Immunologic alterations following excisional wounding and immediate repair with syngeneic or allogeneic skin grafts

Immunosuppression and its associated infectious complications have long been recognized as consequences of major thermal trauma, though the factors that mediate this suppression remain unclear. A murine split-thickness skin graft model was developed to investigate the role of a large surface area wound in the initiation of immunosuppression in the absence of burn injury. Significant T cell-mediated immunosuppression was demonstrated following wounding and immediate repair with either syngeneic or allogeneic split-thickness skin grafts. These results are consistent with previous experiments in a murine burn model treated by escharectomy and resurfacing with syngeneic composite full-thickness skin. Data also supports the concept that mediators of inflammation at the wound site play an important role in postburn immunosuppression. Furthermore, these results suggest that the use of skin allografts during the early postburn period does not adversely affect cell-mediated immunity in any way that could be abrogated by primary autografting.     

Lower limb skin loss: simple outpatient management with meshed skin grafts with immediate mobilization.

Traumatic skin loss is a common problem in elderly patients presenting to an accident and emergency department. The authors report their experience with 25 patients in whom pretibial wounds were debrided, and covered with skin grafts taken under local anaesthetic and meshed by hand. All were immediately mobilized and discharged home. Healing was satisfactory in every case and there were no complications. All the patients found the treatment acceptable, and were delighted to avoid admission to hospital. This is a simple and effective outpatient procedure which can readily be carried out in the accident and emergency department.     

Venous ulcers: Etiology and care of patients treated with human skin equivalent grafts

Care for a patient with a venous ulcer is complex, necessitating collaboration of a multidisciplinary team to achieve the goal of providing comprehensive would care and optimally managing complications, current conditions, and healing time. Patients often have venous ulcers for a long time, and they frequently have multiple diagnoses. Chronic ulcers that do not heal necessitate closure with a graft. Apligraf, (Novartis Pharmaceutical Corp, East Hanover, NJ), a human skin equivalent, is often used in nonhealing or difficult-to-heal ulcers. Knowledge of how to care for the grafted wound and protection of the grafted site is essential.     

复合人工皮肤修复猪全层皮肤缺损

目的:探讨复合人工皮肤在修复中国小型猪全层皮肤缺损中的作用。方法:16头中国实验用小型猪于背部正中分别切除全层皮肤至深筋膜的3个创面,3个创面以数字表法分成复合皮移植组(实验组),刃厚皮移植组(对照组1)及全厚皮移植组(对照组2),术后定期留取创面组织进行组织学检测。结果:人工复合皮肤具有表皮,真皮双层结构,在愈合过程中表皮细胞逐步增殖、分化、发育形成基底层、棘细胞层、颗粒层和角质层。结论:表皮细胞悬液与脱细胞真皮基质重组的复合皮由于含有真皮与表皮双层结构,其组织学形态与超微结构与天然皮肤极为相似;通过表皮细胞培养可扩大皮源,为大面积深度烧伤患者提供了皮源。利用组织工程技术构建人工复合皮肤,可用于皮肤缺损者的治疗,解决了自体供皮不足。     

Exercise or overloading: effect on skeletal muscle grafts of rats

The effects of increased usage on regenerated muscle grafts was studied in rats. Soleus muscles were grafted orthotopically, either without neuromuscular anastomoses (standard grafts), or with their original nerves undamaged (nerve-intact grafts). The rats were either run on a treadmill or their soleus grafts were overloaded by extirpation of approximately 50% of the gastrocnemius muscles. Twitch and tetanic contractions, glycogen concentration, and histological features of the grafts were evaluated 60 days after grafting. The results showed that exercise enhanced glycogen levels in nerve-intact grafts as in normal muscle. Overloading had no effect on glycogen. The nonexercised standard grafts had the lowest values for the mechanical parameters studied. However, this was apparently due to the smaller degree of innervation rather than from the lack of exercise. Within the population of nerve-intact grafts, neither exercise nor overloading significantly improved the twitch and tetanic tensions. It is concluded that exercise, but not overloading, is likely to have positive effects on muscle graft metabolism.     

The behavior of skin grafts incompatible with respect to skin alloantigens on mice rendered tolerant at birth with lymphoid cells

It has been reported that lethally irradiated adult B6 mice restored with (A X B6) hemopoietic cells subsequently reject adult A-strain skin grafts because they are not tolerant of A-strain skin-specific (Sk) antigens. This thesis has been confirmed by a series of experiments conducted on neonatally treated animals. Thus sublethally irradiated neonatal B6 mice, inoculated with (A X B6) lymphoid cells, permanently accept these cells while subsequently rejecting adult strain A skin grafts. Further evidence that the destruction of these grafts results from the reaction of the host to Sk antigens, is provided by the fact that similarly treated recipients often permanently accept neonatal A- strain skin. Such grafts usually induce tolerance of adult A-strain skin grafts.     

