 ),移植后 3周实验 2组 ( 94 .5 5± 3.4 7) %高于实验 1组 ( 89.5 1± 4 70 ) %及对照组 ( 88.5 1± 5 .5 9) % (P <0.0 5),移植后 4周 3组比较 ,差异无显著性意义 (P >0 0 5 )。创面收缩率 :实验 1组大鼠与对照组比较 ,差异无显著性意义 (P >0.0 5),实验 2组各时相点均低于实验 1组及对照组 (P <0.0 5)。组织学检查 :移植后 2周实验组大鼠有明显的淋巴细胞灶性浸润 ,移植后 4周 3组之间比较 ,差异无显著性意义 ( P>0.0 5 )。结论　适量的异体微粒皮混合自体微粒皮移植 ,可以促进创面愈合 ;混合移植等量异体微粒皮时增加其真皮厚度 ,能够减     

5%自体微粒皮混合不同比例异体微粒皮移植促进创面愈合效果的研究

目的596自体微粒皮混合不同量异体微粒皮移植于大鼠背部全层皮肤缺损创面，观察创面愈合和收缩情况，优化异体微粒皮加入量以达到较好的促创面愈合效果。方法实验以雌性SD大鼠为受体，在其背部建立全层皮肤缺损创面模型。供体为雄性Wistar大鼠。实验分3组，每组10只，其中对照组仅植入移植面积扩张比为20：1的自体微粒皮；实验1组和实验2组自体微粒皮的移植面积扩张比均为20：1，加入的异体微粒皮的移植面积扩张比分别为20：3和20：6。术后3、4周分别测定创面愈合率和收缩率，比较各组之间的区别。结果术后3、4周实验1、2组大鼠创面愈合率均明显高于对照组（P〈0．01）；实验组之间的差异也均有统计学意义（P〈0．05），其中实验2组创面愈合情况要优于实验1组。就创面收缩而言，各组之间差异无统计学意义（P〉0．05）。结论适量的异体微粒皮混合自体微粒皮移植可促进创面愈合；在移植面积扩张比为20：1的自体微粒皮中。混合移植面积扩张比为20：6的异体微粒皮较混合20：3的异体微粒皮具有更佳的促创面愈合效果。     

混合移植治疗大面积Ⅲ度烧伤的发展要素

探讨混合移植治疗大面积Ⅲ度烧伤技术的发展要素。方法:1966年1995年底收住并经混合移植治疗的大面积Ⅲ度烧伤(Ⅲ度50％～99％,下称ETDB)184例,以1977年底前后分界分为两组。两组的烧伤面积(TBSA)、Ⅲ度、年龄的均值都具有可比性,比较两组的治愈率、首切痂日期、首切痂面积、总切痂面积、切痂次数、自体供皮总面积、头皮重复供皮次数、大张皮种类及创面闭合的伤后天数。结果:稳定渡过休克期后的早期切痂、扩大首切痂面积、扩大总切痂面积、多途径的扩大自体供皮总面积、灵活应用大张异体皮或异种猪皮覆盖切痂创面、缩短创面闭合天数等是该技术的发展要素,并与提高生存率有关。结论:坚持实施和发展混合移植在救治ETDB中仍具重要意义。结合应用异体(种)皮开孔嵌皮法及微粒植皮法等混合植皮封闭切痂创面,发挥各种方法的优势有望继续提高治愈率。     

异体颗粒状脱细胞真皮基质与自体刃厚皮复合移植修复大鼠皮肤缺损创面效果观察

目的 观察异体颗粒状脱细胞真皮基质(PADM)与自体刃厚皮复合移植修复大鼠皮肤缺损创面的效果.方法 采用随机数字表法将12只SD大鼠分为实验组和对照组,每组6只.于2组大鼠背部制作全层皮肤缺损创面,实验组创面复合移植SD大鼠异体PADM(扩张比10:5)及厚度0.20 mm的自体刃厚皮,对照组创面仅移植厚度0.20 mm自体刃厚皮.术后2周起打开敷料观察大鼠创面愈合情况.术后2、3、4、6、8、12、20周计算2组创面移植皮片成活率、收缩率(或扩张率).术后20周取2组创周正常皮肤及创面皮肤标本,采用HE染色法观察胶原纤维束结构,测量胶原纤维束直径和间隙率;用天狼星红染色法观察Ⅰ、Ⅲ型胶原分布情况,测量Ⅰ、Ⅲ型胶原含量及其比值.对实验数据行独立样本t检验、Levene检验、t'检验.结果 (1)术后2周,实验组大鼠创面移植皮片成活率[(76.1±13.1)%]低于对照组[(94.5±1.3)%,t'=3.440,P=0.018].术后3周,实验组创面移植皮片收缩率[(34±8)%]明显大于对照组[(16±12)%,t=-3.211,P=0.009];术后8周,2组移植皮片扩张率接近一致.(2)HE染色和天狼星红染色显示,与大鼠创周正常皮肤比较,对照组移植皮片胶原纤维束呈均质化改变,胶原纤维纤细,排列紊乱;实验组移植皮片胶原纤维束结构、排列更接近创周正常皮肤,可见未完全降解的PADM.与对照组创面皮肤胶原纤维束直径[(7.3±1.4)μm]、间隙率[(17±4)%]、Ⅰ型胶原含量[(68.1±8.4)%]、Ⅲ型胶原含量[(32.0±8.4)%]以及Ⅰ、Ⅲ型胶原比例(2.3±1.0)比较,实验组胶原纤维束更粗[(9.6±0.8)μm,t=-3.562,P=0.005],间隙率更大[(24±5)%,t=-2.760,P=0.020],Ⅰ型胶原含量更高[(80.2±5.4)%,t=-2.981,P=0.014],Ⅲ型胶原含量更低[(19.8±5.4)%,t=2.981,P=0.014],Ⅰ、Ⅲ型胶原比例更高(4.3±1.2,t=-3.204,P=0.009).实验组创面皮肤上述胶原相关指标更接近于创周正常皮肤水平.结论 异体PADM在体内作为真皮再生模板,有助于改善自体刃厚皮所修复的大鼠皮肤缺损创面中真皮胶原纤维束的结构,提高再生真皮组织的成熟度.

