Heimbach D M
University of Washington Burn Center, Harborview Medical Center, Seattle.
J Burn Care Rehabil. 1992 Jan-Feb;13(1):127-9. doi: 10.1097/00004630-199201000-00029.
Clinical experience assumes major importance as the source of data on cultured epidermal autograft (CEA), since a large controlled study is probably not forthcoming. Among the general questions to be answered are: Which patients are candidates for grafting with CEA? Do selection criteria specify size of total body surface area burn or age? Is CEA more suitable for certain body areas than others? Does CEA close the wound as quickly, as well, and as safely as other available methods of coverage? Fresh or frozen allograft, the gold standard, is presumed to be safe, but the current concern about transmission of viral diseases raises doubts. Presumably, CEA would be safe. Other concerns are care of the wound and control of infection during the 3-week waiting period that is required for CEA. What is actual CEA "take" (i.e., areas that do not require regrafting)? What is the clinical experience with follow-up? Cost-effectiveness of CEA is a factor including hospital stay and hidden costs such as failure of temporary wound coverage. Whether CEA saves lives is probably unanswerable, but as a skin cover it may reduce incidence of burn wound sepsis. Perhaps in the future, a combination of cultured epidermal cells and a type of permanent dermis will produce a cover that is genuine skin. Today we have only materials that are parts of skin.
由于可能无法开展大规模对照研究，临床经验作为培养的表皮自体移植物（CEA）数据的来源具有至关重要的意义。需要回答的一般性问题包括：哪些患者适合接受CEA移植？选择标准是否明确了烧伤总面积或年龄？CEA是否在某些身体部位比其他部位更适用？与其他现有的覆盖方法相比，CEA能否同样快速、有效地安全闭合伤口？新鲜或冷冻的同种异体移植物作为金标准，被认为是安全的，但目前对病毒疾病传播的担忧引发了质疑。据推测，CEA会是安全的。其他问题包括在CEA所需的3周等待期内伤口的护理和感染的控制。实际的CEA“成活率”（即无需再次移植的面积）是多少？随访的临床经验如何？CEA的成本效益是一个因素，包括住院时间和临时伤口覆盖失败等隐性成本。CEA是否能挽救生命可能无法回答，但作为一种皮肤覆盖物，它可能会降低烧伤创面脓毒症的发生率。也许在未来，培养的表皮细胞和一种永久性真皮的组合将产生一种真正的皮肤覆盖物。如今我们只有皮肤的组成部分。