某含碘皮肤消毒剂启用后存放稳定性观察

摘要 目的 观察含碘皮肤消毒剂启用后的存放使用期限。方法 采用细菌定量检测方法,对不同浓度含碘皮肤消毒剂启用后存放于不同温度下的有效期限进行观察。结果 有效碘含量为10 g/L和5 g/L的聚维酮碘消毒剂,启用后带盖存放于37 ℃保存 7 d,消毒液内菌落总数不超标。用储存7 d的该消毒液对手术患者皮肤进行消毒,消毒效果均达到合格要求。结论 该聚维酮碘消毒剂启用后在37 ℃下存放期限以7 d为宜。     

Comparison of scar contracture with the use of microskin and Chinese-type intermingled skin grafts on rats

Wounds that were measured precisely 4 x 5 cm in size were created over the dorsal surfaces of rats. The defects were grafted with the use of either the microskin or Chinese technique of intermingled auto/allograft with an expansion ratio of 10:1. The size of the grafted wound of each rat was recorded on the fifth graft day after grafting and then weekly for 11 weeks. The extent of scar contracture on each rat was calculated weekly as a percentage of the original size. The results showed that the scar contracture associated with the Chinese type of intermingled auto/allograft transplantation was less than that associated with the microskin technique. The healing process in both forms of grafting was uneventful.     

The pathological differences of rejection in the heart allografts which are transplanted alone or with synchronous skin grafts in rats

The morphological patterns of rejection of the heart allografts which were combinedly transplanted with skin grafts was examined to determine whether it was different from that of the heart grafts transplanted alone. The results showed that there were distinct differences in the pathology of the rejection between the two groups because in the single heart grafts mononuclear cells concentrated in almost all layers of myocardium but in the combinedly transplanted heart grafts not only concentration of them but also severe hemorrhage and edema were observed in it, and it suggests that skin graft has effects on rejection process of heart grafts. As we used an outbred strain of rats some survived heart grafts were observed and their pathology was characteristic in the interstitial accumulation of hypertrophic mast cells, most of which were degranulating.     

Cytotoxic T-cell responses to H-Y: correlation with the rejection of syngeneic male skin grafts

The ability of female mice to rapidly reject syngenic male skin grafts is largely determined by dominant genes in the IB region of the H-2b halotype, whereas the ability to produce anti-H-Y cytotoxic cells is determined by a dominant gene in the IA region the H-2b halotype, or by complementary genes in the IC region of some other haplotypes. Thus, it seems that H-2-retricted anti-H-Y cytotoxic T cells are not responsible for the rejection of syngeneic male skin grafts.     

自体与同种异体骨软骨镶嵌移植修复关节软骨缺损的实验

目的:探讨自体和同种异体骨软骨移植的效果、可行性及相关问题。方法:实验于2002-05/12在大连医科大学动物实验中心完成。将27只健康成年新西兰大白兔同侧膝关节造成实验性缺损,随机将动物分成自体移植组(自体骨软骨移植)9只、异体移植组(同种异体骨软骨移植)9只、对照组(软骨缺损无处理)9只。自体移植组和异体移植组动物分别做2柱的自体和异体非负重区骨软骨柱移植,术后不限制运动,各组动物分别于术后4,8,12周处死,进行大体观察、测量修复移植组织厚度、组织学光镜、电镜研究和统计学处理。结果:27只实验兔均进入结果分析。①自体移植组软骨面愈合修复满意。移植后8周时移植的软骨面更鲜活,移植软骨边缘细胞坏死较少,关节面轮廓恢复更佳;12周时,关节面覆盖程度、与周边正常软骨融合程度较好,组织学光镜、电镜示移植物与骨床骨性愈合,陷落极少,无明显退行性变,成熟软骨细胞较多。②同种异体移植组修复软骨缺损结果不佳。术后4周时,排斥-吸收表现明显,移植物的软骨面已吸收近半,骨柱塌陷明显,交界处可见炎细胞浸润,免疫排斥反应明显。关节囊等周边软组织粘连水肿严重,关节退行性变无一例外。12周时,基本完成表面纤维软骨修复,交界处排异反应略轻但始终存在,关节外观凹凸不平,退行性变严重。③修复组织与周边正常软骨平均厚度的百分比,8周时自体移植组高于异体移植组[(96.22±2.69)%,(64.86±3.79)%,P<0.01];12周时自体移植组高于异体移植组[(105.84±7.37)%,(61.57±3.24)%,P<0.01]。结论:自体骨软骨镶嵌移植可以修复兔关节软骨的缺损。以家兔为对象,新鲜无处理的同种异体骨软骨镶嵌移植修复关节软骨缺损不可行,其排斥反应及吸收破坏严重。     

