Hansbrough J F, Doré C, Hansbrough W B
Department of Surgery, University of California, San Diego Medical Center 92103.
J Burn Care Rehabil. 1992 Sep-Oct;13(5):519-29. doi: 10.1097/00004630-199209000-00004.
We evaluated the ability of Dermagraft (Advanced Tissue Sciences, La Jolla, Calif.), a living tissue analog that is composed of human neonatal fibroblasts, which are grown on a polyglactin acid Vicryl mesh (Ethicon Inc., Somerville, N.J.), to function as a dermal replacement when placed beneath meshed, expanded split-thickness skin grafts (MESTSGs). Full-thickness burn wounds in 17 patients with burns (mean age, 31 years; range, 6 to 69 years; mean burn size, 23.8% total body surface area) were excised to subcutaneous fat (nine patients), to fascia (three patients), or to a combination of deep dermis and fat (five patients). Dermagraft was placed over the experimental sites, which were then covered with MESTSGs. Paired control sites on each patient received MESTSGs only. The results showed that "take" of MESTSGs on control sites was slightly better than take on experimental sites that contained the Dermagraft; however, the differences were not statistically significant. Mesh interstices epithelialized over the surface of the full-thickness wound (control sites) or over the surface of Dermagraft (experimental sites). Wound biopsy specimens demonstrated no evidence of rejection of the cultured allogeneic fibroblasts and minimal inflammatory reaction to the Vicryl fibers. Evidence of continuous basement membrane formation at the epithelial-Dermagraft junction, which was identified by immunohistochemical staining for laminin and type IV collagen, was seen by day 14 beneath the healed epithelium in the skin graft interstices. The Vicryl fibers were hydrolyzed in the wound over a 2-to-4-week period, although some expulsion of fibers occurred as the healing epithelium advanced to close the MESTSG interstices. Elastic fibers were not seen in neodermal tissue in either control or experimental wounds at periods of up to 1 year after grafting. Further trials with this living tissue replacement are in progress.
我们评估了Dermagraft（先进组织科学公司，加利福尼亚州拉霍亚）的功能，它是一种由人类新生儿成纤维细胞组成的生物组织类似物，这些细胞生长在聚乙醇酸维可牢网（Ethicon公司，新泽西州萨默维尔）上，当置于网状、扩张的中厚皮片（MESTSGs）下方时，作为真皮替代物发挥作用。对17例烧伤患者（平均年龄31岁；范围6至69岁；平均烧伤面积占体表面积的23.8%）的全层烧伤创面进行清创，清创深度至皮下脂肪（9例患者）、筋膜（3例患者）或深真皮和脂肪联合处（5例患者）。将Dermagraft置于实验部位，然后覆盖MESTSGs。每位患者的配对对照部位仅接受MESTSGs。结果显示，对照部位MESTSGs的“成活情况”略优于含有Dermagraft的实验部位；然而，差异无统计学意义。全层创面（对照部位）表面或Dermagraft表面（实验部位）的网孔间隙均发生了上皮化。伤口活检标本未显示对培养的同种异体成纤维细胞有排斥迹象，对维可牢纤维的炎症反应也很轻微。通过层粘连蛋白和IV型胶原的免疫组织化学染色鉴定，在移植后第14天，在皮肤移植间隙愈合上皮下方可见上皮-Dermagraft交界处有连续基底膜形成的证据。维可牢纤维在伤口内2至4周内被水解，尽管随着愈合上皮推进以闭合MESTSG间隙，会有一些纤维被排出。在移植后长达1年的时间里，对照伤口或实验伤口的新生真皮组织中均未见到弹性纤维。关于这种生物组织替代物的进一步试验正在进行中。
