异种(猪)脱细胞真皮基质与头皮薄皮片复合移植

目的探索异种(猪)脱细胞真皮基质与头皮薄皮片复合移植在整形修复方面应用的可行性.方法将制备好的异种(猪)脱细胞真皮基质移植于烧伤切痂、肉芽及瘢痕切除的创面上,4～5 d后再移植自体头皮薄皮片,并观察其成活率,以及创面修复后的质量.结果 15例25个创面,脱细胞真皮基质的成活率(96.40±2.60)%,头皮薄皮片的成活率(97.44±3.50)%,创面愈合后皮肤的颜色与正常皮肤近似,外观平整,弹性良好,无明显的瘢痕增生,相当或接近于自体大张中厚皮片移植的修复效果.结论异种(猪)脱细胞真皮基质与自体头皮薄皮片复合移植,成活率高,整复效果较为满意,头皮供区可反复供皮而不留瘢痕及影响头发生长,是修复深度烧伤及瘢痕切除后创面的可行手术方法.     

早期负压封闭引流治疗深Ⅱ度烧伤创面的临床疗效评价

目的 前瞻性评价早期VSD治疗深Ⅱ度烧伤创面的临床疗效,为其临床应用提供依据.方法 选择笔者单位2009年5月-2010年3月收治的双下肢烧伤后3 h内入院、总面积小于10%且各下肢深Ⅱ度面积大于1%TBSA的患者22例.依照部位对称、深度相同、面积相近等同体对照原则,将每例患者创面分为VSD治疗组(应用VSD治疗)与对照组(应用10 g/L磺胺嘧啶银霜换药).观察2组患者创面的水分蒸发量、肿胀程度、细菌定植情况、疼痛程度、愈合时间及愈合质量并进行比较分析.数据行t检验与秩和检验.结果 21例患者完成试验,均在伤后4 h内完成创面处理.VSD治疗组正常皮肤及覆盖敷料前创面的水分蒸发量与对照组相近(t值分别为1.310、-0.911,P值均大于0.05);创面覆盖敷料2 h后,敷料表面的水分蒸发量[(44.3±3.9)mL·h-1·m-2]明显少于对照组[(66.1±6.4)mL·h-1·m-2,t=-11.39,P<0.01].伤后3、7 d,VSD治疗组大腿周径较伤后5 h分别增加了(3.48±0.35)、(2.51±0.21)cm,明显小于对照组的(8.02±0.41)、(3.99±0.32)cm(t值分别为4.110、3.569,P值均小于0.01).2组创面入院时及伤后10 d细菌培养阳性率组间比较,差异均无统计学意义(Z值分别为-0.894、0.000,P值均大于0.05);2组伤后10 d细菌培养阳性率均较各组入院时显著降低(Z值分别为-3.220、-3.870,P值均小于0.01).VSD治疗组创面伤后10 d的pH值(7.12±0.06)呈现弱酸性,对照组(7.41±0.13)则为中性.VSD治疗组伤后1、3、7 d创面疼痛程度轻于对照组(t值分别为-16.132、-21.230、-16.453,P值均小于0.01).2组创面愈合时间比较,差异无统计学意义(t=1.186,P>0.05).伤后2、3个月VSD治疗组创面愈合质量评价为佳(100.00%、100.00%),明显优于对照组(19.05%、85.71%,Z值分别为-11.638、-3.870,P值均小于0.01).结论 早期VSD治疗不能使深Ⅱ度烧伤创面愈合时间提前,但能显著提高其愈合质量,是处理深Ⅱ度烧伤创面的有效方法之一,值得临床关注与进一步研究.     

异种脱细胞真皮基质在深Ⅱ度烧伤创面的临床应用

创面处理是深Ⅱ度烧伤治疗的首要问题,自体皮片移植是临床常见的修复手段,然而自体皮源的缺乏却是治疗中难以规避的难题。随着组织工程技术的发展,异种脱细胞真皮基质作为理想的皮肤替代物,具有快速血管化,低免疫原性及较好的稳定性等优点。因此,在深Ⅱ度烧伤创面的修复中具有重要意义。本文就异种脱细胞真皮基质发展历史、生物学特性及研究现状进行综述,以期对临床治疗及研究有所帮助。     

