Gibbs S, van den Hoogenband H M, Kirtschig G, Richters C D, Spiekstra S W, Breetveld M, Scheper R J, de Boer E M
Department of Dermatology, VU Medical Centre, De Boelelaan, 1081 HV Amsterdam, the Netherlands.
Br J Dermatol. 2006 Aug;155(2):267-74. doi: 10.1111/j.1365-2133.2006.07266.x.
Chronic wounds represent a major problem to our society. Therefore, advanced wound-healing strategies for the treatment of these wounds are expanding into the field of tissue engineering.
To develop a novel tissue-engineered, autologous, full-thickness skin substitute of entirely human origin and to determine its ability to heal chronic wounds.
Skin substitutes (fully differentiated epidermis on fibroblast-populated human dermis) were constructed from 3-mm punch biopsies isolated from patients to be treated. Acellular allodermis was used as a dermal matrix. After a prior 5-day vacuum-assisted closure therapy to prepare the wound bed, skin substitutes were applied in a simple one-step surgical procedure to 19 long-standing recalcitrant leg ulcers (14 patients; ulcer duration 0.5-50 years).
The success rate in culturing biopsies was 97%. The skin substitute visibly resembled an autograft. Eleven of the 19 ulcers (size 1-10 cm2) healed within 8 weeks after a single application of the skin substitute. The other eight larger (60-150 cm2) and/or complicated ulcers healed completely (n = 5) or continued to decrease substantially in size (n = 3) after the 8-week follow-up period. Wound healing occurred by direct take of the skin substitute (n = 12) and/or stimulation of granulation tissue/epithelialization (n = 7). Skin substitutes were very well tolerated and pain relief was immediate after application.
Application of this novel skin substitute provides a promising new therapy for healing chronic wounds resistant to conventional therapies.
慢性伤口是社会面临的一个重大问题。因此，用于治疗这些伤口的先进伤口愈合策略正在扩展到组织工程领域。
开发一种全新的、完全源自人类的组织工程自体全层皮肤替代物，并确定其治愈慢性伤口的能力。
从待治疗患者身上获取3毫米的打孔活检组织，构建皮肤替代物（成纤维细胞填充的人真皮上的完全分化表皮）。脱细胞异体真皮用作真皮基质。在进行为期5天的负压封闭引流治疗以准备伤口床后，通过简单的一步手术将皮肤替代物应用于19例长期顽固性腿部溃疡患者（14例患者；溃疡持续时间0.5 - 50年）。
活检组织培养成功率为97%。皮肤替代物明显类似于自体移植皮片。19例溃疡中有11例（面积1 - 10平方厘米）在单次应用皮肤替代物后8周内愈合。其他8例较大（60 - 150平方厘米）和/或复杂的溃疡在8周随访期后完全愈合（5例）或面积继续大幅缩小（3例）。伤口通过皮肤替代物的直接贴附（12例）和/或肉芽组织刺激/上皮化（7例）实现愈合。皮肤替代物耐受性良好，应用后疼痛立即缓解。
应用这种新型皮肤替代物为治愈对传统疗法有抗性的慢性伤口提供了一种有前景的新疗法。
