Randomized, Paired-Site Comparison of Autologous Engineered Skin Substitutes and Split-Thickness Skin Graft for Closure of Extensive, Full-Thickness Burns.
Randomized, Paired-Site Comparison of Autologous Engineered Skin Substitutes and Split-Thickness Skin Graft for Closure of Extensive, Full-Thickness Burns.
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DOI：
10.1097/bcr.0000000000000401
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Kagan RJ
中科院分区：
文献类型：
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作者：
Boyce ST;Simpson PS;Rieman MT;Warner PM;Yakuboff KP;Bailey JK;Nelson JK;Fowler LA;Kagan RJ
全层烧伤创面的稳定闭合仍然是烧伤恢复的一个限制，烧伤面积超过全身表面积（TBSA）的50%。假设，工程皮肤替代品（ESS）由附着在胶原基支架上的自体角质形成细胞和成纤维细胞组成，可能减少对供体皮肤的需求，并降低死亡率。ESS是在16名儿童烧伤患者加入批准的研究方案后收集的裂层皮肤活检中制备的。我们对15例全层烧伤患者应用ESS和劈裂厚度自体移植物（AG），平均TBSA为76.9%。数据包括照片、供体皮肤和愈合伤口的追踪、与国家烧伤资料库（NBR）的死亡率比较、TBSA闭合伤口与TBSA全层烧伤的相关性、再移植频率以及对生物聚合物支架的免疫反应性。1名受试者在应用ESS前过期，15名受试者接受了2056次ESS移植。ESS闭合创面面积与供区面积之比为108.7±9.7，AG最大为4.0±0.0。入组受试者的死亡率为6.25%，NBR可比人群的死亡率为30.3% （p<0.05）。ESS为83.5±2.0%，AG为96.5±0.9。ESS和AG的TBSA关闭率分别为29.9±3.3%和47.0±2.0。这些数值在嫁接类型之间存在显著差异。% TBSA与ESS闭合与% TBSA全层烧伤相关，R2值为0.65 （p<0.001）。这些结果表明自体ESS降低了死亡率和供体皮肤采集的要求，对于TBSA大于50%的全层烧伤移植。
Stable closure of full-thickness burn wounds remains a limitation to recovery from burns of greater than 50% of the total body surface area (TBSA). Hypothetically, engineered skin substitutes (ESS) consisting of autologous keratinocytes and fibroblasts attached to collagen-based scaffolds may reduce requirements for donor skin, and decrease mortality. ESS were prepared from split-thickness skin biopsies collected after enrollment of 16 pediatric burn patients into an approved study protocol. ESS and split-thickness autograft (AG) were applied to 15 subjects with full-thickness burns involving a mean of 76.9% TBSA. Data consisted of photographs, tracings of donor skin and healed wounds, comparison of mortality with the National Burn Repository (NBR), correlation of TBSA closed wounds with TBSA full-thickness burn, frequencies of regrafting, and immunoreactivity to the biopolymer scaffold. One subject expired before ESS application, and 15 subjects received 2056 ESS grafts. The ratio of closed wound to donor areas was 108.7±9.7 for ESS compared with a maximum of 4.0±0.0 for AG. Mortality for enrolled subjects was 6.25%, and 30.3% for a comparable population from the NBR (p<0.05). Engraftment was 83.5±2.0% for ESS and 96.5±0.9 for AG. Percentage TBSA closed was 29.9±3.3% for ESS, and 47.0±2.0 for AG. These values were significantly different between the graft types. Correlation of % TBSA closed with ESS with % TBSA full-thickness burn generated an R2 value of 0.65 (p<0.001). These results indicate that autologous ESS reduce mortality and requirements for donor skin harvesting, for grafting of full-thickness burns of greater than 50% TBSA.