Yuru Shang, Dawei Li, Chuanan Shen, Kai Yin, Li Ma, Longzhu Li, Dongxu Zhao, Wenfeng Cheng
From the Department of Burns and Plastic Surgery, First Affiliated Hospital of People's Liberation Army General Hospital, Beijing, People's Republic of China.
J Burn Care Res. 2017 Nov/Dec;38(6):348-353. doi: 10.1097/BCR.0000000000000552.
Patients with extensive deep burns often lack enough autologous skin to cover the wounds. This study explores a new method using microskin in combination with autologous keratinocytes in the treatment of extensive deep burn. Wounds in the combination group were treated with automicroskin at an area expansion ratio of 20:1 (wound area to automicroskin area) and autologous keratinocyte suspension, which were compared with the following treatments: no autotransplant, only allografts (control group); autologous keratinocyte suspension only (keratinocyte only group); automicroskin at an area expansion ratio of 20:1 (20:1 group); and automicroskin at an area expansion ratio of 10:1 (10:1 group, positive control). The authors used epithelialization rate (epithelialized area on day 21 divided by original wound area), hematoxylin and eosin staining, laminin, and type IV collagen immunohistochemistry to assess wound healing. The epithelialization rate of combination group (74.2% ± 8.0%) was similar to that of 10: 1 group (84.3% ± 11.9%, P = .085) and significantly (P < .05) higher than that of 20:1 group (59.2% ± 10.8%), keratinocyte only group (53.8% ± 11.5%), and control group (22.7% ± 5.5%). The hematoxylin and eosin staining and immunohistochemistry showed the epithelialization in the combination group was better than that in the keratinocyte only group and control group. Microskin in combination with autologous keratinocyte suspension can promote the reepithelialization of full-thickness wounds and reduce the requirements for automircoskin, and it is a useful option in the treatment of extensive deep burns.
大面积深度烧伤患者往往缺乏足够的自体皮肤来覆盖创面。本研究探索一种使用微型皮联合自体角质形成细胞治疗大面积深度烧伤的新方法。联合组创面采用面积扩大比例为20:1(创面面积与微型皮面积之比)的自体微型皮和自体角质形成细胞悬液进行治疗,并与以下治疗方法进行比较:不进行自体移植,仅行异体皮移植(对照组);仅使用自体角质形成细胞悬液(仅角质形成细胞组);面积扩大比例为20:1的自体微型皮(20:1组);面积扩大比例为10:1的自体微型皮(10:1组,阳性对照组)。作者采用上皮化率(第21天的上皮化面积除以原始创面面积)、苏木精-伊红染色、层粘连蛋白和IV型胶原免疫组化来评估创面愈合情况。联合组的上皮化率(74.2%±8.0%)与10:1组(84.3%±11.9%,P=0.085)相似,且显著高于20:1组(59.2%±10.8%)、仅角质形成细胞组(53.8%±11.5%)和对照组(22.7%±5.5%)(P<0.05)。苏木精-伊红染色和免疫组化显示联合组的上皮化情况优于仅角质形成细胞组和对照组。微型皮联合自体角质形成细胞悬液可促进全层创面的再上皮化,减少对自体微型皮的需求,是治疗大面积深度烧伤的一种有效选择。