Desai M H, Mlakar J M, McCauley R L, Abdullah K M, Rutan R L, Waymack J P, Robson M C, Herndon D N
Shriners Burns Institute, Galveston, TX 77550.
J Burn Care Rehabil. 1991 Nov-Dec;12(6):540-5. doi: 10.1097/00004630-199111000-00009.
Cultured epithelial autografts have been advocated for permanent closure of skin surfaces after massive thermal injuries. A 10-year-old boy sustained a nearly 100% total body surface area burn (98% full-thickness) in an explosion accident. Cultured epithelial autograft was used to cover 70% of the total body surface area on postburn day 26. In spite of early success of coverage, 60% of cultured epithelial autograft areas blistered and sloughed over the ensuing weeks. Electron microscopic examination of a biopsy specimen of the healed cultured epithelial autograft (80 days after placement) revealed a lack of dermal attachments of the anchoring fibrils. Additionally, blister fluid that was taken from the bullae of the cultured epithelial autograft revealed levels of 18 ng/ml thromboxane and 24 ng/ml prostaglandin E2. These levels are significantly higher than those seen in acute burn blister fluid and indicate an ongoing inflammatory process. Cultured keratinocytes, although they provide early wound closure, may not provide adequate long-term coverage for patients with massive burns.
培养的上皮自体移植片已被提倡用于大面积热烧伤后皮肤表面的永久性闭合。一名10岁男孩在一次爆炸事故中遭受了近100%的体表面积烧伤（98%为全层烧伤）。在烧伤后第26天，使用培养的上皮自体移植片覆盖了70%的体表面积。尽管早期覆盖成功，但在随后的几周内，60%的培养上皮自体移植片区域出现水泡并脱落。对愈合的培养上皮自体移植片（放置后80天）的活检标本进行电子显微镜检查发现，锚定原纤维缺乏真皮附着。此外，从培养上皮自体移植片的水泡中抽取的水泡液显示血栓素水平为18 ng/ml，前列腺素E2水平为24 ng/ml。这些水平明显高于急性烧伤水泡液中的水平，表明存在持续的炎症过程。培养的角质形成细胞虽然能早期闭合伤口，但对于大面积烧伤患者可能无法提供足够的长期覆盖。
