Pourmoussa Austin, Gardner Daniel J, Johnson Maxwell B, Wong Alex K
Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA 90033, USA.
Ann Transl Med. 2016 Dec;4(23):457. doi: 10.21037/atm.2016.12.44.
Chronic wounds affect over 4 million individuals and pose a significant burden to the US healthcare system. Diabetes, venous stasis, radiation or paralysis are common risk factors for chronic wounds. Unfortunately, the current standard of care (SOC) has a high relapse rate and these wounds continue to adversely affect patients' quality of life. Fortunately, advances in tissue engineering have allowed for the development of cell-based wound dressings that promote wound healing by improving cell migration and differentiation. As the available options continue to increase in quantity and quality, physicians should have a user-friendly guide to reference when deciding which dressing to use. The objective of this review is to identify the currently available biologic dressings, describe their indications, and provide a framework for integration into clinical practice. This review included 53 studies consisting of prospective and retrospective cohorts as well as several randomized control trials. Three general categories of cell-based biologic dressings were identified and nine brands were included. Cell-based biologic dressings have shown efficacy in a broad range of scenarios, and studies examining their efficacy have improved our understanding of the pathophysiology of chronic wounds. Amniotic and placental membranes have the widest scope and can be used to treat all subtypes of chronic wounds. Human skin allografts and bioengineered skin substitutes can be used for chronic ulcers but generally require a vascularized wound bed. Autologous platelet rich plasma (PRP) has shown promise in venous stasis ulcers and decubitus ulcers that have failed conventional treatment. Overall, more research is necessary to determine if these novel therapeutic options will change the current SOC, but current studies demonstrate encouraging results in the treatment of chronic wounds.
慢性伤口影响着超过400万人，给美国医疗保健系统带来了沉重负担。糖尿病、静脉淤滞、放疗或瘫痪是慢性伤口的常见风险因素。不幸的是，当前的标准护理（SOC）复发率很高，这些伤口继续对患者的生活质量产生不利影响。幸运的是，组织工程学的进展使得基于细胞的伤口敷料得以开发，这些敷料通过改善细胞迁移和分化来促进伤口愈合。随着可用选择在数量和质量上不断增加，医生在决定使用哪种敷料时应有一份便于使用的指南作为参考。本综述的目的是识别当前可用的生物敷料，描述其适应症，并提供一个整合到临床实践中的框架。本综述纳入了53项研究，包括前瞻性和回顾性队列研究以及多项随机对照试验。确定了基于细胞的生物敷料的三个一般类别，并纳入了九个品牌。基于细胞的生物敷料在广泛的情况下都显示出了疗效，对其疗效的研究增进了我们对慢性伤口病理生理学的理解。羊膜和胎盘膜的适用范围最广，可用于治疗所有亚型的慢性伤口。人同种异体皮肤和生物工程皮肤替代品可用于慢性溃疡，但通常需要有血管化的伤口床。自体富血小板血浆（PRP）在传统治疗失败的静脉淤滞性溃疡和压疮溃疡中显示出了前景。总体而言，需要更多研究来确定这些新的治疗选择是否会改变当前的标准护理，但目前的研究在慢性伤口治疗中显示出了令人鼓舞的结果。
