Singer Adam J, Hirth Douglas, McClain Steve A, Clark Richard A F
Department of Emergency Medicine, Stony Brook University, Stony Brook, New York 11794-8350, USA.
J Burn Care Res. 2012 Mar-Apr;33(2):286-90. doi: 10.1097/BCR.0b013e3182331de2.
One of the most important and earliest measures of burn healing is wound reepithelialization. Reepithelialization is a vital determinant of wound infection and scarring. Reepithelialization is generally based on gross visual assessment; however, histological assessment remains the criterion standard. We hypothesized that there would be poor agreement (r < .4) between gross visual and histological assessments of burn reepithelialization in a porcine model. The study design was prospective observational using three anesthetized female pigs (20-25 kg). Forty-eight 2.5- × 2.5-cm burns were created on the flanks of pig's using an aluminum bar (150 g) preheated to 80°C for 20 seconds. Burns were treated with an occlusive or antimicrobial dressing and photographed at day 10 for determination of gross percentage reepithelialization in a 1-cm diameter circle in the center of the burn by two experienced clinicians masked to each other's measurements. A 10-mm full-thickness punch biopsy was taken from the center of the burns and evaluated by a board-certified dermatopathologist masked to clinical assessments. One clinician and the dermatopathologist repeated the assessments 1 month apart. The outcome was percentage wound reepithelialization at 10 days. The criterion standard was the histological assessment. Intraobserver and interobserver agreements were calculated with Pearson's correlation coefficients. A coefficient less than .4 was considered poor. Sixteen burns were created on each of three animals. Six wounds were excluded because of the presence of a thick eschar covering the burn, making the gross determination of reepithelialization impossible. Intraobserver agreement for histological reepithelialization was 0.96 (P < .001). Intraobserver agreement for gross visual assessment of reepithelialization was 0.75 (P < .001). Interobserver agreement for gross visual assessment of reepithelialization was 0.60 (P < .001). The agreement between gross visual and histological assessment of burn reepithelialization was -0.25. Although there was a good interobserver agreement for gross visual assessments, there was a poor agreement between gross visual and histological assessments of burn reepithelialization. Care should be used when determining burn reepithelialization based on gross visual assessments alone.
烧伤愈合最重要且最早的指标之一是伤口再上皮化。再上皮化是伤口感染和瘢痕形成的关键决定因素。再上皮化通常基于肉眼大体评估；然而，组织学评估仍是标准判定方法。我们假设在猪模型中，烧伤再上皮化的肉眼大体评估与组织学评估之间的一致性较差（r < 0.4）。本研究设计为前瞻性观察性研究，使用三只麻醉后的雌性猪（20 - 25千克）。使用预热至80°C的铝棒（150克）在猪的侧腹制造48个2.5×2.5厘米的烧伤创面，持续20秒。烧伤创面用封闭性或抗菌敷料处理，并在第10天拍照，由两名相互不知对方测量结果的经验丰富的临床医生确定烧伤创面中心直径1厘米圆圈内的再上皮化肉眼大体百分比。从烧伤创面中心取一块10毫米全层皮肤打孔活检组织，由一名对临床评估不知情的皮肤科病理学家进行评估。一名临床医生和皮肤科病理学家相隔1个月重复评估。观察指标为第10天时伤口再上皮化的百分比。标准判定方法为组织学评估。观察者内和观察者间的一致性通过Pearson相关系数计算。系数小于0.4被认为一致性较差。在三只动物身上各制造了16个烧伤创面。由于烧伤处覆盖有厚焦痂，无法进行再上皮化的肉眼大体判定，因此排除6个伤口。组织学再上皮化的观察者内一致性为0.96（P < 0.001）。再上皮化肉眼大体评估的观察者内一致性为0.75（P < 0.001）。再上皮化肉眼大体评估的观察者间一致性为0.60（P < 0.001）。烧伤再上皮化的肉眼大体评估与组织学评估之间的一致性为 - 0.25。尽管在肉眼大体评估方面观察者间一致性良好，但烧伤再上皮化的肉眼大体评估与组织学评估之间的一致性较差。仅基于肉眼大体评估确定烧伤再上皮化时应谨慎。