早期负压封闭引流治疗深Ⅱ度烧伤创面的临床疗效评价

Objective To evaluate the clinical curative effect of applying vaccum sealing drainage (VSD) therapy in treating deep partial-thickness burn wound at the initial stage prospectively, and to provide the basis for its clinical application. Methods Twenty-two patients with about 10% TBSA burn of the lower limbs, and in which partial-thickness wound exceeded 1% TBSA in each limb, were admitted to our hospital within 3 hours after burn from May 2009 to March 2010. Wounds in each patient were divided into VSD treatment group (treated with VSD therapy) and control group (treated with 10 g/L silver sulfadia-zine cream) based on the principles of symmetry of location, identical deepness, and similarity in size etc. The amount of water evaporation, the swelling intensity, the status of bacterial colonization, the degree of pain, the healing time, and the quality of healing of wounds in 2 groups were observed and compared. Data were processed with t test and rank-sum test. Results The observation was completed in 21 patients. All of the wounds were treated within 4 hours post burn (PBH). The amount of water evaporation of the normal skin and burn wounds before dressing coverage in VSD treatment group was respectively close to that in control group (with t value respectively 1.310, - 0. 911, P values all above 0.05) ; the amount of water evaporation on the surface of dressing in VSD treatment group [(44. 3 ±3.9) mL·h-1·m-2] was less than that in control group [(66.1 ±6.4) mL · h-1· m-2, t = -11.39, P <0.01]. In VSD treatment group, the circumference of proximal thigh increased (3.48 ±0.35) and (2.51 ±0.21) cm on post burn day (PBD) 3 , 7 as compared with that on PBH 5 , which was respectively smaller than that [(8.02 ± 0.41) , (3. 99 ± 0. 32) cm] in control group (with t value respectively 4. 110, 3. 569, P values all below 0. 01). Positive bacteria' culture rate on PBD 10 of each group was respectively lower than that at admission (with Z value respectively -3.220, -3.870, P values all below 0. 01) , and there was no significant statistical difference between 2 groups at admission or on PBD 10 (with Z value respectively - 0. 894, 0.000, P values all above 0.05). The wound surface in VSD treatment group was weak acidic (pH value 7. 12 ±0.06) on PBD 10,and it was neutral (pH value 7.41 ±0. 13) in control group. The wound pain degree in control group on PBD 1,3,7 was respectively higher than that in VSD treatment group (with t value respectively - 16. 132, -21.230, -16.453, P values all below 0.01). There was no significant statistical difference between 2 groups in healing time of wounds (t =1. 186, P >0.05). The healing quality of wounds in VSD treatment group (100. 00% , 100. 00%) 2 or 3 months after burn was better than that in control group (19. 05% , 85. 71%) (with Z value respectively -11.638, -3. 870, P values all below 0.01). Conclusions Early application of VSD therapy cannot expedite the healing process of deep partial-thickness burn wounds, but it can improve the healing quality. It is one of the effective methods to deal with deep partial-thickness burn wounds, which is worthy of clinical attention and further research.     

