Travis Taryn E, Mauskar Neil A, Mino Matthew J, Prindeze Nick, Moffatt Lauren T, Fidler Philip E, Jordan Marion H, Shupp Jeffrey W
From the The Burn Center, MedStar Washington Hospital Center, MedStar Health Research Institute, District of Columbia.
J Burn Care Res. 2014 Sep-Oct;35(5):e321-9. doi: 10.1097/BCR.0000000000000013.
The authors investigated whether the application of platelet-derived growth factor (PDGF) to donor site wounds would speed healing in a porcine model. In a red duroc pig model, three wounds that were 3 inches × 3 inches were created with a dermatome (0.06-inch depth) on one side of two different animals. These wounds were digitally and laser Doppler (LDI) imaged and biopsied immediately pre- and postwound creation and every 2 days for 2 weeks. A set of identical wounds were subsequently created on the opposite side of the same animals and treated with topical PDGF (becaplermin gel 0.01%, 4 g/wound) immediately on wounding. PDGF-treated wounds were imaged and biopsied as above. Digital images of wounds were assessed for epithelialization by clinicians using an ordinal scale. Perfusion units (PU) were evaluated by LDI. Wound healing was evaluated by hematoxylin and eosin histological visualization of an epithelium and intact basement membrane. First evidence of partial epithelialization was seen in control and PDGF-treated wounds within 7.7 ± 1.4 and 6.4 ± 1.1 days postwounding, respectively (P=.03). Completely epithelialized biopsies were seen in control and PDGF-treated wounds at 11.7 ± 2.6 and 9.6 ± 1.5 days, respectively (P=.02). Clinician evaluation of digital images showed that on day 9, control wounds were, on average, 48.3 ± 18.5% epithelialized vs 57.2 ± 20.2% epithelialized for PDGF-treated wounds. At day 16, control wounds showed an average of 72.9 ± 14.6% epithelialization and PDGF-treated wounds showed an average of 90 ± 11.8%epithelialization. Overall, PDGF-treated wounds had statistically significantly higher scores across all timepoints (P=.02). Average perfusion units as measured by LDI were similar for control and PDGF-treated wounds at time of excision (225 ± 81and 257 ± 100, respectively). On day 2 postwounding, average PU for control wounds were 803 and were 764 for PDGF-treated wounds. Control wounds maintained higher PU values compared with PDGF-treated wounds at all time points and returned to excision PU values by day 12.2 ± 1.1 postwounding. PDGF-treated wounds reached the same values by day 9.7 ± 2.3 (P=.03). The authors conclude that topical PDGF speeds time to epithelialization of partial-thickness wounds in a porcine model as evidenced by histology, clinical appearance, and time to return to prewounding vascularity.
作者们研究了在猪模型中,将血小板衍生生长因子(PDGF)应用于供皮区伤口是否会加速愈合。在一个红色杜洛克猪模型中,在两只不同动物的一侧用取皮刀制造了三个3英寸×3英寸的伤口(深度为0.06英寸)。在伤口制造前、后立即以及在接下来的2周内每2天对这些伤口进行数字成像和激光多普勒(LDI)成像,并进行活检。随后在同一动物的另一侧制造一组相同的伤口,并在受伤后立即用局部PDGF(0.01%的贝卡普勒明凝胶,4克/伤口)进行治疗。对用PDGF治疗的伤口进行如上所述的成像和活检。临床医生使用序数量表对伤口的数字图像进行上皮化评估。通过LDI评估灌注单位(PU)。通过苏木精和伊红对上皮和完整基底膜进行组织学观察来评估伤口愈合情况。在受伤后7.7±1.4天和6.4±1.1天,分别在对照伤口和用PDGF治疗的伤口中首次出现部分上皮化的迹象(P = 0.03)。在受伤后11.7±2.6天和9.6±1.5天,分别在对照伤口和用PDGF治疗的伤口中看到完全上皮化的活检样本(P = 0.02)。临床医生对数字图像的评估显示,在第9天,对照伤口平均上皮化程度为48.3±18.5%,而用PDGF治疗的伤口为57.2±20.2%。在第16天,对照伤口平均上皮化程度为72.9±14.6%,用PDGF治疗的伤口平均上皮化程度为90±11.8%。总体而言,在所有时间点,用PDGF治疗的伤口得分在统计学上显著更高(P = 0.02)。在切除时,通过LDI测量的对照伤口和用PDGF治疗的伤口的平均灌注单位相似(分别为225±81和257±100)。在受伤后第2天,对照伤口的平均PU为803,用PDGF治疗的伤口为764。在所有时间点,对照伤口的PU值均高于用PDGF治疗的伤口,并在受伤后12.2±1.1天恢复到切除时的PU值。用PDGF治疗的伤口在9.7±2.3天达到相同值(P = 0.03)。作者得出结论,如组织学、临床外观以及恢复到受伤前血管状态的时间所证明的,局部应用PDGF可加快猪模型中部分厚度伤口的上皮化时间。