Topical negative pressure therapy: Does it accelerate neovascularisation within the dermal regeneration template, Integra? A prospective histological in vivo study
Topical negative pressure therapy: Does it accelerate neovascularisation within the dermal regeneration template, Integra? A prospective histological in vivo study
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DOI：
10.1016/j.burns.2010.04.011
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发表时间：
2010-09-01
期刊：
影响因子：
2.7
通讯作者：
Mendonca, Derek
中科院分区：
文献类型：
--
作者：
Moiemen, Naiem S.;Yarrow, Jeremy;Mendonca, Derek
背景资料：使用局部负压（TNP）敷料和皮肤再生模板（DRT）Integra改善了结局并简化了术后护理。先前的临床研究表明加速了血管形成;应用Integra后第一阶段的持续时间从2 - 4周缩短至4天，但没有组织学证据。然而，没有TNP的组织学研究表明，血管形成发生在第二周和第四周之间。本研究着手研究组织学DRT新生血管形成率时，结合TNP。方法：8例患者与9个重建网站被列入。使用非网状Integra和纤维蛋白封闭剂促进粘附。TNP应用于第一和第二阶段之间的持续时间。患者在应用后第7、14、21和28天进行连续活检。活组织检查用H&E和内皮标记物⑶ 31和⑶ 34染色。模板血管化被评估为模板深度的百分比，在模板深度中，可以显示通畅的、管腔化的血管通道。结果：显示管腔化通道的模板深度的中位百分比在第7、14、21和28天分别为0%、20%、61%和80%。将TNP敷料应用于真皮模板可以降低剪切力，限制血清肿和血肿形成，简化伤口护理并提高患者耐受性。然而，这项研究不能证明TNP加速新生血管形成，如组织学上通畅的血管通道所证实的。皇冠版权所有（C）2010由Elsevier Ltd和ISBI出版。All rights reserved.
Background: The use of topical negative pressure (TNP) dressings with dermal regeneration template (DRT), Integra, has improved outcomes and simplified aftercare. Previous clinical studies have suggested accelerated vascularisation; with a reduction in the duration of the 1st stage after the application of Integra, from 2 to 4 weeks to as little as 4 days, but with no histological evidence. However, histological studies, without TNP, have shown that vascularisation occurs between the second and the fourth week. This study set out to examine histologically the rate of DRT neovascularisation when combined with TNP.Methods: Eight patients with nine reconstruction sites were enlisted. Unmeshed Integra and fibrin sealant to promote adherence were used. TNP was applied for the duration between the 1st and the 2nd stages. Patients underwent serial biopsies on days 7, 14, 21 and 28 post-application. The biopsies were stained with H&E and endothelial markers CD31 and CD34. Template vascularisation was assessed as a percentage of the template depth in which patent, canalised vascular channels could be demonstrated.Results: The median percentage of the template depth which demonstrated canalised channels was 0%, 20%, 61% and 80% for days, 7, 14, 21 and 28, respectively.Conclusion: The application of TNP dressings to dermal templates can reduce shearing forces, restrict seroma and haematoma formation, simplify wound care and improve patient tolerance. However, this study could not demonstrate that TNP accelerates neovascularisation as verified by the presence of histologically patent vascular channels. Crown Copyright (C) 2010 Published by Elsevier Ltd and ISBI. All rights reserved.