早期负压封闭引流治疗深Ⅱ度烧伤创面的临床疗效评价

Objective To evaluate the clinical curative effect of applying vaccum sealing drainage (VSD) therapy in treating deep partial-thickness burn wound at the initial stage prospectively, and to provide the basis for its clinical application. Methods Twenty-two patients with about 10% TBSA burn of the lower limbs, and in which partial-thickness wound exceeded 1% TBSA in each limb, were admitted to our hospital within 3 hours after burn from May 2009 to March 2010. Wounds in each patient were divided into VSD treatment group (treated with VSD therapy) and control group (treated with 10 g/L silver sulfadia-zine cream) based on the principles of symmetry of location, identical deepness, and similarity in size etc. The amount of water evaporation, the swelling intensity, the status of bacterial colonization, the degree of pain, the healing time, and the quality of healing of wounds in 2 groups were observed and compared. Data were processed with t test and rank-sum test. Results The observation was completed in 21 patients. All of the wounds were treated within 4 hours post burn (PBH). The amount of water evaporation of the normal skin and burn wounds before dressing coverage in VSD treatment group was respectively close to that in control group (with t value respectively 1.310, - 0. 911, P values all above 0.05) ; the amount of water evaporation on the surface of dressing in VSD treatment group [(44. 3 ±3.9) mL·h-1·m-2] was less than that in control group [(66.1 ±6.4) mL · h-1· m-2, t = -11.39, P <0.01]. In VSD treatment group, the circumference of proximal thigh increased (3.48 ±0.35) and (2.51 ±0.21) cm on post burn day (PBD) 3 , 7 as compared with that on PBH 5 , which was respectively smaller than that [(8.02 ± 0.41) , (3. 99 ± 0. 32) cm] in control group (with t value respectively 4. 110, 3. 569, P values all below 0. 01). Positive bacteria' culture rate on PBD 10 of each group was respectively lower than that at admission (with Z value respectively -3.220, -3.870, P values all below 0. 01) , and there was no significant statistical difference between 2 groups at admission or on PBD 10 (with Z value respectively - 0. 894, 0.000, P values all above 0.05). The wound surface in VSD treatment group was weak acidic (pH value 7. 12 ±0.06) on PBD 10,and it was neutral (pH value 7.41 ±0. 13) in control group. The wound pain degree in control group on PBD 1,3,7 was respectively higher than that in VSD treatment group (with t value respectively - 16. 132, -21.230, -16.453, P values all below 0.01). There was no significant statistical difference between 2 groups in healing time of wounds (t =1. 186, P >0.05). The healing quality of wounds in VSD treatment group (100. 00% , 100. 00%) 2 or 3 months after burn was better than that in control group (19. 05% , 85. 71%) (with Z value respectively -11.638, -3. 870, P values all below 0.01). Conclusions Early application of VSD therapy cannot expedite the healing process of deep partial-thickness burn wounds, but it can improve the healing quality. It is one of the effective methods to deal with deep partial-thickness burn wounds, which is worthy of clinical attention and further research.     

异种(猪)脱细胞真皮基质在瘢痕整形中的应用

目的 探讨异种(猪)脱细胞真皮基质在切除瘢痕后做为真皮替代物的临床作用.方法 采用DR脱细胞猪皮和大张自体刃厚皮复合移植(一步法和二步法)覆盖切除瘢痕后的创面.结果 对47例瘢痕患者中的22例进行异种(猪)脱细胞真皮基质移植7 d左右,再植大张自体刃厚皮的二步法复合移植,其中在脂肪层上复合移植成活率(88.3±3.7)%,在深筋膜层上复合移植成活率为(89.7±3.4)%.25例采用异种(猪)脱细胞真皮基质+自体刃厚皮同时复合移植的一步法,在脂肪层上复合移植成活率(92.5±4.1)%,在深筋膜层上复合移植成活率为(93.2±5.2)%.复合移植成活后,创面颜包淡红,表面平坦光滑,柔韧性好.最长随访时间90 d,复合区皮肤近似正常,皮肤结实、光滑、平整,可捏起,仅见移植边缘有少许轻微瘢痕增生,功能好.结论 一步法复合移植比二步法成活率高,且脂肪层上的复合移植皮比深筋膜上的复合移植皮肤弹性较好,也更柔软、丰满,两者在功能上则无区别.异种(猪)脱细胞真皮基质是覆盖瘢痕切除后创面的较理想的真皮替代物.     

异种(体)脱细胞真皮基质治疗手部深度烧伤疗效观察

应用异种脱细胞真皮基质（ADM）覆盖烧伤创面以及将异体ADM植入人体已有数历史。2004年2月-2006年2月，笔单位用异种ADM以及异体ADM＋自体超薄皮片复合移植修复手部深度烧伤创面，取得较好的效果。     

异种脱细胞真皮基质在深Ⅱ度烧伤创面处理中的应用分析

目的分析在深Ⅱ度烧伤创面处理中异种脱细胞真皮基质的应用效果。方法随机选取2017年8月至2019年8月本院深Ⅱ度烧伤患者90例,随机分为异种脱细胞真皮基质敷料覆盖创面组(研究组,n=45)和凡士林纱布覆盖创面组(对照组,n=45)两组,统计分析两组患者的临床疗效、换药次数、愈合时间、瘢痕评分、并发症发生情况。结果在治疗的总有效率方面,研究组为95.6%(43/45),对照组为80.0%(36/45),前者显著高于后者(P0.05)。研究组患者的换药次数显著少于对照组(P0.05),愈合时间显著短于对照组(P0.05)。研究组患者治疗后较治疗前的色泽、厚度、柔软度、血管分布评分及温哥华瘢痕评定量表总分降低幅度均显著高于对照组(P0.05)。在并发症发生率方面,研究组为6.7%(3/45),对照组为22.2%(10/45),前者显著低于后者(P0.05)。结论在深Ⅱ度烧伤创面处理中异种脱细胞真皮基质的应用效果较凡士林纱布好。     