自体与同种异体骨软骨镶嵌移植修复关节软骨缺损的实验

目的：探讨自体和同种异体骨软骨移植的效果、可行性及相关问题.方法：实验于2002-05/12在大连医科大学动物实验中心完成.将27只健康成年新西兰大白兔同侧膝关节造成实验性缺损,随机将动物分成自体移植组（自体骨软骨移植）9只、异体移植组（同种异体骨软骨移植）9只、对照组（软骨缺损无处理）9只.自体移植组和异体移植组动物分别做2柱的自体和异体非负重区骨软骨柱移植,术后不限制运动,各组动物分别于术后4,8,12周处死,进行大体观察、测量修复移植组织厚度、组织学光镜、电镜研究和统计学处理.结果：27只实验兔均进入结果分析.①自体移植组软骨面愈合修复满意.移植后8周时移植的软骨面更鲜活,移植软骨边缘细胞坏死较少,关节面轮廓恢复更佳;12周时,关节面覆盖程度、与周边正常软骨融合程度较好,组织学光镜、电镜示移植物与骨床骨性愈合,陷落极少,无明显退行性变,成熟软骨细胞较多.②同种异体移植组修复软骨缺损结果不佳.术后4周时,排斥-吸收表现明显,移植物的软骨面已吸收近半,骨柱塌陷明显,交界处可见炎细胞浸润,免疫排斥反应明显.关节囊等周边软组织粘连水肿严重,关节退行性变无一例外.12周时,基本完成表面纤维软骨修复,交界处排异反应略轻但始终存在,关节外观凹凸不平,退行性变严重.③修复组织与周边正常软骨平均厚度的百分比,8周时自体移植组高于异体移植组[（96.22&;#177;2.69）%,（64.86&;#177;3.79）%,P＜0.01];12周时自体移植组高于异体移植组[（105.84&;#177;7.37）%,（61.57&;#177;3.24）%,P＜0.01].结论：自体骨软骨镶嵌移植可以修复兔关节软骨的缺损.以家兔为对象,新鲜无处理的同种异体骨软骨镶嵌移植修复关节软骨缺损不可行,其排斥反应及吸收破坏严重.     

Porous composite prosthetic pylon for integration with skin and bone

This article presents results of the further development and testing of the "skin and bone integrated pylon" (SBIP-1) for percutaneous (through skin) connection of the residual bone with an external limb prosthesis. We investigated a composite structure (called the SBIP-2) made of titanium particles and fine wires using mathematical modeling and mechanical testing. Results showed that the strength of the pylon was comparable with that of anatomical bone. In vitro and in vivo animal studies on 30 rats showed that the reinforcement of the composite pylon did not compromise its previously shown capacity for inviting skin and bone cell ingrowth through the device. These findings provide evidence for the safe and reliable long-term percutaneous transfer of vital and therapeutic substances, signals, and necessary forces and moments from a prosthetic device to the body.     

Effect of graft bed on long-term functional results of extremity skin grafts

The purpose of the current study was to determine whether the long-term functional results of extremity burns grafted on fat were different from those grafted on fascia. Twelve patients (mean burn size, 38% TBSA) who had fascial excision of the majority of one or more extremities were examined a minimum of one year postinjury. Range of motion, motor strength, and sensation of the fascially excised extremities were measured. Twelve comparable patients with extremity burns (mean burn size, 35% TBSA) who had grafts placed on fat were used as positive controls. Patients whose burns were excised to fat had better joint mobility (P = 0.001) and sensory function (P = 0.001) than did patients whose burns were excised to fascia. Both groups had comparable muscle strength. These results indicate that patients with full-thickness burns of the extremities who have grafts placed on fat have significantly better long-term extremity function than do patients who have their skin grafts placed on fascia.     

The adoptive transfer of pregnancy-induced unresponsiveness to male skin grafts with thymus-dependent cells

A majority of C57BL/10Sn females pregnant six or more times by syngeneic males do not reject male skin grafts. The pregnancy induced tolerance of male skin grafts was transferred adoptively to virgin recipients by thymus-dependent cells from multiparous tolerant donors.     

复合皮移植修复创面的临床观察

目的 观察移植以小肠黏膜下层（SIS）为真皮替代物体外构建的复合皮修复创面的效果。方法制取家猪空肠黏膜下层为真皮替代物,致密层表面种植自体表皮细胞,构建人工复合皮,移植复合皮修复37例皮肤肉芽组织创面;观察复合皮早期成活率,并分别于移植后第1周、第2周取复合皮标本作组织学观察。结果表皮细胞在SIS表面定位、生长,24例移植的复合皮早期成活良好,SIS内新生血管形成,炎性细胞浸润,无移植排斥反应。结论以SIS为真皮替代物构建的复合皮,有可能成为一种新型的创面修复材料。     

复合皮移植术治疗瘢痕挛缩畸形患者的护理

总结报道异体脱细胞真皮与自体刃厚皮片复合移植治疗瘢痕挛缩畸形患的护理方法。对20例实施异体脱细胞真皮与自体刃厚皮片复合移植术的瘢痕挛缩畸形患术前进行心理护理，认真做好植皮区的皮肤准备、术后着重病房准备，肢体制动护理，密切观察病情．加强营养支持疗法，康复期护理等。本组18例移植皮片全部1次成活．2例大部分成活，小部分经第2次移植后成活，肢体活动功能恢复满意。