Qiu Y X, Zhang G A, Wan J B, Zhao X Z
Department of Burns, Beijing Jishuitan Hospital, Beijing 100035, China.
Zhonghua Shao Shang Za Zhi. 2016 Sep 20;32(9):555-9. doi: 10.3760/cma.j.issn.1009-2587.2016.09.009.
To explore the influence of covering of auto-crosslinked sodium hyaluronate gel in combination with xenogenic acellular dermal matrix (ADM) on healing of full-thickness skin defect wound in pig.
Totally four 10 cm×10 cm full-thickness skin defect wounds were reproduced symmetrically on both sides of spine on the back of each one of the six Chinese experimental minipigs. After autologous microskin grafting, the 4 wounds in each pig were divided into 4 groups according to the random number table, with 6 wounds in each group. Wounds in allogenic skin group (AS) were covered by full-thickness skin from one (not the recipient) of the 6 pigs; wounds in xenogenic skin group (XS) were covered by full-thickness skin of sheep; wounds in xenogenic ADM group (XA) were covered by ADM of sheep; wounds in combination group (C) were covered by ADM of sheep combined with auto-crosslinked sodium hyaluronate gel. The wounds were bound up with pressure, and the dressing was changed once every 7 days. On post surgery day (PSD) 7, 14, 21, 28, 35, and 42 when changing dressing, the condition of wounds and the exfoliation of the covering on microskin were observed, and the complete exfoliation time of the covering was recorded. On PSD 28, 35, and 42, the wound healing rate was calculated. Data were processed with one-way analysis of variance and SNK test.
(1) On PSD 7, no fluid appeared under the covering of wounds in groups AS and C, while plenty of fluid appeared under the covering of wounds in groups XS and XA. From PSD 14 to 35, most of the full-thickness skin of pig in group AS did not exfoliate. All the full-thickness skin of sheep in group XS exfoliated, leaving a lot of crusts on the surface of the wounds on PSD 14. Most of the ADM of sheep in group XA separated from the wound with the crusts turning dry and exfoliating on PSD 14. All the ADM of sheep exfoliated with most of the wounds healed in group C on PSD 35. On PSD 42, all the full-thickness skin of pig in group AS exfoliated, leaving most of the wounds unhealed; all the crusts exfoliated and the majority of wounds were healed in group XS and XA group; all the wounds in group C were healed. (2) Compared with that in group C[(32.7±3.3) d], the complete exfoliation time of the covering was obviously shorter in group XS[(15.2±4.8) d]and group XA[(22.2±6.3) d], with P values below 0.05, while the complete exfoliation time of the covering in group AS[(44.8±2.7) d]was obviously longer (P<0.05). (3) On PSD 28, 35, and 42, the wound healing rates in groups XS and XA[(21.2±2.6)%, (51.4±2.4)%, (89.6±2.8)%, and (23.7±3.4)%, (53.6±6.3)%, (91.3±4.9)%, respectively]were obviously lower than those in group C[(35.1±3.4)%, (62.1±6.7)%, (98.8±1.0)%, respectively, with P values below 0.05]. On PSD 42, the wound healing rate in group AS[(44.0±3.8)%]was significantly lower than the rates in the other 3 groups (with P values below 0.05).
Auto-crosslinked sodium hyaluronate gel combined with ADM of sheep used as covering of microskin grafts on full-thickness wound in pig can lengthen the persistence time of ADM of sheep on the wound, as well as promote wound healing.
探讨自交联透明质酸钠凝胶联合异种脱细胞真皮基质（ADM）覆盖对猪全层皮肤缺损创面愈合的影响。
选用6只中国实验用小型猪，在每只猪背部脊柱两侧对称制作4个10 cm×10 cm的全层皮肤缺损创面。自体微粒皮移植后，每只猪的4个创面按随机数字表法分为4组，每组6个创面。异体皮肤组（AS）创面覆盖取自6只猪中1只（非受体猪）的全层皮肤；异种皮肤组（XS）创面覆盖绵羊全层皮肤；异种ADM组（XA）创面覆盖绵羊ADM；联合组（C）创面覆盖绵羊ADM并联合自交联透明质酸钠凝胶。创面加压包扎，每7天换药1次。术后第7、14、21、28、35和42天换药时，观察创面情况及微粒皮覆盖物的脱落情况，记录覆盖物完全脱落时间。术后第28、35和42天，计算创面愈合率。数据采用单因素方差分析和SNK检验进行处理。
（1）术后第7天，AS组和C组创面覆盖物下无渗液，而XS组和XA组创面覆盖物下有大量渗液。术后第14天至35天，AS组猪的大部分全层皮肤未脱落。XS组绵羊的全层皮肤全部脱落，术后第14天创面表面留有大量痂皮。XA组绵羊的大部分ADM于术后第14天与创面分离，痂皮干燥脱落。C组绵羊的ADM于术后第35天全部脱落，大部分创面愈合。术后第42天，AS组猪的全层皮肤全部脱落，大部分创面未愈合；XS组和XA组痂皮全部脱落，大部分创面愈合；C组所有创面均愈合。（2）与C组[（32.7±3.3）d]相比，XS组[（15.2±4.8）d]和XA组[（22.2±6.3）d]覆盖物完全脱落时间明显缩短，P值均<0.05，而AS组[（44.8±2.7）d]覆盖物完全脱落时间明显延长（P<；0.05）。（3）术后第28、35和42天，XS组和XA组创面愈合率[分别为（21.2±2.6）%、（51.4±2.4）%、（89.6±2.8）%和（23.7±3.4）%、（53.6±6.3）%、（91.3±4.9）%]明显低于C组[分别为（35.1±3.4）%、（62.1±6.7）%、（98.8±1.0）%]，P值均<0.05。术后第42天，AS组创面愈合率[（44.0±3.8）%]明显低于其他3组（P值均<0..05）。
自交联透明质酸钠凝胶联合绵羊ADM覆盖猪全层创面的微粒皮移植，可延长绵羊ADM在创面上的存留时间，促进创面愈合。