自体网状皮片与异种(猪)脱细胞真皮基质复合移植的临床应用

目的：探讨1：3自体网状皮片与异种（猪）脱细胞真皮基质复合移植的可行性。方法：选择9例烧伤及瘢痕患者，在Ⅲ度烧伤创面行切痂术或瘢痕切除术后的创面上移植异种（猪）脱细胞真皮基质，摊平固定后，在支架上再植1：3网状自体刃厚皮片，表面再覆盖辐照猪皮。结果：9例复合移植皮肤全部成活，临床效果满意。结论：1：3自体网状刃厚片可以与异种（猪）脱细胞真皮基质复合移植，同时将自体皮扩增3倍，成活后的复合网状皮片有相当于中厚皮片或者全厚皮片移植的效果。     

人表皮细胞与无细胞异种真皮复合移植的实验研究

目的 观察人表皮细胞与无细胞异种真皮复合移植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 42只裸鼠作背部全层皮肤缺损创面,分别进行复合皮移植（复合皮组）和单纯表皮细胞膜片移植（对照组）,术后定期观察创面愈合情况并进行创面愈合率及创面收缩率的计算,同时留取创面组织进行组织学检查。结果 与对照组相比较,复合皮组的创面愈合及外观情况良好,两组创面愈合率及收缩率的差异有显性意义（P＜0．05）;组织学检测提示复合皮上皮分化充分,胶原增生有序,表皮－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 人表皮细胞与无细胞异种真皮复合移植能改善创面愈合质量,可作为一种新的皮肤代用品。     

Control of hypertrophic scar from inception by using xenogenic (porcine) acellular dermal matrix (ADM) to cover deep second degree burn

OBJECTIVE: We have spent 7 years to investigate the method of applying porcine acellular dermal matrix (ADM) on deep partial thickness burn wound until the wound heals without dressing change. Known as "Feng's pig skin method" by our hospital, the method appears to encourage rapid re-epithilization with minimum scarring. METHOD: The deep partial thickness burn wound was rinsed cleanly under anesthesia when the patient admitted. ADM was applied on the wound after the detached epidermis was thoroughly removed, wrapped and fixed by sterile gauze and bandages. The dressing was removed within two weeks and the wound completely healed. The outcome of the treatment was analyzed by using the modified Vancouver Burn Scar Assessment Scale. RESULT: All the wounds healed with one dressing within 2 weeks, and the time of wound re-epithelialization shortened to 7-12 days. Scar hyperplasia did not occur, or it was greatly ameliorated compared with traditional treatment after a followed-up period of 3 months to 2 years. The Scar Index was significant lower than that of the traditional exposure method. CONCLUSION: Using ADM to cover deep second degree burn can preserve maximally residual dermal tissue and epithelium, help accelerate the regeneration of epithelial and stem cells, thus shorten the healing time, remodel the skin structure, and consequently has the effect of controlling hypertrophic scar at inception.     

去细胞异体真皮、去细胞猪真皮和自体刃厚皮移植在临床中的应用

目的观察去细胞异体真皮或去细胞猪真皮加自体刃厚皮移植在深度烧伤和整形外科中的应用效果。方法采用去细胞异体真皮或我们研制的去细胞猪真皮加自体刃厚皮移植的方法,修复各种创面119例次,比较不同创面的植皮成活率,观察应用不同部位的皮肤覆盖去细胞异体真皮或去细胞猪真皮与植皮成活的关系,并对部分病例进行了组织学观察和随访。结果削痂、切痂和切瘢创面植皮成活率分别为(93．4％±3．1)％、(92．1±4．6)％和(94．5±3．8)％,三者间差异无显著意义;去细胞异体真皮加自体刃厚皮移植与去细胞猪真皮加自体刃厚皮移植,二者植皮成活率差异无显著意义。躯干、四肢自体刃厚皮覆盖的去细胞异体真皮或去细胞猪真皮,植皮成活率分别为(93．1±4．8)％、(89．0±6．2)％,而应用刃厚头皮或自体微粒皮加异体皮覆盖的去细胞异体真皮或去细胞猪真皮,植皮成活率明显下降(P<0．05或0．01)。组织学观察,术后19个月时表皮、真皮形态正常,胶原纤维排列规则,未见胶原纤维明显增生和瘢痕化,无皮肤附件。成活的复合移植皮肤,与邻近正常肤色近似,色素沉着轻,无明显皱缩,触之软,活动度好。结论去细胞异体真皮或去细胞猪真皮加自体刃厚皮移植修复深度烧伤创面或切瘢后创面不失为一种较理想的材料。     

