Qian Li-Wu, Fourcaudot Andrea B, Leung Kai P
From the US Army Institute of Surgical Research/Dental and Craniofacial Trauma Research and Tissue Regeneration, Joint Base Fort Sam Houston, San Antonio, Texas.
J Burn Care Res. 2017 Jan/Feb;38(1):e418-e422. doi: 10.1097/BCR.0000000000000406.
This study evaluated the effects of topical use of silver sulfadiazine cream (SSD) on wound healing and subsequent scarring in a rabbit ear wound model. Seven millimeter full-thickness excisional wounds were created in rabbit ears. Twenty-four rabbits were randomized into four groups in which each group received base cream, 0.01% SSD, 0.1% SSD, or 1% SSD, respectively. Each treatment was applied at 2-day intervals from postoperative days (PODs) 2 to 14. At POD 7, half of the rabbits from each group were killed and tissues were harvested to measure wound healing parameters that included epithelial gap and granulation area. At POD 28, the remaining rabbits from each group were assessed for hypertrophic scarring. Epithelial gaps in SSD-treated groups at concentrations of 0.1 and 1% were significantly larger than those of base cream-treated controls. In contrast, analysis of granulation areas that represent volume of granulation tissue formed during healing did not show any statistical differences between the base cream-treated group and all three SSD-treated groups. At POD 28, when compared to the base cream-treated group (1.44 ± 0.03), SSD-treated-groups (0.1 and 1%) had more (P < .05) hypertrophic scar formation (scar elevation index = 1.65 ± 0.04, 0.1%; 1.63 ± 0.06, 1%). The results of this study demonstrate that SSD treatment contributes not only to impaired reepithelialization but also to a greater hypertrophic scar formation. These results also indicate that caution should be exercised when using SSD clinically to prevent or treat wound infections.
本研究在兔耳伤口模型中评估了局部使用磺胺嘧啶银乳膏（SSD）对伤口愈合及后续瘢痕形成的影响。在兔耳上制造7毫米全层切除伤口。24只兔子被随机分为四组，每组分别接受基础乳膏、0.01% SSD、0.1% SSD或1% SSD治疗。从术后第2天（PODs）至第14天，每隔2天进行一次每种治疗。在POD 7时，每组半数兔子被处死并采集组织，以测量包括上皮间隙和肉芽组织面积在内的伤口愈合参数。在POD 28时，对每组剩余兔子进行增生性瘢痕评估。浓度为0.1%和1%的SSD治疗组的上皮间隙明显大于基础乳膏治疗对照组。相比之下，代表愈合过程中形成的肉芽组织体积的肉芽组织面积分析显示，基础乳膏治疗组与所有三个SSD治疗组之间没有任何统计学差异。在POD 28时，与基础乳膏治疗组（1.44±0.03）相比，SSD治疗组（0.1%和1%）有更多（P<0.05）增生性瘢痕形成（瘢痕隆起指数=1.65±0.04，0.1%；1.63±0.06，1%）。本研究结果表明，SSD治疗不仅会导致再上皮化受损，还会导致更大程度的增生性瘢痕形成。这些结果还表明，临床上使用SSD预防或治疗伤口感染时应谨慎。
