Single-stage application of a novel decellularized dermis for treatment-resistant lower limb ulcers: Positive outcomes assessed by SIAscopy, laser perfusion, and 3D imaging, with sequential timed histological analysis
Single-stage application of a novel decellularized dermis for treatment-resistant lower limb ulcers: Positive outcomes assessed by SIAscopy, laser perfusion, and 3D imaging, with sequential timed histological analysis
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DOI：
10.1111/wrr.12113
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发表时间：
2013-11-01
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.;Benatar, Brian;Bayat, Ardeshir
我们介绍了一项原始临床研究的结果，该研究调查了脱细胞真皮替代品 (DCD) 作为顽固性腿部溃疡一阶段治疗策略的一部分的功效。 20例难治性溃疡患者行水刀清创术，术后应用DCD并负压敷料覆盖1周。在 6 个月内对参与者进行了七次审查。使用 3D 摄影、全场激光灌注成像、分光光度皮内分析和顺序活检来监测愈合情况。 DCD放置前的平均溃疡持续时间和表面积分别为4.76年（范围0.25-40年）和13.11cm(2)（范围1.06-40.75cm(2)）。百分之七十的溃疡是静脉性的。治疗后所有患者的表面积均下降（范围 23-100%）。 6 个月后平均缩小率为 87%，60% 的患者完全治愈。治疗后 6 周，创面床血红蛋白通量显着增加 (p=0.005)。组织学和免疫组织化学分析证实 DCD 与宿主成纤维细胞、淋巴细胞和中性粒细胞定植进行性整合，导致纤维增生、上皮再形成和血管生成，同时 CD31、胶原蛋白 I 和胶原蛋白 III 水平升高。亚组分析显示，根据伤口持续时间不同，细胞行为也不同，血管生成延迟、胶原蛋白沉积减少、溃疡表面积减少幅度较小，持续时间超过一年。包括纤连蛋白、胶原蛋白和 CD31 在内的免疫组织化学标记物的染色强度根据距伤口表面的深度和完整上皮的存在而不同。 DCD 安全地显着改善了难治性腿部溃疡。由于不需要住院、麻醉或自体皮肤移植，这种治疗可以在医院和社区环境中进行。
We present results of an original clinical study investigating efficacy of a decellularized dermal skin substitute (DCD) as part of a one-stage therapeutic strategy for recalcitrant leg ulcers. Twenty patients with treatment-resistant ulcers underwent hydrosurgical debridement, after which DCD was applied and covered with negative pressure dressings for 1 week. Participants were reviewed on seven occasions over 6 months. 3D photography, full-field laser perfusion imaging, spectrophotometric intracutaneous analysis, and sequential biopsies were used to monitor healing. Mean ulcer duration and surface area prior to DCD placement were 4.76 years (range 0.25-40 years) and 13.11cm(2) (range 1.06-40.75cm(2)), respectively. Seventy percent of ulcers were venous. Surface area decreased in all patients after treatment (range 23-100%). Mean reduction was 87% after 6 months, and 60% of patients healed completely. Wound bed hemoglobin flux increased significantly 6 weeks after treatment (p=0.005). Histological and immunohistochemical analysis confirmed progressive DCD integration with colonization by host fibroblasts, lymphocytes, and neutrophils, resulting in fibroplasia, reepithelialisation, and angiogenesis, with correlating raised CD31, collagen I, and collagen III levels. Subgroup analysis showed differing cellular behavior depending on wound duration, with delayed angiogenesis, reduced collagen deposition, and smaller reductions in surface area in ulcers present for over 1 year. The stain intensities of immunohistochemical markers including fibronectin, collagen, and CD31 differed depending on depth from the wound surface and presence of intact epithelium. DCD safely produced significant improvement in treatment-resistant leg ulcers. With no requirement for hospital admission, anesthetic, or autogenic skin grafting, this treatment could be administered in hospital and community settings.