Teepe R G, Kreis R W, Koebrugge E J, Kempenaar J A, Vloemans A F, Hermans R P, Boxma H, Dokter J, Hermans J, Ponec M
Department of Dermatology, University Hospital, Leiden, The Netherlands.
J Trauma. 1990 Mar;30(3):269-75. doi: 10.1097/00005373-199003000-00004.
Seventeen patients with deep second- and third-degree burn wounds have been grafted with cultured autologous epidermis. These epidermal cell sheets were cultivated according to the feeder layer technique as described by Rheinwald and Green. After dispase treatment and detachment from the culture vessel, the cell sheets, mounted on a polyamide mesh, were ready for grafting. Patients with wounds excised at an early stage, prepared with human cadaver allografts or synthetic dressings, showed a significantly better graft take than nonexcised, chronic granulating wounds which were grafted at a later stage (47% versus 15%; p less than 0.002). Sandwich treatment of expanded mesh autografts and cultured autograft overlay did not improve the graft take, although in some cases wound healing was accelerated. The graft take was inversely correlated with the age of the patient (p = 0.01), and showed a weak inverse correlation with the day of first (and subsequent) culture grafting (p = 0.07). Wound infection was the main cause of graft failure. Up to 4 years after grafting, the grafted areas showed continued stability and the regenerated skin became supple, smooth, and pliable. Hypertrophic scar formation was less than observed in comparable areas treated with meshed grafts. Wound contraction occurred approximately to the same extent as in split-thickness skin grafts. We emphasize that by a better control of wound infection the graft take, also in secondary-stage procedures, can significantly improve.
17例深二度和三度烧伤创面患者接受了自体培养表皮移植。这些表皮细胞片是按照莱茵瓦尔德和格林描述的饲养层技术培养的。经Dispase处理并从培养容器上分离后，安装在聚酰胺网上的细胞片即可用于移植。早期切除创面并用人类尸体同种异体移植物或合成敷料处理的患者，其移植成活率明显高于未切除的慢性肉芽创面患者，后者在后期进行移植（47%对15%；p<0.002）。尽管在某些情况下伤口愈合加速，但扩展网状自体移植物和培养自体移植物覆盖的三明治治疗并未提高移植成活率。移植成活率与患者年龄呈负相关（p = 0.01），与首次（及后续）培养移植的天数呈弱负相关（p = 0.07）。伤口感染是移植失败的主要原因。移植后长达4年，移植区域持续稳定，再生皮肤变得柔软、光滑且有柔韧性。肥厚性瘢痕形成比用网状移植物治疗的可比区域少。伤口收缩程度与中厚皮片移植大致相同。我们强调，通过更好地控制伤口感染，即使在二期手术中，移植成活率也能显著提高。
