Wang Hsian-Jenn, Wei Lin-Gwei, Wang Chi-Hsien, Cheng Ya-Chen, Chang Junn-Liang, Tsou Tai-Li, Ku Chih-Hung, Li Chun-Chang, Chiu Wen-Kuan, Chen Chieh-Feng
From the *Department of Plastic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei; †Division of Plastic Surgery, Department of Surgery, ‡Department of Pathology, Taoyuan Armed Forces General Hospital; §School of Healthcare and Management, Kainan University, Taoyuan; and ∥School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China.
Ann Plast Surg. 2017 Mar;78(3 Suppl 2):S148-S152. doi: 10.1097/SAP.0000000000001021.
Although tendon-exposed or bone-exposed wounds can be resurfaced with flaps, such surgeries may not be feasible in patients with poor general or local conditions. Biosynthetic artificial skin is an alternative for critical wound coverage. We designed a new artificial skin bilayer to close difficult wounds permanently.
This study compares incorporation and wound contraction between silicone acellular porcine dermis (SAPD) and the Integra graft (Integra Life Sciences Corp., Billerica, Mass) in a rat model.
The SAPD was manufactured according to our previously described standard procedures. Integra grafts were obtained commercially. We included 24 male adult Sprague-Dawley rats and divided them into 2 groups. After creating a 3 × 4-cm full-thickness wound on the back, we transplanted the same-sized SAPD and Integra grafts onto the rat wounds. Autologous full-thickness skin (FTS) was grafted onto the acellular porcine dermal matrix (APDM) of the SAPD and the Integra dermal matrix (IDM) 2 weeks later. We measured the wound size and contraction rate of recipient wounds, studied the incorporation of FTS on the dermal matrix, and did pathological examination. Generalized estimating equations were used to assess the data from repeated wound and scar contraction measurements using SAS v9.2.
The sizes of wounds of both groups decreased over time. No difference in wound contraction was observed between the SAPD and Integra groups at weeks 2, 4, or 6 after grafting. However, the contraction rates in both groups increased significantly. The pathological examination showed that the FTS was well incorporated in the APDM and IDM. The recipient wounds showed new vessels and cell infiltration in the new matrix, but no severe inflammation. Skin appendages were regenerating in the FTS. There was no rejection sign.
Both SAPD and Integra are double-layered artificial skin products. Our results demonstrate that APDM and IDM are good templates and show excellent incorporation with autologous FTS graft. The results also demonstrated gradual wound contraction over time, but the contraction rate was not different between SAPD and Integra 6 weeks after grafting in a rat model.
尽管肌腱外露或骨外露伤口可用皮瓣进行覆盖，但对于全身或局部状况较差的患者，此类手术可能不可行。生物合成人工皮肤是用于严重伤口覆盖的一种替代方法。我们设计了一种新型人工皮肤双层结构，以永久性闭合难愈伤口。
本研究在大鼠模型中比较了硅酮脱细胞猪真皮（SAPD）与Integra移植物（Integra生命科学公司，马萨诸塞州比勒里卡）之间的植入情况和伤口收缩情况。
SAPD按照我们之前描述的标准程序制造。Integra移植物购自商业渠道。我们纳入了24只成年雄性Sprague-Dawley大鼠，并将它们分为2组。在大鼠背部制造一个3×4厘米的全层伤口后，我们将相同大小的SAPD和Integra移植物移植到大鼠伤口上。2周后，将自体全层皮肤（FTS）移植到SAPD的脱细胞猪真皮基质（APDM）和Integra真皮基质（IDM）上。我们测量了受体伤口的大小和收缩率，研究了FTS在真皮基质上的植入情况，并进行了病理检查。使用广义估计方程，通过SAS v9.2评估来自重复伤口和瘢痕收缩测量的数据。
两组伤口大小均随时间减小。移植后第2周、第4周或第6周，SAPD组和Integra组之间在伤口收缩方面未观察到差异。然而，两组的收缩率均显著增加。病理检查显示FTS很好地植入了APDM和IDM。受体伤口在新基质中显示有新血管和细胞浸润，但无严重炎症。FTS中有皮肤附属器再生。无排斥迹象。
SAPD和Integra均为双层人工皮肤产品。我们的结果表明，APDM和IDM是良好的模板，与自体FTS移植物显示出良好的植入情况。结果还表明伤口随时间逐渐收缩，但在大鼠模型中移植6周后，SAPD和Integra之间的收缩率并无差异。
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