Abstract：

Objective To evaluate the effects of mixed grafting of allogeneic PADM and autologous STS on wound healing of full-thickness defect in rats. Methods Full-thickness defects with size of 6 cm×4 cm were produced on the back of 12 SD rats, and they were divided into E group(n =6) and C group ( n = 6) according to the random number table. The wounds in E group were grafted with a mix of allogeneic PADM (expansion rate 10: 5) and autologous STS with thickness of 0.2 mm, while those in C group were grafted with autologous STS in the same thickness. The wound healing rate, survival rate, contraction rate,and expansion rate of transplanted skin were observed at post operation week (POW) 2, 3, 4, 6, 8, 12,20. Tissue samples form wounds and surrounding normal skin were harvested at POW 20 for histopathological observation as follows. The structure of collagen fiber bundle was observed by HE staining, the diameter and gap rate of collagen fiber bundle were also measured. The distribution of type Ⅰ and Ⅲ collagen was observed by sirsus red staining, and the contents of type Ⅰ , Ⅲ collagen and their ratio were also examined.Data were processed with independent samples t test, Levene test, and t' test. Results Survial rate of transplanted skin in E group at POW 2 [(76. 1 ± 13. 1)%] was obviously lower than that in C group [(94.5 ± 1.3)%, t' =3.440, P =0.018]. Contraction rate of transplanted skin in E, C groups at POW 3 showed significant difference [(34±8)%vs. (16 ±12)%, t = -3.211, P =0.009]. Compared with those in peri-wound normal skin, collagen fiber bundles in C group showed signs of homogenization, and collagen fibers were thin with irregular arrangement. Collagen fiber structure and arrangement of composite skin in E group were similar to those surrounding normal skin with incomplete degradation of PADM. Diameter of collagen fiber bundle [( 9.6 ± 0.8) μm] , gap rate between collagen bundle [( 24±5) %] , content of type Ⅰ collagen [( 80.2 ± 5.4) %] and the ratio of typeⅠto type Ⅲ collagen(4.3 ± 1.2) in E group were all increased as compared with those inC group [(7.3±1.4) μm (t = -3.562, P =0.005), (17±4)%( t =-2.760, P =0.020), (68.1 ±8.4)%(t = -2.981, P =0.014), 2.3±1.0(t = -3.204, P =0. 009)], while content of type Ⅲ collagen [( 19.8 ± 5.4) %] in E group was lower than that in C group [(32.0 ±8.4)% , t = 2. 981, P = 0. 014]. Above-mentioned indexes of collagen in wound of E group were similar to those of normal skin surrounding the wound. Conclusions Allogeneic PADM used as dermal regeneration template is beneficial in improving collagen fiber bundle structure in dermis layer of rats with fullthickness skin wounds when repaired with autologous STS, and it accelerates maturation of regenerative dermal tissue.     

两种植皮方式治疗大面积深度烧伤患者的经济学评价

Objective To evaluate the economic significance of Meek skin grafting and automicro-grafting combined with large piece of allogenous skin (micrografting in brief) in the treatment of patients with extensive deep burn. Methods Twenty-four patients with extensive deep burn admitted to the First Affili-ated Hospital of Wenzhou Medical College were divided into Meek skin grafting group and micrografting group, with 12 patients in each group. Statistical comparison between Meek skin grafting group and micro-grafting group in respect of wound healing time, consumption of each special dressing , total cost of hospitali-zation, rehabilitation cost during convalescence was made. Then the cost and effect value was compared be-tween two groups. Results The wound healing time, consumption of each special dressing, total cost of hospitalization and rehabilitation cost in Meek skin grafting group was (14.4±1.9) d, ￥(16 590±521) , ￥(421 628 ± 145) , ￥(39 571±225) , respectively, and that in micrografting group was (25.6±4.2)d, ￥(136 441±356), ￥(539 526±686), ￥(55 853±794) , respectively. The difference between two groups were statistically significant (P<0.01 ). Conclusions In a definite range of burn size, Meek skin grafting has a lower therapeutic cost and better therapeutic effects as compared with micrografiing.     

