Girard Dorothée, Laverdet Betty, Buhé Virginie, Trouillas Marina, Ghazi Kamélia, Alexaline Maïa M, Egles Christophe, Misery Laurent, Coulomb Bernard, Lataillade Jean-Jacques, Berthod François, Desmoulière Alexis
1 University of Limoges , Myelin Maintenance and Peripheral Neuropathies (EA 6309), Faculties of Medicine and Pharmacy, Limoges, France .
2 University of Western Brittany , Laboratory of Neurosciences of Brest (EA 4685), Brest, France .
Tissue Eng Part B Rev. 2017 Feb;23(1):59-82. doi: 10.1089/ten.TEB.2016.0195. Epub 2016 Oct 7.
Many wound management protocols have been developed to improve wound healing after burn with the primordial aim to restore the barrier function of the skin and also provide a better esthetic outcome. Autologous skin grafts remain the gold standard in the treatment of skin burn, but this treatment has its limitation especially for patients presenting limited donor sites due to extensive burn areas. Deep burn injuries also alter the integrity of skin-sensitive innervation and have an impact on patient's quality of life by compromising perceptions of touch, temperature, and pain. Thus, patients can suffer from long-term disabilities ranging from cutaneous sensibility loss to chronic pain. The cellular mechanisms involved in skin reinnervation following injury are not elucidated yet. Depending on the depth of the burn, nerve sprouting can occur from the wound bed or the surrounding healthy tissue, but somehow this process fails to provide correct reinnervation of the wound during scarring. In addition, several clinical observations indicate that damage to the peripheral nervous system influences wound healing, resulting in delayed wound healing or chronic wounds, underlining the role of innervation and neuromediators for normal cutaneous tissue repair development. Promising tissue engineering strategies, including the use of biomaterials, skin substitutes, and stem cells, could provide novel alternative treatments in wound healing and help in improving patient's sensory recovery.
人们已经制定了许多伤口管理方案，以促进烧伤后的伤口愈合，其首要目标是恢复皮肤的屏障功能，并实现更好的美学效果。自体皮肤移植仍然是治疗皮肤烧伤的金标准，但这种治疗方法存在局限性，特别是对于那些因大面积烧伤而供体部位有限的患者。深度烧伤还会改变皮肤敏感神经支配的完整性，并通过损害触觉、温度觉和痛觉，对患者的生活质量产生影响。因此，患者可能会遭受从皮肤感觉丧失到慢性疼痛等长期残疾。损伤后皮肤再神经化所涉及的细胞机制尚未阐明。根据烧伤深度的不同，神经芽生可从创面床或周围健康组织长出，但在某种程度上，这一过程在瘢痕形成期间未能为创面提供正确的再神经支配。此外，一些临床观察表明，外周神经系统损伤会影响伤口愈合，导致伤口愈合延迟或形成慢性伤口，这突出了神经支配和神经介质在正常皮肤组织修复发育中的作用。包括使用生物材料、皮肤替代物和干细胞在内的有前景的组织工程策略，可为伤口愈合提供新的替代治疗方法，并有助于改善患者的感觉恢复。
