Moiemen Naiem S, Vlachou Evangelia, Staiano Jonathan J, Thawy Yi, Frame James D
University Hospital Birmingham, Birmingham, United Kingdom.
Plast Reconstr Surg. 2006 Jun;117(7 Suppl):160S-174S. doi: 10.1097/01.prs.0000222609.40461.68.
Yannas and Burke developed the concept of the dermal regeneration template in the 1970s. It is now a widely accepted tool in the treatment of burns as well as in reconstructive surgery.
The authors present a previously published study of Integra used in 20 consecutive patients to reconstruct 30 anatomical sites and then analyze the histologic and clinical outcomes. Wound healing was evaluated by examination of weekly punch biopsy specimens with standard and immunohistochemical stains. Patient satisfaction was assessed using a visual analogue scale, and scar appearance was assessed using a modified Vancouver Scar Scale.
Four distinct phases of dermal regeneration could be demonstrated histologically: imbibition, fibroblast migration, neovascularization, and remodeling and maturation. Full vascularization of the neodermis occurred at 4 weeks. Patients reported increased range of movement and improvement in appearance compared with their preoperative states.
The color of the matrix reflected the stage of neodermal vascularization. No adnexa, nerve endings, or elastic fibers were seen in any of the specimens. The new collagen was histologically indistinguishable from normal dermal collagen. The authors also present their current protocol and experience with using Integra for a range of reconstructive procedures.
20世纪70年代，扬纳斯和伯克提出了真皮再生模板的概念。如今，它在烧伤治疗以及重建手术中已成为一种被广泛接受的工具。
作者展示了一项此前发表的研究，该研究对连续20例患者使用Integra来重建30个解剖部位，然后分析组织学和临床结果。通过用标准染色和免疫组化染色检查每周的打孔活检标本评估伤口愈合情况。使用视觉模拟量表评估患者满意度，使用改良温哥华瘢痕量表评估瘢痕外观。
组织学上可证明真皮再生有四个不同阶段：吸收、成纤维细胞迁移、新血管形成以及重塑和成熟。新真皮在4周时实现完全血管化。与术前状态相比，患者报告活动范围增加且外观有所改善。
基质的颜色反映了新真皮血管化的阶段。在任何标本中均未见到附属器、神经末梢或弹性纤维。新胶原蛋白在组织学上与正常真皮胶原蛋白无法区分。作者还介绍了他们目前使用Integra进行一系列重建手术的方案和经验。
