Cutaneous wound healing
Cutaneous wound healing
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DOI：
10.1097/bcr.0b013e318093e44c
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发表时间：
2007-07-01
影响因子：
1.4
通讯作者：
Greenhalgh, David G.
中科院分区：
文献类型：
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作者：
Gibran, Nicole S.;Boyce, Steven;Greenhalgh, David G.
在过去的30年里，烧伤创面的早期切除和移植无疑比任何其他干预措施都更能影响烧伤患者的生存率。据报道，切除烧伤创面可减少感染，缩短住院时间，减少重建手术的需要，并使患者更快地恢复到发病前的功能水平。2这些临床进步已经创建了一个护理标准，强调尽可能使用片状皮肤移植物，建议网状移植物覆盖较大全层伤口患者的烧伤。3，4较大的伤口可能受益于皮肤替代品的覆盖。现有的皮肤替代品包括真皮替代模板和表皮培养物。5皮肤替代物，如Integra（Integra Life Sciences Corp.，Plainsboro，NJ）替代皮肤结缔组织，并为来自伤口床的固有细胞向内生长提供模板。6，7据报道，真皮替代物可减少瘢痕形成并改善伤口柔韧性。角质细胞移植物修复表皮层，并恢复皮肤对感染和体液流失的屏障。培养的同种异体表皮移植物在治疗不愈合的慢性伤口中得到了普及，但由于排斥反应，其在确定性烧伤治疗中的适用性有限。用培养的真皮-表皮自体移植物成功治疗大面积烧伤的报道8，-12还没有进展到多中心试验，因为它们的费用和制造的复杂性。13.虽然这些产品的开发已经推进了该领域的发展，但制备时间和费用限制了它们用于治疗大面积烧伤患者的可用性。
BACKGROUNDEarly excision and grafting of the burn wound have indisputably impacted burn survival more than any other intervention during the past 30 years. 1 Removing the burn wound has been reported to decrease infection, shorten hospital length of stay, reduce the need for reconstructive surgery, and return patients to their premorbid level of function sooner. 2 These clinical advances have created a standard of care that emphasizes use of sheet skin grafts whenever possible with meshed grafts recommended for coverage of burns in patients with larger full-thickness wounds. 3, 4 Larger wounds may benefit from coverage with skin substitutes. Existing skin substitutes include both dermal replacement templates and epidermal cultures. 5 Dermal substitutes, such as Integra (Integra Life Sciences Corp., Plainsboro, NJ), replace the cutaneous connective tissue and provide a template for ingrowth of indigenous cells from the wound bed. 6, 7 Dermal substitutes have been reported to reduce scar formation and improve wound pliability. Keratinocyte grafts restore the epidermal layer and restore the cutaneous barrier to infection and fluid loss. Cultured epidermal allografts, which have gained popularity for treatment of nonhealing chronic wounds, have limited applicability in definitive burn treatment because of rejection. Reports of successful treatment of large burns with cultured dermal–epidermal autografts 8,–12 have not yet progressed to multicenter trials because of their expense and complexity of fabrication. 13 Whereas development of these products has advanced the field, time of preparation and expense limit their availability for treatment of patients with extensive burn injuries.