荷负电气溶胶治疗Ⅱ度烧伤创面的临床效果及病理学观察

目的观察荷负电气溶胶(下称气溶胶)治疗Ⅱ度烧伤创面的效果。方法选择单纯浅Ⅱ、深Ⅱ度烧伤患者,随机分为:(1)气溶胶组:浅Ⅱ度180例、深Ⅱ度100例,伤后6h~2d开始用气溶胶治疗创面,l~2次/d,1.5h/次。(2)对照组:浅Ⅱ、深Ⅱ度患者各30例,常规治疗。(3)自身对照组:浅Ⅱ、深Ⅱ度患者各10例,同上用气溶胶治疗,但同一患者部分创面覆盖无菌金属片屏蔽气溶胶(屏蔽组),部分创面不屏蔽(非屏蔽组)。观察气溶胶治疗过程中患者创面的大体变化,治疗前后进行创面细菌培养,并监测其肝、肾功能及血生化指标有无改变。记录各组患者创面愈合时间。另制作深Ⅱ度烫伤大鼠模型,同前分为气溶胶组和对照组并治疗。取两组大鼠治疗前及治疗后1、2、3周的创面组织标本,作病理学观察。结果气溶胶治疗后患者创面渗出少,治疗前后均无细菌生长。总体来讲,气溶胶治疗前后患者肝、肾功能及血生化指标无明显改变。气溶胶组患者浅Ⅱ度创面伤后(6.3±1.6)d愈合,深Ⅱ度创面(15.1±3.1)d愈合,明显短于对照组相同深度创面[(11.3±1.4)、(21.2±1.4)d,P<0.01]。自身对照组中,相同烧伤深度的非屏蔽组与屏蔽组比较,创面愈合时间也明显缩短(P<0.01)。病理学检查显示,气溶胶组大鼠治疗后第3周皮肤结构已基本恢复正常,而对照组此时恢复较差。结论气溶胶能有效促进Ⅱ度烧伤创面的愈合且使用安全。     

伍重道远:进一步加强瘢痕的基础与临床研究

Scar,either hypertrophic scar or keloid,is one of the most common complications due to proliferative disorder of fibrosis in the process of wound healing after burn injuries,trauma,and surgical operations.To repair the cosmetic and functional impairments caused by scars poses a great challenge to all the burn surgery workers.With the advances in both basic research and clinical treatment,the understanding of scar formation and the therapeutic strategies of scar have been improved significantly.However,the remaining problems are still outstanding.In this discussion,the advances and problems in the scientific research in this field,including genetic predisposition,candidate gene,dysfunction of fibroblasts,interaction between fibroblasts and keratinocytes,as well as animal models for hypertrophic scar and keloid were summarized.In addition,the progreses in the clinical therapies are also discussed,including pressure treatment,silicone gel sheeting,corticosteroids,laser,and other emerging treatment strategies.The understanding and treatment of scar will improve in the future with further deepening basic research and clinical trials with stricter standard of assessment.     

Comparative study of Silver Sulfadiazine with other materials for healing and infection prevention in burns: A systematic review and meta-analysis

