Myers Simon R, Partha Vaiude N, Soranzo Carlo, Price Richard D, Navsaria Harshad A
Centre for Cutaneous Research, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom.
Tissue Eng. 2007 Nov;13(11):2733-41. doi: 10.1089/ten.2007.0109.
Keratinocyte stem cell technology provides at least an adjuvant therapy to clinically close large cutaneous wounds (e.g., burn wounds). Here, the performance of keratinocyte cultures depends primarily on the quality of the bed to which they are applied. Clinical take rates for cultured keratinocyte grafts are optimal when applied to a vascularized dermal bed with minimal bacterial colonization. In the absence of autologous dermis, staged reconstruction with a dermal equivalent or dermal regeneration template is required. A novel product, Hyalomatrix, is a bilayer of an esterified hyaluronan scaffold beneath a silicone membrane. The scaffold delivers hyaluronan to the wound bed, and the silicone membrane acts as a temporary epidermal barrier. The product has been investigated in a controlled, porcine, acute full-thickness excisional wound model. Cultured autologous keratinocytes (CAKs) were delivered on Laserskin to acute full-thickness wounds treated with Hyalomatrix within chambers, and graft take rates were assessed longitudinally using image analysis. In the absence of chambers, wound contraction was assessed. Clinical CAK take rates fall sequentially with delay in application post-Hyalomatrix pre-treatment, but repeated pre-treatment removed this, with maximal take of 57.2% at 5 weeks post-wounding. In the absence of chambers, more-complete wound closure resulted from edge re-epithelialization and contraction, by a factor of 5 at 1 month, and was achieved at least 2 weeks sooner in the gold standard controls of split-thickness autograft to an acute or pre-treated wound bed. Wound contraction and late neodermal morphology (1 year) were similar in pre-treated CAKs and split-thickness autograft wounds. In this model, the Hyalomatrix wound bed pre-treatment increase in CAK take appeared to be dose dependent. The product appeared to act as a hyaluronan delivery system rather than a dermal regeneration template. The silicone membrane may limit wound bed colonization, and the combination of this temporary barrier with hyaluronan delivery and neodermis induction has been termed a barrier-delivery-induction system. The development of similar systems for serial application offers an alternative to a dermal regeneration template when CAKs are engrafted in the hostile, colonized environment of large burn wounds.
角质形成干细胞技术至少为临床上闭合大面积皮肤伤口（如烧伤创面）提供了一种辅助治疗方法。在此，角质形成细胞培养物的性能主要取决于其应用的创面质量。当应用于细菌定植最少的血管化真皮创面时，培养的角质形成细胞移植物的临床成活率最佳。在没有自体真皮的情况下，需要使用真皮替代物或真皮再生模板进行分期重建。一种新型产品Hyalomatrix是一种在硅酮膜下方的酯化透明质酸支架双层结构。该支架将透明质酸输送到创面床，硅酮膜作为临时的表皮屏障。该产品已在一个受控的猪急性全层切除伤口模型中进行了研究。将培养的自体角质形成细胞（CAK）接种在Laserskin上，用于在腔室内用Hyalomatrix治疗的急性全层伤口，并使用图像分析纵向评估移植物成活率。在没有腔室的情况下，评估伤口收缩情况。临床CAK成活率随Hyalomatrix预处理后应用延迟而依次下降，但重复预处理可消除这种情况，伤后5周时最大成活率为57.2%。在没有腔室的情况下，更完全的伤口闭合是由边缘再上皮化和收缩导致的，在1个月时达到5倍，并且在急性或预处理伤口床的中厚自体皮移植的金标准对照中至少提前2周实现。预处理的CAK伤口和中厚自体皮移植伤口的伤口收缩和晚期新真皮形态（1年）相似。在该模型中，Hyalomatrix创面床预处理使CAK成活率增加似乎呈剂量依赖性。该产品似乎起到了透明质酸输送系统的作用，而不是真皮再生模板。硅酮膜可能会限制创面床的定植，并且这种临时屏障与透明质酸输送和新真皮诱导的组合被称为屏障 - 输送 - 诱导系统。当CAK移植到大面积烧伤伤口的恶劣定植环境中时，开发类似的连续应用系统可作为真皮再生模板的替代方法。