The use of cultured epithelial autograft in the treatment of major burn wounds: eleven years of clinical experience

INTRODUCTION: In patients with burns involving over 50% total body surface area (TBSA), donor skin is limited. Tissue engineering, particularly cultured epithelial autograft (CEA), offers a potential solution to assist in expedient wound closure. MATERIALS AND METHODS: Prior to 1994, the application of CEA was restricted to confluent cell sheets. The introduction of an autologous cell suspension (CellSpray) in 1994 enabled cells to be delivered to the wound via aerosol onto debrided burn and donor skin graft wound areas. This retrospective clinical audit of major burn injured patients (n=84) describes the use of CEA in those with over 50%TBSA in Western Australia (WA) between 1992 and 2002. RESULTS: The initial introduction of CEA was as confluent sheets, as this evolved to the use of CEA in suspension there was a reduction in the required surgical intervention and total length of stay (TLOS) divided by %TBSA. DISCUSSION: With the audit covering an 11-year period, many facets of clinical burn care have evolved. The WA experience has demonstrated CEA has been positively integrated into clinical practice in association with traditional wound care techniques of skin grafting to augment wound healing.     

烧伤后期特大未愈创面伴脓毒症患者的救治

This article analyzed the medical records of a patient with 90％ TBSA unhealed wound accompanied with wound sepsis 50 days post burn (PBD) and to discuss the ideal strategies of treatment for such patients in such condition.This was a 24-year-old male patient suffering from flame burn with 95％ TBSA wound and severe inhalation injury.Meek skin grafting with autologous scalp was performed once to the thoracic and abdominal regions; intermingled skin grafting of autologous scalp microskin and large sheet of allograft was performed twice to the limbs within PBD 31.The patient was transferred to our hospital on PBD 50 with 90％ TBSA wound unhealed,leaving a vast amount of necrotic tissue and allografts.Furthermore,he was complicated by sepsis,pulmonary infection,and gastric ulcer.Debridement and allogenic skin grafting were performed on the first day after hospitalization.When the condition of wounds was improved,transplantation of a large sheet of allogenic skin with inlaid small pieces of autologous skin,intermingled skin grafting of autologous and allogenic skin,and small pieces of autologous skin grafting were performed.Because of the shortage of donor area,the exposed wounds were temporarily covered with allogeneic skin.Epidermal growth factor was used to promote the healing of autologous skin donor site and deep partial-thickness bum wound.Autologous skin grafting was performed whenever source of healthy skin was available.Systemic use of effective antibiotics,nutritional support and therapy,and other comprehensive measures also contributed to the success of treatment of this patient suffering from wound sepsis.The patient was cured and discharged on PBD 145.     

负压封闭引流技术在治疗小腿骨筋膜室综合征中的应用

目的探讨传统敷料覆盖技术和负压封闭引流技术（VSD）在治疗小腿骨筋膜室综合征筋膜切开减压中的疗效。方法 46例小腿骨筋膜室综合征患者,经筋膜切开减压后采用传统敷料覆盖技术治疗19例（A组）、VSD技术治疗27例（B组）。将两组的治疗时间、感染率、植皮率进行比较。结果治疗时间：A组为6~19（10.73±3.61）d,B组为5~12（6.7±1.38）d。术后感染：A组6例,感染率31.57%;B组2例,感染率7.4%。植皮：A组11例,植皮率57.89%;B组7例,植皮率25.92%。两组的治疗时间、感染率、植皮率比较差异均有统计学意义（P〈0.05）。结论在小腿骨筋膜室综合征筋膜切开减压的治疗中,VSD技术比传统敷料覆盖技术更有效。     

Treatment of burns and chronic wounds using a new cell transfer dressing for delivery of autologous keratinocytes

This study describes a new methodology for delivering cultured autologous keratinocytes to wounds on a sterile medical grade polymer coated with a chemically defined plasma polymerised functional surface containing 20% carboxylic acid (referred to as PPS). Seven patients (two acute major burns and five chronic non-healing wounds) were treated with applications of autologous keratinocytes delivered on a 6 cm diameter medical grade polymer disc whose surface was functionalised by PPS. For initial keratinocyte expansion a split-thickness skin biopsy was taken from each patient followed by keratinocyte isolation and expansion and, where required for repeated applications, freezing down of keratinocytes. After expansion, cells were cultured on the PPS for 2 days then the PPS with cells was inverted onto the patients wound bed to allow cell transfer to wound beds. For two burns patients transfer of cells from PPS onto donor sites was seen for both patients and it appeared to facilitate healing of grafted burns wounds. For five patients with intractable chronic wounds (with nine ulcers in total) repeated applications of cells resulted in complete healing in 5/9 ulcers with a major reduction in ulcer size for all other (4/9) ulcers. This reduction in ulcer size improved the wound conditions for two of these patients such that they were then considered suitable for conventional grafting and orthopaedic surgery respectively. In conclusion, PPS delivery of autologous cells is a promising approach for acute burns injuries and chronic wounds.This paper is dedicated to the memory of Mr Archibald Newman (Patient 3) who sadly died in January 2005.