The aim of this systematic review with meta-analysis was to compare the effect of Silver Sulfadiazine (SSD) with other new dressings, with or without silver, on healing and infection prevention in burns. The electronic search was carried out in the electronic databases of Pubmed, ScienceDirect, Lilacs and BVS. The articles included were randomized clinical trials about burn treatment with SSD, which evaluated the healing and infection of burn wounds in humans. The exclusion criteria included articles, editorials and letters published in the form of abstracts, unpublished reports and case series, cross-sectional, observational experimental studies, and the use of sulfadiazine for other types of wounds. The search identified 873 references, and 24 studies were included in accordance with the eligibility criteria. The results showed a statistically favorable difference related to the time of healing for silver dressings (p < 0.0001; MD 3.83; 95% CI 2.03–5.62) and dressings without silver (p < 0.007; MD 2.9; 95% CI 0.81–5.00) in comparison with SSD. The rate of infection showed no difference in the group treated with SSD compared with the group treated with dressings containing silver (p > 0.05). The rate of infection was significantly higher in the SSD group compared with the group treated with dressings without silver (p < 0.005; MD 25.29% and MD 12.97%). Considering the clinical trials conducted up to the present time, the authors concluded that new dressings with and without silver show better results than SSD for wound healing, and burns treated with dressings without silver are less likely to become infected than burns with SSD. No differences between SSD and new silver materials were observed in relation to infection prevention.     

Porcine dermal collagen as a wound dressing for skin donor sites and deep partial skin thickness burns

Collagen was extracted by pepsin digestion from porcine skin, and collagen membrane was prepared by salt precipitation. The porcine collagen membrane was evaluated as a burn wound dressing in deep partial skin thickness burn wounds in rats. Burn wounds, 4 × 4 cm, were inflicted by exposure of skin to 75°C for 15 s followed by de-epithelialization. Wound healing was assessed by planimetry of epithelialization on day 10 after injury. Open wounds exhibited 24 per cent of wound area re-epithelialized. Collagen membrane dressing significantly improved the healing to 69 per cent of wound area (P < 0.0001). In a completely separate experiment, the porcine collagen membrane was applied as a wound dressing to the donor sites of burn patients, and its effect on wound healing was compared with that of a petroleum jelly gauze dressing. The donor sites covered with petroleum jelly gauze had re-epithelialized by an average of 14.5 days (ranging from 13 to 16 days) after wounding. The wounds dressed with collagen membrane demonstrated a significant increase in the healing rate. Complete re-epithelialization was observed by 10.3 days (ranging from 10 to 12 days) after wounding (P < 0.0001).     

Influence of hyaluronic acid on wound healing using composite porcine acellular dermal matrix grafts and autologous skin in rabbits

This study aims to explore the influence of hyaluronic acid (HA) on wound healing during xenogeneic porcine acellular dermal matrix (PADM) composite skin grafting. The results will facilitate the development of methods for improving graft contracture and poor elasticity of composite transplantation. Exogenous HA was added to composite PADM grafts and to thin autologous skin grafts during rabbit full‐thickness skin wound repair. The influence of HA on wound healing was evaluated according to its contracture rate and its expression of collagen types I and III. The possible mechanism was then explored based on HA metabolism and vascularisation in the skin graft. The results show that exogenous HA relieves graft contracture on rabbit wound surfaces, increases collagen I and III expression and decreases the ratio between collagen types. HA stimulates the generation of more CD44 receptors to strengthen its enzymolysis. The resulting metabolites promote the vascularisation of the wound surface, which are conducive for mitigating graft contracture, and further improve the composite grafting effect.     

应用异种脱细胞真皮的眼睑原位重建术的实验研究

目的探讨应用异种(猪)脱细胞真皮施行兔眼睑原位重建术后的组织相容性,比较异种(猪)脱细胞与异体巩膜替代睑板后的组织转归。方法采用兔眼睑缺损动物模型,随机分别给予异种(猪)脱细胞真皮、兔异体巩膜施行眼睑原位重建术。活体观察动物术后和移植物情况,于术后1、2、4、6、8和12周,取带植片的眼睑,光镜下观察替代材料和自体睑板交界处的组织病理学改变,包括炎症反应、纤维血管化情况和融合情况;取4、8和12周标本做透射电镜观察上述组织的超微结构改变。结果光镜和电镜下二者反应类似,差异无统计学意义。组织学检查显示异种脱细胞真皮引起的免疫和炎症反应轻微。结论异种(猪)脱细胞真皮在植入兔眼睑后有较好的组织相容性,并可引导新生胶原的生长,起到替代睑板的作用。     

