Faucher Lee D, Kleinbeck Kyle R, Kao Weiyuan John
Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA.
J Burn Care Res. 2010 Jan-Feb;31(1):137-45. doi: 10.1097/BCR.0b013e3181cb8f27.
Previously, we have shown in a cross-comparison study that multifunctional photopolymerized semiinterpenetrating network (sIPN) system is an effective donor site treatment in a swine model. The advantages of sIPN include spray-on application, in situ photopolymerization, and ability to cover large contoured areas. sIPN has also been shown to be an effective delivery vehicle for keratinocyte growth factor, dexamethasone, bupivacaine, and silver sulfadiazine in vitro. Our aim for this study was to show that these products delivered to the wound bed with sIPN would not change the wound healing characteristics compared with the control site through qualitative clinical evaluation and to compare the rate and quality of donor site healing through histologic evaluation. Eight Yucatan swine of 40 lbs each were randomly divided into four groups of two pigs before surgery. Each animal had 5.6% TBSA of skin harvested from two different dorsal regions, with one at 22/1000th-inch and the other at 30/1000th-inch setting on the dermatome. Each test site on each animal was then sequentially dressed with 50 cm(2) of Xeroform gauze, sIPN, sIPN loaded with 0.5% bupivacaine, or sIPN loaded with 1% silver sulfadiazine. sIPN with or without soluble drugs were applied as liquid, then photopolymerized in situ to form an elastic covering. Each of the test areas was separated by 50 cm(2) of autograft, which was used to divide the test areas. Wound assessment and killing occurred at days 7, 9, 14, and 21. A full-thickness biopsy was taken from each of the study areas for histological analysis. By 14 days, all areas showed complete epidermal coverage histologically. The 30/1000th-inch site revealed a thicker, more irregular dermis compared with the 22/1000th-site. Evaluation of the day-21 sites revealed equal thinning and flattening of the new epidermis. No site showed full restoration of the rete ridges. No signs of infection were seen in clinical or histological evaluations of any treatment. The addition of bupivacaine and silver sulfadiazine to sIPN does not show any alterations in wound healing of a donor site in a swine model when compared with sIPN without loaded drugs and a standard control dressing. This efficacy may be coupled with established localized sIPN drug delivery profiles and allow further studies to evaluate the efficacy of these drugs to promote healing, eradicate and prevent infection, and manage pain.
此前,我们在一项交叉对比研究中表明,多功能光聚合半互穿网络(sIPN)系统在猪模型中是一种有效的供皮区治疗方法。sIPN的优点包括喷雾式应用、原位光聚合以及覆盖大轮廓区域的能力。sIPN在体外也已被证明是角质形成细胞生长因子、地塞米松、布比卡因和磺胺嘧啶银的有效递送载体。本研究的目的是通过定性临床评估表明,与对照部位相比,通过sIPN递送至创面床的这些产品不会改变伤口愈合特征,并通过组织学评估比较供皮区愈合的速度和质量。8只体重各为40磅的尤卡坦猪在手术前被随机分为四组,每组两只猪。每只动物从两个不同的背部区域取皮,面积为总体表面积的5.6%,一个区域在取皮刀设置为22/1000英寸,另一个区域在取皮刀设置为30/1000英寸。然后在每只动物的每个测试部位依次用50平方厘米的干纱布、sIPN、载有0.5%布比卡因的sIPN或载有1%磺胺嘧啶银的sIPN进行包扎。含或不含可溶性药物的sIPN以液体形式应用,然后原位光聚合形成弹性覆盖物。每个测试区域由50平方厘米的自体移植物隔开,自体移植物用于分隔测试区域。在第7、9、14和21天进行伤口评估和处死动物。从每个研究区域取全层活检组织进行组织学分析。到第14天时,所有区域在组织学上均显示表皮完全覆盖。与22/1000英寸部位相比,30/1000英寸部位的真皮更厚且更不规则。对第21天的部位评估显示,新表皮的变薄和平坦程度相同。没有一个部位显示出 rete 嵴完全恢复。在任何治疗的临床或组织学评估中均未发现感染迹象。与未加载药物的sIPN和标准对照敷料相比,在sIPN中添加布比卡因和磺胺嘧啶银在猪模型中并未显示出供皮区伤口愈合有任何改变。这种有效性可能与已确立的局部sIPN药物递送特性相结合,并允许进一步研究评估这些药物促进愈合、根除和预防感染以及控制疼痛的功效。