Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA.
Department of Otolaryngology-Head and Neck Surgery, University of Alabama Birmingham, Birmingham, AL.
Int Forum Allergy Rhinol. 2018 Oct;8(10):1162-1168. doi: 10.1002/alr.22156. Epub 2018 Jun 1.
To better understand upper airway tissue regeneration, the exposed cartilage and bone at donor sites of tissue flaps may serve as in vivo "Petri dishes" for active wound healing. The pedicled nasoseptal flap (NSF) for skull-base reconstruction creates an exposed donor site within the nasal airway. The objective of this study is to evaluate whether grafting the donor site with a sinonasal repair cover graft is effective in promoting wound healing.
In this multicenter, prospective trial, subjects were randomized to intervention (graft) or control (no graft) intraoperatively after NSF elevation. Individuals were evaluated at 2, 6, and 12 weeks postintervention with endoscopic recordings. Videos were graded (Likert scale) by 3 otolaryngologists blinded to intervention on remucosalization, crusting, and edema. Scores were analyzed for interrater reliability and cohorts compared. Biopsy and immunohistochemistry at the leading edge of wound healing was performed in select cases.
Twenty-one patients were randomized to intervention and 26 to control. Subjects receiving the graft had significantly greater overall remucosalization (p = 0.01) than controls over 12 weeks. Although crusting was less in the small intestine submucosa (SIS) group, this was not statistically significant (p = 0.08). There was no overall effect on nasal edema (p = 0.2). Immunohistochemistry demonstrated abundant upper airway basal cell progenitors in 2 intervention samples, suggesting that covering grafts may facilitate tissue proliferation via progenitor cell expansion.
This prospective, randomized, controlled trial indicates that a porcine SIS graft placed on exposed cartilage and bone within the upper airway confers improved remucosalization compared to current practice standards.
为了更好地了解上呼吸道组织再生，组织瓣供体部位暴露的软骨和骨可能成为体内“培养皿”，促进活跃的伤口愈合。用于颅底重建的带蒂鼻中隔鼻瓣（NSF）会在上鼻道内产生暴露的供体部位。本研究旨在评估在上皮化过程中，将供体部位用鼻腔鼻窦修复覆盖移植物进行移植是否能有效促进伤口愈合。
在这项多中心、前瞻性试验中，在 NSF 抬高后，将患者随机分为干预（移植）或对照（无移植）组。在术后 2、6 和 12 周，通过鼻内镜检查对患者进行评估。录像由 3 位耳鼻喉科医生进行评分（Likert 量表），这些医生对干预措施不知情，评估内容为黏膜化、结痂和水肿。对评分进行组内和组间的可靠性分析。在选择的病例中，对伤口愈合前缘进行活检和免疫组织化学检查。
21 名患者被随机分配到干预组，26 名患者被分配到对照组。在 12 周的时间内，接受移植物的患者总体上黏膜化程度更高（p = 0.01）。虽然小肠黏膜下层（SIS）组的结痂程度较低，但这没有统计学意义（p = 0.08）。对鼻腔水肿没有总体影响（p = 0.2）。免疫组织化学显示，2 例干预样本中存在丰富的上呼吸道基底细胞祖细胞，这表明覆盖移植物可能通过祖细胞的扩增促进组织增殖。
这项前瞻性、随机、对照试验表明，与当前的标准治疗相比，在上呼吸道暴露的软骨和骨上放置猪 SIS 移植物可促进更好的上皮化。
