Osti E
Emergency Department, San Donà di Piave, Venice, Italy.
Ann Burns Fire Disasters. 2008 Jun 30;21(2):73-7.
The aim of this trial was to measure the pH value of the skin of burn patients using a non-invasive method, from the acute phase through to complete re-epithelialization. The research was then completed by treating the patients with new materials and innovative methods to verify whether this had an effect on the skin pH and on re-epithelialization time. In this clinical trial, the patients were medicated repeatedly with hydrogel (Burnshield®) kept in place by a transparent, semipermeable adhesive film with a moisture vapour transmission rate equivalent to 1600 until day 5 or 6 post-burn. In one patient, treated silk (DermaSilk®) was applied several times until re-epithelialization; in another patient, synthetic hyaluronic acid (Hyalomatrix®) was applied. Various studies using Dermasilk® have confirmed that the fibroin in silk stimulates re-epithelialization, in addition to keeping the burned skin disinfected, thanks to the antimicrobial agent contained in the treated silk. Hyalomatrix® was used on the other patient, as in other studies, as a temporary substitute for the skin in deep burns. Late complications (keloids and hypertrophic scars) can give rise, even after prolonged periods of time, to Marjolin's ulcer (carcinoma but also melanoma and sarcoma), which can develop in the course of a year. A recent Danish trial affirms that appropriate burn treatment facilitates re-epithelialization and decreases the incidence of Marjolin's ulcer. For the trial, we used a centimetre-wide strip of reactive paper sensitive to pH variations and an acid test (Duotest® kit) as a reference, applied for more than one minute on the patient's burned and slightly damp skin. We performed control procedures on the patient's normal skin, away from the wound site. The pH was measured from day 1 post-burn and every other day thereafter until complete re-epithelialization. We found alkaline pH values for the burned skin from the day of the burn until day 12, with an alkaline pH peak on day 4 (10.5 in the first patient, 9.5 in the second). The values then gradually returned to normal (pH, 5.5) from day 13 onwards. The mean re-epithelialization time was similar in the two patients, equivalent to 24.5 days (25 days in the first patient, 24 in the second), with a mean follow-up of 21 months (33 months in the first case, 9 in the second). No early or late complications were observed.
本试验的目的是采用非侵入性方法测量烧伤患者从急性期直至完全重新上皮化过程中皮肤的pH值。然后，通过用新材料和创新方法治疗患者来完成研究，以验证这是否会对皮肤pH值和重新上皮化时间产生影响。在这项临床试验中，患者反复使用水凝胶（Burnshield®）进行治疗，该水凝胶由透明的半透性粘合膜固定，其水汽透过率相当于1600，直至烧伤后第5天或第6天。在一名患者中，多次应用经处理的丝绸（DermaSilk®）直至重新上皮化；在另一名患者中，应用了合成透明质酸（Hyalomatrix®）。使用DermaSilk®的各种研究证实，丝绸中的丝素蛋白除了能保持烧伤皮肤消毒外，还能刺激重新上皮化，这得益于经处理丝绸中含有的抗菌剂。与其他研究一样，在另一名患者身上使用Hyalomatrix®作为深度烧伤皮肤的临时替代品。晚期并发症（瘢痕疙瘩和增生性瘢痕）即使在很长一段时间后也可能引发马乔林溃疡（癌，也可能是黑色素瘤和肉瘤），这种溃疡可在一年内形成。最近一项丹麦试验证实，适当的烧伤治疗有助于重新上皮化并降低马乔林溃疡的发生率。在试验中，我们使用了一条对pH变化敏感的1厘米宽的反应纸和一种酸度测试（Duotest®试剂盒）作为参考，将其在患者烧伤且略潮湿的皮肤上放置1分钟以上。我们在患者远离伤口部位的正常皮肤上进行了对照程序。从烧伤后第1天开始测量pH值，此后每隔一天测量一次，直至完全重新上皮化。我们发现，从烧伤当天到第12天，烧伤皮肤的pH值呈碱性，在第4天出现碱性pH峰值（第一名患者为10.5，第二名患者为9.5）。然后，从第13天起，pH值逐渐恢复正常（pH为5.5）。两名患者的平均重新上皮化时间相似，相当于24.5天（第一名患者为25天，第二名患者为24天），平均随访时间为21个月（第一例为33个月，第二例为9个月）。未观察到早期或晚期并发症。
