Association of Dutch Burn Centers, Beverwijk, The Netherlands.
Wound Repair Regen. 2012 Nov-Dec;20(6):797-805. doi: 10.1111/j.1524-475X.2012.00845.x. Epub 2012 Oct 30.
Previous research has shown clinical effectiveness of dermal substitution; however, in burn wounds, only limited effect has been shown. A problem in burn wounds is the reduced take of the autograft, when the substitute and graft are applied in one procedure. Recently, application of topical negative pressure (TNP) was shown to improve graft take. The aim of this study was to investigate if application of a dermal substitute in combination with TNP improves scar quality after burns. In a four-armed multicenter randomized controlled trial, a split-skin graft with or without a dermal substitute and with or without TNP was compared in patients with deep dermal or full-thickness burns requiring skin transplantation. Graft take and rate of wound epithelialization were evaluated. Three and 12 months postoperatively, scar parameters were measured. The results of 86 patients showed that graft take and epithelialization did not reveal significant differences. Significantly fewer wounds in the TNP group showed postoperative contamination, compared to other groups. Highest elasticity was measured in scars treated with the substitute and TNP, which was significantly better compared to scars treated with the substitute alone. Concluding, this randomized controlled trial shows the effectiveness of dermal substitution combined with TNP in burns, based on extensive wound and scar measurements.
先前的研究表明皮肤替代物具有临床疗效；然而，在烧伤创面中，其疗效有限。在烧伤创面中存在一个问题，当替代物和移植物在一个程序中应用时，自体移植物的吸收率会降低。最近，应用负压创面治疗技术（TNP）已被证明可以提高移植物的吸收率。本研究旨在探讨在烧伤后应用皮肤替代物联合 TNP 是否能改善瘢痕质量。在一项四臂多中心随机对照试验中，比较了深二度或三度烧伤患者接受皮肤移植时，应用带或不带皮肤替代物的刃厚皮片游离移植，以及应用或不应用 TNP 的效果。评估移植物吸收率和创面上皮化率。术后 3 个月和 12 个月测量瘢痕参数。86 例患者的结果表明，移植物吸收率和上皮化率没有显著差异。与其他组相比，TNP 组术后污染的创面明显更少。接受替代物和 TNP 治疗的瘢痕弹性最高，与单独接受替代物治疗的瘢痕相比有显著改善。综上，本随机对照试验基于广泛的创面和瘢痕测量，表明皮肤替代物联合 TNP 在烧伤中的有效性。
