Ryssel H, Gazyakan E, Germann G, Ohlbauer M
Department for Hand, Plastic and Reconstructive Surgery, Burn Center, BG-Trauma Center Ludwigshafen, The University of Heidelberg, Ludwig Guttmann Str. 13, D-67071 Ludwigshafen, Germany.
Burns. 2008 Feb;34(1):93-7. doi: 10.1016/j.burns.2007.01.018. Epub 2007 Jul 17.
The application of dermal substitutes in deep partial and full-thickness burn wounds in a two-stage procedure prior to skin grafting has become increasingly popular. Synchronous application of dermal substitutes and skin graft has not yet been established as a standard procedure. In a consecutive study 20 wounds in 10 patients with severe burns (age 49.5+/-16.2 years; TBSA 45.6+/-14.5%) were treated with either simultaneous transplantation of Matriderm, a bovine based collagen I, III, V and elastin hydrolysate based dermal substitute and split-thickness skin grafting (STSG), or STSG alone after appropriate excision of the burn wound. The study was designed as a prospective intra-individual comparative study. After 1 week all wounds were assessed for the percentage of autograft survival. Autograft survival was not altered by simultaneous application of a dermal matrix (p=0.015). Skin elasticity was measured after 3-4 months with the Vancouver Burn Skin Score (VBSS). The VBSS demonstrated a significant increase of elasticity in the group with dermal substitutes (p=0.04) as compared with non-substituted wounds for sheet autograft, but not for meshed autograft (p=0.24). From this pilot study it can be concluded that simultaneous application of a dermal matrix is safe and feasible, yielding significantly better results with respect to skin elasticity. Skin elasticity was considerably improved by the collagen/elastin dermal substitute Matriderm in combination with sheet autograft.
在皮肤移植前分两阶段将真皮替代物应用于深Ⅱ度和全层烧伤创面已越来越普遍。真皮替代物与皮肤移植同步应用尚未成为标准术式。在一项连续性研究中，对10例重度烧伤患者（年龄49.5±16.2岁；烧伤总面积45.6±14.5%）的20个创面，分别采用同时移植基于牛I型、III型、V型胶原蛋白和弹性蛋白水解物的真皮替代物Matriderm与中厚皮片移植（STSG），或在适当切除烧伤创面后仅行STSG进行治疗。该研究设计为前瞻性个体内对照研究。1周后评估所有创面的自体皮片存活百分比。同时应用真皮基质对自体皮片存活无影响（p=0.015）。3 - 4个月后用温哥华烧伤皮肤评分（VBSS）测量皮肤弹性。与未使用替代物的自体皮片创面相比，使用真皮替代物的组VBSS显示弹性显著增加（p=0.04），但对网状自体皮片而言无显著差异（p=0.24）。从这项初步研究可以得出结论，同时应用真皮基质是安全可行的，在皮肤弹性方面能产生显著更好的效果。胶原蛋白/弹性蛋白真皮替代物Matriderm与自体皮片联合应用可显著改善皮肤弹性。
