Boyce Steven T, Kagan Richard J, Greenhalgh David G, Warner Petra, Yakuboff Kevin P, Palmieri Tina, Warden Glenn D
Department of Surgery, University of Cincinnati, OH 45267, USA.
J Trauma. 2006 Apr;60(4):821-9. doi: 10.1097/01.ta.0000196802.91829.cc.
Rapid and effective closure of full-thickness burn wounds remains a limiting factor in burns of greater than 50% of the total body surface area (TBSA). Hypothetically, cultured skin substitutes (CSS) consisting of autologous cultured keratinocytes and fibroblasts attached to collagen-based sponges may reduce requirements for donor skin, and morbidity from autograft harvesting and widely-meshed skin grafts.
To test this hypothesis, CSS were prepared from split-thickness skin biopsies collected after enrollment of 40 burn patients by informed consent into a study protocol approved by the local Institutional Review Boards of three participating hospitals. CSS and split-thickness skin autograft (AG) were applied in a matched-pair design to patients with full-thickness burns involving a mean value of 73.4% of the TBSA. Data collection consisted of photographs, area measurements of donor skin and healed wounds after grafting, qualitative outcome by the Vancouver Scale for burn scar, and biopsies of healed skin.
Engraftment at postoperative day (POD) 14 was 81.5 +/- 2.1% for CSS and 94.7 +/- 2.0 for AG. Percentage TBSA closed at POD 28 was 20.5 +/- 2.5% for CSS, and 52.1 +/- 2.0 for AG. The ratio of closed to donor areas at POD 28 was 66.2 +/- 8.4 for CSS, and 4.0 +/- 0.0 for each harvest of AG. Each of these values was significantly different between the graft types. Correlation of percent TBSA closed with CSS at POD 28 with percent TBSA full-thickness burn generated an r value of 0.37 (p < 0.0001). Vancouver Scale scores at 1 year after were not different for erythema, pliability, or scar height, but pigmentation remained deficient in CSS.
These results demonstrate that CSS reduce requirements for donor skin harvesting for grafting of excised, full-thickness burns of greater than 50% TBSA with qualitative outcome that is comparable to meshed AG. Availability of CSS for treatment of extensive, deep burns may reduce time to wound closure, morbidity, and mortality in this patient population.
对于超过体表面积（TBSA）50%的烧伤患者，快速有效地闭合全层烧伤创面仍然是一个限制因素。理论上，由自体培养角质形成细胞和成纤维细胞附着于胶原海绵组成的培养皮肤替代物（CSS）可能会减少对供皮的需求，以及自体皮采集和大张网状植皮带来的发病率。
为验证这一假设，在40例烧伤患者经知情同意纳入由三家参与医院的当地机构审查委员会批准的研究方案后，从其取皮后的断层皮肤活检样本中制备CSS。CSS和断层皮肤自体皮移植（AG）采用配对设计应用于平均TBSA达73.4%的全层烧伤患者。数据收集包括照片、供皮区和植皮后愈合创面的面积测量、温哥华烧伤瘢痕量表的定性结果以及愈合皮肤的活检。
术后第14天（POD 14）CSS的移植率为81.5±2.1%，AG为94.7±2.0%。POD 28时CSS闭合的TBSA百分比为20.5±2.5%，AG为52.1±2.0%。POD 28时闭合面积与供皮区面积之比CSS为66.2±8.4，每次AG采集为4.0±0.0。这些值在不同移植类型之间均有显著差异。POD 28时CSS闭合的TBSA百分比与全层烧伤的TBSA百分比的相关性产生的r值为0.37（p<0.0001）。1年后温哥华量表评分在红斑、柔韧性或瘢痕高度方面无差异，但CSS的色素沉着仍不足。
这些结果表明，CSS减少了对超过50%TBSA的切除全层烧伤植皮时供皮采集的需求，定性结果与网状AG相当。CSS可用于治疗大面积深度烧伤，这可能会减少该患者群体的创面闭合时间、发病率和死亡率。
