Wassermann D, Schlotterer M, Toulon A, Cazalet C, Marien M, Cherruau B, Jaffray P
Burn Center, Cochin Hospital, Paris, France.
Burns Incl Therm Inj. 1988 Aug;14(4):326-30. doi: 10.1016/0305-4179(88)90076-9.
The possibility of covering large areas of full thickness skin loss with 'living skin equivalent' produced by a modification of Bell's method was studied. Living skin equivalents, composed of a dermal equivalent (fibroblasts plus collagen) covered by epithelial cells were grafted, meshed or non-meshed, onto granulation tissue and, in one patient, onto fascia. Eight patients with full skin thickness burn wounds covering over 15 per cent of the body surface area were thus partially covered. The graft 'take' was evaluated every 48 h. In every patient grafted, an extensive lysis (60-90 per cent) of the skin equivalent graft was observed at the first dressing (48 h). In one patient only, a significant percentage of 'take' (40 per cent) was observed 14 days after grafting. These disappointing results were probably related to the presence of collagenases or proteases produced on the wound bed either by bacteria or by surrounding human cells. It appears that at the present time the biochemical nature of the dermal equivalent used is not yet completely appropriate to serve routinely as a substitute for human skin.
研究了通过改良贝尔方法制备的“活性皮肤替代物”覆盖大面积全层皮肤缺损的可能性。将由上皮细胞覆盖的真皮替代物（成纤维细胞加胶原蛋白）组成的活性皮肤替代物，以网状或非网状形式移植到肉芽组织上，在一名患者中移植到筋膜上。8名全层皮肤烧伤创面面积超过体表面积15%的患者因此得到部分覆盖。每48小时评估一次移植物的“存活情况”。在每例接受移植的患者中，首次换药（48小时）时均观察到皮肤替代物移植物大量溶解（60%-90%）。仅在一名患者中，移植后14天观察到显著比例（40%）的“存活”。这些令人失望的结果可能与伤口床中由细菌或周围人体细胞产生的胶原酶或蛋白酶的存在有关。目前看来，所使用的真皮替代物的生化性质尚不完全适合常规用作人体皮肤的替代品。
