The 1999 Clinical Research Award - Cultured skin substitutes combined with integra artificial skin to replace native skin autograft and allograft for the closure of excised full-thickness burns
The 1999 Clinical Research Award - Cultured skin substitutes combined with integra artificial skin to replace native skin autograft and allograft for the closure of excised full-thickness burns
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DOI：
10.1097/00004630-199920060-00006
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发表时间：
1999-11-01
期刊：
影响因子：
--
通讯作者：
Warden, GD
中科院分区：
文献类型：
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作者：
Boyce, ST;Kagan, RJ;Warden, GD
切除的全层烧伤的及时和永久闭合仍然是患者从大面积烧伤中恢复的关键因素。假设，Integra人工皮肤（Integra）可以取代对同种异体移植物的需求，以立即覆盖伤口，含有复层上皮的培养皮肤替代品（CSS）可以取代对自体移植物的需求，以最终闭合伤口。为了验证这一假设，3例全层烧伤面积超过体表总面积60%的患者在入院后14天内切除了焦痂。应用Integra，并从每个患者收集皮肤活检用于制备CSS。在应用Integra和收集皮肤活检后3周或更长时间，移除Integra的外部硅橡胶覆盖物并移植CSS。CSS用营养物和抗菌剂冲洗6天，然后用抗菌软膏和棉纱布敷料。在CSS移植后第14天和第28天追踪治疗的伤口，分别用于确定植入和伤口闭合。没有进行成本分析。术后第14天（POD）的植活率为98% +/- 1%（平均值+/-平均值的标准误），POD 28时的闭合区域与供体区域的比值为52.3 +/- 5.2，没有治疗部位需要再次植活。闭合伤口的组织学显示稳定的上皮，其覆盖在降解的Integra的网状结构上方的一层新形成的纤维血管组织。POD 28后闭合伤口的临床结局显示皮肤光滑、柔韧和色素减退。从POD 8或POD 9开始，在Integra上背部接受CSS移植物的2例患者仰卧在气垫床上，由于机械负荷，移植物丢失最小。1例患者的全层烧伤面积占全身表面积的88%，在烧伤后55天确定覆盖。这些结果表明，CSS和Integra的组合可以在大面积全层烧伤患者中实现功能稳定和美容可接受的伤口闭合。这种替代传统断层皮肤移植的组合允许用Integra替代尸体同种异体移植物，用CSS替代供体自体移植物。这种闭合切除的全层烧伤的方法预计将大大缩短烧伤伤口最终闭合的时间，并降低与获取供皮区用于自体刃厚皮肤移植相关的发病率。
Prompt and permanent closure of excised full-thickness burns remains a critical factor in a patient's recovery from massive burn injuries. Hypothetically, Integra Artificial Skin (Integra) may replace the need for allografts for immediate wound coverage, and cultured skin substitutes (CSS) that contain stratified epithelium may replace the need for autografts for definitive wound closure. To test this hypothesis, 3 patients with full-thickness burns of greater than 60% of their total body surface areas had their eschar excised within 14 days of admission. Integra was applied, and a skin biopsy was collected from each patient for the preparation of CSS. At 3 weeks or more after the application of the Integra and the collection of skin biopsies, the outer silastic cover of the Integra was removed and CSS were grafted. The CSS were irrigated with nutrients and antimicrobials for 6 days and then dressed with antimicrobial ointment and cotton gauze. Treated wounds were traced on days 14 and 28 after the grafting of CSS for determination of engraftment and wound closure, respectively. Cost analysis was not performed. Engraftment on postoperative day (POD) 14 was 98% +/- 1% (mean +/- standard error of the mean), the ratio of closed:donor areas on POD 28 was 52.3 +/- 5.2, and no treated sites required regrafting. The histology of the closed wounds showed stable epithelium that covered a layer of newly formed fibrovascular tissue above the reticulated structure of the degrading Integra. The clinical outcomes of the closed wounds after POD 28 demonstrated smooth, pliable, and hypopigmented skin. Two patients who had received CSS grafts over Integra on their backs were positioned supine on air beds from POD 8 or POD 9 with minimal graft loss because of mechanical loading. One patient with a full-thickness burn of 88% of the total body surface area was covered definitively at 55 days postburn. These results demonstrate that the combination of CSS and Integra can accomplish functionally stable and cosmetically acceptable wound closure in patients with extensive full-thickness burns. This combination of alternatives to the conventional grafting of split-thickness skin permits the substitution of cadaveric allograft with Integra and the substitution of donor autograft with CSS. This approach to the closure of excised full-thickness burns is expected to reduce greatly the time to definitive closure of burn wounds and to reduce the morbidity associated with the harvesting of donor sites for split-thickness skin autografts.