烧伤变性脱细胞真皮基质可再生利用的实验研究

目的 探讨烧伤变性脱细胞真皮基质(DADM)作为真皮替代物用于创面修复的可行性. 方法 (1)取12只Wistar大鼠,其中9只背部造成深Ⅱ度烫伤(以下称烧伤)创面,分别于伤后1、2、3d(每时相点3只)取创面全厚皮肤,用2.5 g/L胰蛋白酶-体积分数0.5％ Triton X-100行脱细胞处理制成DADM,相应称为DADM-1 d、DADM-2 d、DADM-3 d;余下3只大鼠不致伤,同法制备ADM作为对照.对ADM和各DADM行大体、组织学观察及微生物学和生物力学检测(极限抗拉强度、最大拉力、断裂伸长率、应力-应变关系).(2)另取64只Wistar大鼠,按随机数字表法分为ADM组、DADM-1d组、DADM-2 d组、DADM-3d组,每组16只.于各大鼠背部制作一2.0 cm×1.8 cm大小皮瓣,将前述ADM和DADM-1 d、DADM-2d、DADM-3 d切制成1.8cm×1.5 cm大小后分别埋植于皮瓣下.术后1、3、5、9周,每组每时相点取4只大鼠,肉眼观察创面愈合情况及埋植物的变化,并对埋植物行组织学观察.对数据行单因素方差分析及t检验. 结果 (1)新鲜制备的各DADM呈乳白色,质地柔软有弹性,韧性较ADM弱.光学显微镜下见ADM和各DADM中均无上皮结构和细胞存在,DADM胶原纤维增粗程度不均匀,排列紊乱,嗜伊红性增强.各DADM微生物学检测结果均为阴性.DADM-1d、DADM-2 d、DADM-3 d之间极限抗拉强度、最大拉力、断裂伸长率和应力-应变关系比较,差异均无统计学意义(F值为0.088～3.591,P值均大于0.05);其中DADM-3d此4项指标值最高,分别为(13.0±2.4) MPa、(61 ±4)N、(173±7)％、(45 7±2.0)％.ADM此4项指标各为(19.0±2.6) MPa、(95±4)N、(201±5)％、(62.5±2.2)％,与3种DADM两两比较均偏高(t值为6.424 ～17.125,P值均小于0.01).(2)埋植术后1周,各组大鼠创面无渗出或红肿,埋植物未收缩或卷曲;创面有炎性细胞浸润并有Fb及毛细血管长入.术后3周时,DADM-1d、DADM-2 d、ADM组埋植区毛发生长正常,DADM-3 d组埋植区毛发较稀疏;各组炎性细胞减少,Fb增多,有新生小血管长入,DADM-3 d组炎性细胞减退稍延迟.术后第5周,各组埋植区毛发恢复正常,埋植物收缩、变薄,表面纤维膜包裹紧密,有较大血管束长入;各组真皮基质与周围正常组织融合.术后第9周,ADM和DADM均为薄、软白色组织片,与皮瓣内面连接紧密;各组无炎性细胞浸润,胶原纤维排列规则、致密,与正常胶原组织融合. 结论 烧伤DADM无明显免疫原性,生物相容性好,经离体改造有望成为创面修复治疗中的真皮替代物.     

Evaluation of healing outcomes combining a novel polymer formulation with autologous skin cell suspension to treat deep partial and full thickness wounds in a porcine model: a pilot study

Autologous skin cell suspensions (ASCS) can treat burns of varying depths with the advantage of reduced donor site wound burden. The current standard primary dressing for ASCS is a nonabsorbant, non-adherent, perforated film (control) which has limited conformability over heterogeneous wound beds and allows for run-off of the ASCS. To address these concerns, a novel spray-on polymer formulation was tested as a potential primary dressing in porcine deep partial thickness (DPT) and full thickness (FT) wounds. It was hypothesized that the polymer would perform as well as control dressing when evaluating wound healing and scarring.DPT or FT wounds were treated with either a spray-on poly(lactic-co-glycolic acid) (PLGA) and poly(lactide-co-caprolactone) (PLCL) formulation or control ASCS dressings. Throughout the experimental time course (to day 50), we found no significant differences between polymer and control wounds in % re-epithelialization, graft-loss, epidermal or dermal thickness, or % dermal cellularity in either model. Pigmentation, erythema, elasticity, and trans-epidermal water loss (TEWL), were not significantly altered between the treatment groups, but differences between healing wounds/scars and un-injured skin were observed. No cytotoxic effect was observed in ASCS incubated with the PLGA and PLCL polymers.These data suggest that the novel spray-on polymer is a viable option as a primary dressing, with improved ease of application and conformation to irregular wounds. Polymer formulation and application technique should be a subject of future research.