El-Khatib H A, Hammouda A, Al-Ghol A, Habib B
Hamad Medical Hospitals, Burn Department, Doha, Qatar.
Ann Burns Fire Disasters. 2007 Jun 30;20(2):78-82.
Background. The use of skin substitutes as temporary or permanent coverings has been a subject of research and study since 1500 BC. Temporary coverage of the burn wound can decrease the metabolic rate, fluid loss, pain, and colonization. The aim of this study is to review clinical experience with Biobrane and aldehyde-treated porcine skin (E.Z. Derm) as biosynthetic skin substitutes for the treatment of excised burn wounds. Methods. Fifty-two patients (42 males and 10 females) with deep dermal and full-thickness burns were selected for this retrospective study. Half of these patients were treated with Biobrane (this part of the study covered the period Jan. 1995/Dec. 1999) and the other half were treated with E.Z. Derm (Jan. 2000/Dec. 2005). The mean total body surface area (TBSA) burned was 30%. The excisional therapy was carried out in stages, each procedure being limited to 7-15% TBSA. All the patients underwent either tangential excision or excision down to the muscle fascia. The male/female ratio was 3:1 and the patients' ages ranged between 5 and 67 yr (mean, 35 yr). Data collection included: initial observation (age, sex extent of burn, depth of burn, photograph), skin substitute observation (adherence, presence of fluid collection, rejection, infection, photograph), and follow-up wound evaluation. Results. Both Biobrane and E.Z. Derm reduced pain, decreased evaporative water and heat loss, and limited bacterial growth. Both decreased exudative protein loss, protected the underlying vessels and nerves, and enhanced the healing of partial-thickness wounds. Both promoted the development of granulation tissues to be ready for autografting, and neither presented antigenicity or transmitted diseases. Porcine skin showed limited wound adhesion and limited control of infection compared to Biobrane. Conclusion. Biobrane and E.Z. Derm protected excised burn wounds from bacterial contamination and dehydration. It can be concluded that Biobrane has the potential for long-term adherence (10 days). Aldehyde-treated porcine skin (E.Z. Derm) is a reliable tool for short-term use and should not remain on the wound more than 3-4 days.
背景。自公元前1500年以来，使用皮肤替代物作为临时或永久性覆盖物一直是研究的课题。烧伤创面的临时覆盖可降低代谢率、减少液体丢失、减轻疼痛并减少细菌定植。本研究的目的是回顾使用生物膜（Biobrane）和醛处理猪皮（E.Z. Derm）作为生物合成皮肤替代物治疗切除烧伤创面的临床经验。方法。选取52例（42例男性和10例女性）深Ⅱ度和全层烧伤患者进行这项回顾性研究。其中一半患者接受生物膜治疗（该部分研究涵盖1995年1月/1999年12月期间），另一半患者接受E.Z. Derm治疗（2000年1月/2005年12月）。烧伤的平均总体表面积（TBSA）为30%。切除治疗分阶段进行，每个步骤限于TBSA的7 - 15%。所有患者均接受了削痂或直至肌肉筋膜的切除。男女比例为3:1，患者年龄在5至67岁之间（平均35岁）。数据收集包括：初始观察（年龄、性别、烧伤范围、烧伤深度、照片）、皮肤替代物观察（粘附情况、有无积液、排斥反应、感染、照片）以及随访伤口评估。结果。生物膜和E.Z. Derm均能减轻疼痛、减少蒸发水和热量损失，并限制细菌生长。两者均减少渗出性蛋白质丢失，保护深层血管和神经，并促进浅Ⅱ度创面愈合。两者均促进肉芽组织生长以便进行自体植皮，且均未表现出抗原性或传播疾病。与生物膜相比，猪皮的伤口粘附有限且感染控制能力有限。结论。生物膜和E.Z. Derm可保护切除的烧伤创面免受细菌污染和脱水。可以得出结论，生物膜具有长期粘附（10天）的潜力。醛处理猪皮（E.Z. Derm）是短期使用的可靠工具，在伤口上停留不应超过3 - 4天。
