游离足背皮瓣移植修复鼻面部软组织缺损患者的护理

目的探讨游离足背皮瓣修复鼻面部软组织缺损的护理措施。方法回顾性分析和总结游离足背皮瓣修复鼻面部软组织缺损患者的护理经验。结果本组13例患者移植皮瓣全部存活,鼻面部外形恢复满意,足背创面愈合良好。结论充分的术前准备,积极的心理护理,严密细致的术后观察是手术成功的重要保障。     

枸杞多糖与维生素E延缓小鼠皮肤衰老的实验研究

目的比较枸杞多糖与维生素E延缓小鼠皮肤衰老的作用。方法将60只雌性昆明种小鼠随机分为4组:正常对照组皮下注射生理盐水;其余3组每日颈背部皮下注射D-半乳糖造成小鼠衰老模型,同时各组分别灌胃生理盐水(衰老模型组)、枸杞多糖、维生素E。42 d后,测定小鼠背部皮肤组织匀浆中超氧化物歧化酶(SOD)活力、过氧化脂质代谢产物丙二醛(MDA)含量。结果灌服枸杞多糖与维生素E后,衰老模型小鼠皮肤中SOD活力增强、MDA含量降低,且枸杞多糖效果较维生素E显著。结论枸杞多糖与维生素E都有显著的抗小鼠皮肤衰老作用,枸杞多糖效果优于维生素E。     

人毛囊细胞来源双层皮肤替代物的构建和组织学特征

目的 探索人毛囊细胞构建的双层皮肤替代物的组织学特征.方法 用毛乳头细胞、真皮鞘细胞分别与外根鞘细胞构建复合壳多糖双层皮肤替代物,分析其体外和移植至大白鼠后的组织学特征.结果 毛囊来源细胞构建的皮肤替代物中表皮细胞排列更紧密、角化突出,真皮内可见与表皮相连的上皮细胞柱及球形膨大细胞团形成.结论 毛囊细胞是构建皮肤替代物的良好细胞来源.     

Wound healing with “spray‐on” autologous skin grafting (ReCell) compared with standard care in patients with large diabetes‐related foot wounds: an open‐label randomised controlled trial

There is an urgent need for interventions that improve healing time, prevent amputations and recurrent ulceration in patients with diabetes‐related foot wounds. In this randomised, open‐label trial, participants were randomised to receive an application of non‐cultured autologous skin cells (“spray‐on” skin; ReCell) or standard care interventions for large (>6 cm²), adequately vascularised wounds. The primary outcome was complete healing at 6 months, determined by assessors blinded to the intervention. Forty‐nine eligible foot wounds in 45 participants were randomised. An evaluable primary outcome was available for all wounds. The median (interquartile range) wound area at baseline was 11.4 (8.8‐17.6) cm². A total of 32 (65.3%) index wounds were completely healed at 6 months, including 16 of 24 (66.7%) in the spray‐on skin group and 16 of 25 (64.0%) in the standard care group (unadjusted OR [95% CI]: 1.13 (0.35‐3.65), P = .845). Lower body mass index (P = .002) and non‐plantar wounds (P = .009) were the only patient‐ or wound‐related factors associated with complete healing at 6 months. Spray‐on skin resulted in high rates of complete healing at 6 months in patients with large diabetes‐related foot wounds, but was not significantly better than standard care (Australian New Zealand Clinical Trials Registry: ACTRN12618000511235).     

A bioreactor for studying negative pressure wound therapy on skin grafts

Negative pressure wound therapy (NPWT) has become the prevailing standard of care for treating complex soft tissue wounds and is now being considered for use in alternative applications including improving skin graft take. While it is generally agreed that negative pressure leads to improved wound healing, universal consensus on its optimal application is not supported in the literature. We describe the design and validation of a bioreactor to determine the prospective benefits of NPWT on skin grafts and engineered skin substitutes (ESS). Clinically relevant pressures were applied, and the native human skin was able to withstand greater negative pressures than the engineered substitutes. Both skin types were cultured under static, flow‐only, and −75 mm Hg conditions for 3 days. While it remained intact, there was damage to the epidermal‐dermal junction in the ESS after application of negative pressure. The normal skin remained viable under all culture conditions. The engineered skin underwent apoptosis in the flow‐only group; however, the application of negative pressure reduced apoptosis. Vascular endothelial growth factor levels were significantly higher in the normal flow‐only group, 152.0 ± 75.1 pg/mg protein, than the other culture conditions, 81.6 ± 35.5 pg/mg for the static and 103.6 ± pg/mg for the negative pressure conditions. The engineered skin had a similar trend but the differences were not significant. This bioreactor design can be used to evaluate the impacts of NPWT on the anatomy and physiology of skin to improve outcomes in wounds after grafting with normal or engineered skin.     

中、小面积深度烧伤符合功能与美学要求的皮肤移植术

目的:探讨非面颈部中、小面积深度烧伤更加符合人体皮肤功能与美学要求的皮肤移植技术.方法:受皮区创面采用浅切痂、削痂法,尽可能多保留创面正常皮下组织,严密止血.以低浓度肾上腺素生理盐水皮下注射肿胀供皮区,鼓式取皮机、电动切皮机或滚轴取皮刀切取厚0.2～0.6 mm大张中厚断层皮;游离皮片长轴垂直于受区纵轴不开洞移植.皮片与创缘、皮片与皮片3-0丝线严密缝合,妥善包扎、制动.结果:接受改进的皮肤移植术的患者共592例,受区面积为1%～30%[平均(11.2±2.7)%]TBSA.全部病例移植皮片成活率＞95%,移植皮片100%成活者91.9%(544/592),随访1 a以上评价,受区皮肤组织丰满,质地柔软、光滑,无明显增生性瘢痕,肢体关节活动自如,轻度色素沉着,供皮区表面较正常皮肤略粗糙,色素沉着不明显.结论:加强创面处理,改进和熟练掌握取皮技术,选择合适供区,中、小面积深度烧伤采用大张中厚和薄中厚断层皮不开洞移植,供皮区和修复部位均获得较理想的功能与美容效果.     

间隙连接蛋白43突变与皮肤疾病相关性研究

间隙连接蛋白(Cx)在保证细胞间物质信息传递及维持皮肤屏障稳态方面发挥着重要作用,其基因突变,甚至表达水平异常均会引起多种疾病,严重影响患者生活质量。在编码人类Cx家族的21个基因中,与Cx基因突变相关的临床伴随疾病至少有14种。其中,Cx43分布最广,不仅在大多数器官组织中均有报道,也是伤口愈合、皮肤角质化,以及皮肤肿瘤发展等重要生理病理过程中的关键调控节点。本文总结了近年来Cx43基因(GJA1)在皮肤屏障中的作用、GJA1基因突变相关皮肤疾病及其潜在致病机制这几个快速发展领域中的研究成果,以期为Cx43临床伴发疾病防治及相关研究提供参考。