The role of skin substitutes in the management of chronic cutaneous wounds
The role of skin substitutes in the management of chronic cutaneous wounds
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DOI：
10.1111/wrr.12029
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发表时间：
2013-03-01
影响因子：
2.9
通讯作者：
Bayat, Ardeshir
中科院分区：
文献类型：
--
作者：
Greaves, Nicholas S.;Iqbal, Syed A.;Bayat, Ardeshir
慢性伤口，包括糖尿病和静脉溃疡，代表正常愈合过程的破坏，导致不愈合的皮肤炎症的病理状态。它们给医疗保健提供者带来了越来越大的经济负担，因为它们的患病率随着人口老龄化而上升。目前的治疗方式见效慢，资源密集。来自自体、同种异体或异种来源的生物工程皮肤替代品已成为一种新的替代治疗选择。一系列这样的产品被许可用于临床使用，它们在结构和细胞含量方面有所不同。直接放置在准备好的伤口床上，皮肤替代品可以通过提供适当的支架材料促进伤口区域的血管再生、细胞迁移和再增殖来刺激或加速愈合，以促进这些过程。含有胎儿或自体细胞的产品也受益于生物活性分子的早期释放，包括生长因子和细胞因子。迄今为止，研究皮肤替代品的随机对照试验数量有限，但来自病例系列和病例对照研究的证据令人鼓舞。这篇综述讨论了慢性伤口生物学，皮肤替代品可以施加在这个环境中的影响，目前可用的产品，并检查它们在慢性伤口管理中使用的证据。
Chronic wounds, including diabetic and venous ulcers, represent disruption of normal healing processes resulting in a pathological state of nonhealing cutaneous inflammation. They place an increasingly significant economic burden on healthcare providers as their prevalence is rising in keeping with an aging population. Current treatment modalities are slow acting and resource intensive. Bioengineered skin substitutes from autogenic, allogenic, or xenogenic sources have emerged as a new and alternative therapeutic option. A range of such products is licensed for clinical use, which differ in terms of structure and cellular content. Placed directly onto a prepared wound bed, skin substitutes may stimulate or accelerate healing by promoting revascularization, cellular migration, and repopulation of wound fields through provision of an appropriate scaffold material to facilitate these processes. Products containing fetal or autologous cells also benefit from early release of bioactive molecules including growth factors and cytokines. To date, limited numbers of randomized controlled trials studying skin substitutes have been published but evidence from case series and case-control studies is encouraging. This review discusses chronic wound biology, the influence that skin substitutes can exert on this environment, the products currently available, and examines the evidence for their use in chronic wound management.