Supp Andrew P, Neely Alice N, Supp Dorothy M, Warden Glenn D, Boyce Steven T
Department of Research, Shriners Hospitals for Children, Cincinnati, Ohio 45229-3095, USA.
J Burn Care Rehabil. 2005 May-Jun;26(3):238-46.
Cultured skin substitutes (CSS) have become a useful adjunctive treatment for closure of burn wounds, but CSS are avascular and remain susceptible to microbial destruction longer than split-thickness skin grafts. Irrigation of CSS grafted to burn wounds with a topical antimicrobial solution (TAS) has been shown to promote engraftment of CSS, but TAS usage has potential limitations. Acticoat Burn Dressing (Acticoat; Westaim Biomedical, Exeter, NH) is a silver-coated barrier dressing reported to exhibit antimicrobial activity and to reduce infection in partial-thickness and full-thickness wounds. This study evaluated the cytotoxicity of Acticoat with CSS and the efficacy of Acticoat for the management of microbial contamination in CSS grafted to full-thickness wounds in athymic mice. The cytotoxicity of Acticoat was assessed in preliminary studies after 1 week of exposure to CSS during in vitro maturation or healing on wounds in athymic mice. Histologies were analyzed and cellular viability in the CSS was determined by MTT conversion on days 0, 1, and 7 of Acticoat exposure. At 1, 2, 3, and 4 weeks after grafting, wounds were traced, and areas of healing CSS were calculated by image analysis. At 4 weeks, wound biopsies were evaluated and scored for engraftment of human cells. In a subsequent study, wounds were inoculated with strain SBI-N of Pseudomonas aeruginosa at 1 x 10(5) cfu/wound before the application of CSS or inoculated onto the surface of Acticoat. At 4 weeks, swab cultures were collected from the surface of CSS and scored for the presence of SBI-N. Statistical significance was accepted at the 95% confidence level (P <.05). The data show that exposure in vitro of CSS to Acticoat was cytotoxic within 1 day, but 1 week of exposure in vivo did not injure CSS or inhibit wound healing. Contaminated wounds treated with Acticoat healed similarly to control treatments, with comparable rates of engraftment, and detection of SBI-N on the surface of only one graft. No SBI-N was detected on CSS after inoculation onto the surface of Acticoat. These results suggest that Acticoat may be suitable as a protective dressing to reduce environmental contamination of CSS, if used in conjunction with additional antimicrobials to control organisms present in the wound.
培养皮肤替代物（CSS）已成为烧伤创面闭合的一种有用辅助治疗方法，但CSS无血管，且比中厚皮片更易长期受到微生物破坏。用局部抗菌溶液（TAS）冲洗移植到烧伤创面的CSS已被证明可促进CSS的植入，但TAS的使用存在潜在局限性。Acticoat烧伤敷料（Acticoat；Westaim Biomedical，埃克塞特，新罕布什尔州）是一种镀银屏障敷料，据报道具有抗菌活性，并可减少部分厚度和全厚度伤口的感染。本研究评估了Acticoat对CSS的细胞毒性以及Acticoat在无胸腺小鼠全厚度伤口移植CSS中管理微生物污染的疗效。在体外成熟或无胸腺小鼠伤口愈合期间，将Acticoat暴露于CSS 1周后，在初步研究中评估Acticoat的细胞毒性。在Acticoat暴露的第0、1和7天，分析组织学并通过MTT转化测定CSS中的细胞活力。移植后1、2、3和4周，追踪伤口，通过图像分析计算愈合CSS的面积。在4周时，评估伤口活检并对人细胞的植入进行评分。在随后的一项研究中，在应用CSS之前或接种到Acticoat表面之前以1×10(5) cfu/伤口的剂量用铜绿假单胞菌菌株SBI-N接种伤口。在4周时，从CSS表面收集拭子培养物并对SBI-N的存在进行评分。在95%置信水平（P <.05）下接受统计学显著性。数据表明，CSS在体外暴露于Acticoat 1天内具有细胞毒性，但在体内暴露1周不会损伤CSS或抑制伤口愈合。用Acticoat治疗的污染伤口与对照治疗的愈合情况相似，植入率相当，且仅在一个移植物表面检测到SBI-N。接种到Acticoat表面后，CSS上未检测到SBI-N。这些结果表明，如果与额外抗菌剂联合使用以控制伤口中存在的微生物，则Acticoat可能适合作为一种保护性敷料以减少CSS的环境污染。
