Greenwood John Edward, Dearman Bronwyn Louise
Adult Burn Centre, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
J Burn Care Res. 2012 Jan-Feb;33(1):7-19. doi: 10.1097/BCR.0b013e3182372be9.
The objective of this study is to further investigate the NovoSorb™ biodegradable polyurethane in generating dermal scaffolds; to perform a pilot study comparing the previously used spun mat against a recently developed NovoSorb™ foam, ascertaining the optimum structure of the matrix; and to evaluate the successful matrix as an immediate adjunct to split skin grafting and as a temporizing matrix in a prospective six-pig study. A pilot study comparing a previously investigated form of the polymer (spun mat) against a new structural form, a foam, was performed. This was followed by a six-pig study of the foam matrix with three treatment arms-autologous split skin graft alone, polymer foam with immediate engraftment, and polymer foam with delayed engraftment. The foams allowed less wound contraction than the spun mats. The foam structure is less dense (cheaper to produce and having less degradation products). The material remained in situ despite clinical wound infection. Proof of concept was achieved in both treatment modalities in the main study. Split skin graft applied immediately over the polymer foam was able to engraft successfully. The result was "thicker" to pinch and "flush" with the skin surrounding the wound. There was no significant difference in the degree of wound contraction between the graft alone and the polymer plus immediate graft groups. Split skin graft also "took" when applied to the surface of a polymer that had been applied to a wound 11 days earlier, again with a thicker result, flush with the surrounding skin. Split skin grafts alone left a persisting depression. However, a significant degree of wound contraction (compared with the other two groups) was observed in the polymer plus delayed graft group. This has prompted further investigation into "sealing" the polymer foam with a membrane, to prevent evaporative water loss, when the foam is to be used as a biodegradable temporizing matrix. The studies indicate that the NovoSorb™ platform will allow the creation of two inexpensive dermal matrix products; an immediate scaffold to allow a thicker grafting result and a biodegradable temporizing matrix (BTM) for wound integration after burn debridement while donor sites become reharvestable. However, further modification on the BTM structure is necessary to further reduce wound contraction pregrafting.
本研究的目的是进一步研究诺沃索布™（NovoSorb™）可生物降解聚氨酯在生成真皮支架方面的作用；开展一项初步研究，将先前使用的纺丝垫与最近开发的诺沃索布™泡沫进行比较，确定基质的最佳结构；并在一项前瞻性六头猪研究中，评估成功的基质作为即时辅助性植皮以及作为临时基质的效果。开展了一项初步研究，将先前研究过的聚合物形式（纺丝垫）与一种新的结构形式——泡沫进行比较。随后对泡沫基质进行了一项六头猪研究，设有三个治疗组：单独的自体断层皮片移植、即刻植入的聚合物泡沫，以及延迟植入的聚合物泡沫。与纺丝垫相比，泡沫导致的伤口收缩更少。泡沫结构密度更低（生产成本更低且降解产物更少）。尽管临床伤口发生感染，该材料仍留在原位。在主要研究的两种治疗方式中均实现了概念验证。立即覆盖在聚合物泡沫上的断层皮片能够成功植入。结果是捏起来“更厚”，且与伤口周围皮肤“齐平”。单独植皮组与聚合物加即刻植皮组之间的伤口收缩程度无显著差异。当将断层皮片应用于11天前已应用于伤口的聚合物表面时，也能“成活”，结果同样更厚，与周围皮肤齐平。单独的断层皮片会留下持续的凹陷。然而，在聚合物加延迟植皮组中观察到显著程度的伤口收缩（与其他两组相比）。这促使进一步研究在将泡沫用作可生物降解临时基质时，用膜“密封”聚合物泡沫以防止水分蒸发流失的情况。研究表明，诺沃索布™平台将能够制造两种低成本的真皮基质产品；一种即时支架，以实现更厚的植皮效果，以及一种可生物降解的临时基质（BTM），用于烧伤清创后伤口愈合，同时供皮区可再次取材。然而，有必要对BTM结构进行进一步改进，以进一步减少植皮前的伤口收缩。
