Fang Taolin, Lineaweaver William C, Sailes Frederick C, Kisner Carson, Zhang Feng
From the *Department of Orthopaedic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; †Division of Plastic Surgery, University of Mississippi Medical Center, Jackson; and ‡Rakin Medical Center, Brandon, MS.
Ann Plast Surg. 2014 Nov;73(5):509-15. doi: 10.1097/SAP.0b013e3182840883.
Achieving permanent replacement of skin in extensive full-thickness and deep partial-thickness burn injuries and chronic wounds remains one of the fundamental surgical problems. Presently, split-thickness skin grafts are still considered the best material for surgical repair of an excised burn wound. However, in burns that affect greater than 50% of total body surface area, the patient has insufficient areas of unaffected skin from which split-thickness skin grafts can be harvested. The use of cultured epithelial (or epidermal) autografts (CEAs) has achieved satisfactory results. But the take rate of CEAs is poor in full-thickness bed or in chronically infected area. Providing temporary cover with allograft skin, or a more permanent allodermis, may increase clinical take. This review aims to (1) describe the use of CEAs in the regeneration of the epidermis, (2) introduce the application of the acellular dermal matrices (ADMs) in the clinics, and (3) enhance understanding of the CEAs applied with ADM as an appropriate strategy to treat the extended burn injuries. The current evidence regarding the cultured epithelial cell or keratinocyte autograft and dermal grafts applied in the treatment of burn injuries was investigated with an extensive electronic and manual search (MEDLINE and EMBASE). The included literature (N=136 publications) was critically evaluated focusing on the efficacy and safety of this technique in improving the healing of the deep dermal and full-thickness burn injuries. This review concluded that the use of ADM with CEAs is becoming increasingly routine, particularly as a life-saving tool after acute thermal trauma.
在大面积全层和深部部分厚度烧伤以及慢性伤口中实现皮肤的永久性替代仍然是基本的外科问题之一。目前，断层皮片仍然被认为是切除烧伤创面手术修复的最佳材料。然而，在烧伤面积超过体表面积50%的患者中，可供采集断层皮片的未受影响皮肤区域不足。使用培养的上皮（或表皮）自体移植物（CEA）已取得了令人满意的结果。但CEA在全层创面或慢性感染区域的成活率较低。提供同种异体皮肤或更持久的异体真皮作为临时覆盖物，可能会提高临床成活率。本综述旨在：（1）描述CEA在表皮再生中的应用；（2）介绍脱细胞真皮基质（ADM）在临床上的应用；（3）加深对CEA与ADM联合应用作为治疗大面积烧伤合适策略的理解。通过广泛的电子和手工检索（MEDLINE和EMBASE），研究了目前关于培养的上皮细胞或角质形成细胞自体移植物以及真皮移植物用于治疗烧伤的证据。对纳入的文献（N = 136篇出版物）进行了严格评估，重点关注该技术在改善深部真皮和全层烧伤愈合方面的有效性和安全性。本综述得出结论，CEA与ADM联合使用正变得越来越常规，尤其是作为急性热创伤后的一种救命工具。
