Hayashi Minoru, Muramatsu Hideyuki, Nakano Minoru, Ito Hideaki, Inoie Masukazu, Tomizuka Yosuke, Inoue Mayuko, Yoshimoto Shinya
From the *Department of Plastic and Reconstructive Surgery, †Advanced Medical Emergency and Critical Care Center, and ‡Department of Diagnostic Pathology, Japanese Maebashi Red Cross Hospital, Maebashi, Gunma; §Department of Research and Development, J-TEC, Gamagori, Aichi; and ∥Department of Plastic and Reconstructive Surgery, Showa University School of Medicine, Tokyo, Japan.
Ann Plast Surg. 2014 Jul;73(1):25-9. doi: 10.1097/SAP.0000000000000200.
In Japan, the cultured epithelial autografts "JACE" was accepted as a health insurance adaptation from January 1, 2009. We examined the extensive burn wounds in 8 patients by using a combination of autograft and JACE. After debridement, we managed the wound bed preparation by using artificial dermis. The wound bed was covered with fine tissue 2 weeks after we implanted artificial dermis and trafermin was used every day. Meshed 6:1 split-thickness autografts were placed onto the recipient wound bed under the JACE. The epidermalization was nearly complete within 3 to 4 weeks.
A total of 39 patients underwent medical treatment of burns. All patients burned more than 30% total body surface area (TBSA). We divided them into 2 groups. The control group consisted of 31 patient, 23 men and 8 women. They underwent operation not using JACE but only autograft. The average age of the patients was 59.61 (3.85) years. The TBSA burned in this control group was 58.94% (3.89%). Operation times were 2.16 (0.24) hours. The overall survival rate was 35.5%. The study group consisted of 8 patients, 5 men and 3 women. The average age of the patients was 56.38 (7.04) years. The TBSA burned in this study group was 51.63% (4.17%). Operation times were 4.25 (0.59) hours, and the overall survival rate in this study group was 87.5%. The average take rate of JACE was 80.0% (3.09%) 4 weeks postoperatively.
JACE is one of the cultured epithelial autografts. Although we managed the wound bed preparation by using artificial dermis instead of cryopreserved cadaver allograft, we were able to recognize a good result from grafting JACE on meshed 6:1 split-thickness autografts. The study group observed a significant difference in operation times compared with the control group. However, this treatment contributed to reducing the area of the donor site.
在日本，培养的上皮自体移植物“JACE”自2009年1月1日起被纳入健康保险适用范围。我们通过自体移植物和JACE联合使用的方法检查了8例大面积烧伤患者的伤口。清创后，我们使用人工真皮进行创面准备。植入人工真皮2周后，创面覆盖有薄组织，每天使用曲伐沙星。将6:1的网状中厚自体移植物置于JACE下的受区创面上。表皮化在3至4周内几乎完成。
共有39例患者接受了烧伤治疗。所有患者的烧伤面积均超过总体表面积（TBSA）的30%。我们将他们分为2组。对照组由31例患者组成，其中男性23例，女性8例。他们接受的手术未使用JACE，仅使用自体移植物。患者的平均年龄为59.61（3.85）岁。该对照组的TBSA烧伤面积为58.94%（3.89%）。手术时间为2.16（0.24）小时。总体生存率为35.5%。研究组由8例患者组成，其中男性5例，女性3例。患者的平均年龄为56.38（7.04）岁。该研究组的TBSA烧伤面积为51.63%（4.17%）。手术时间为4.25（0.59）小时，该研究组的总体生存率为87.5%。术后4周JACE的平均成活率为80.0%（3.09%）。
JACE是培养的上皮自体移植物之一。尽管我们使用人工真皮而非冷冻保存的同种异体尸体皮肤进行创面准备，但我们能够认识到将JACE移植到6:1的网状中厚自体移植物上能取得良好效果。研究组与对照组相比，手术时间存在显著差异。然而，这种治疗有助于减少供皮区面积。
