Waldner Matthias, Ismail Tarek, Lunger Alexander, Klein Holger J, Schweizer Riccardo, Alan Oramary, Breckwoldt Tabea, Giovanoli Pietro, Plock Jan A
Plastic Surgery and Hand Surgery, UniversitätsSpital Zürich, Zurich, Switzerland.
Division of Plastic Surgery and Hand Surgery, UniversitätsSpital Zürich, Zurich, Switzerland.
Scars Burn Heal. 2022 Jan 6;8:20595131211052394. doi: 10.1177/20595131211052394. eCollection 2022 Jan-Dec.
BACKGROUND: Deep partial-thickness burns are traditionally treated by tangential excision and split thickness skin graft (STSG) coverage. STSGs create donor site morbidity and increase the wound surface in burn patients. Herein, we present a novel concept consisting of enzymatic debridement of deep partial-thickness burns followed by co-delivery of autologous keratinocyte suspension and plated-rich fibrin (PRF) or fibrin glue. MATERIAL AND METHODS: In a retrospective case study, patients with deep partial-thickness burns treated with enzymatic debridement and autologous cell therapy combined with PRF or fibrin glue (BroKerF) between 2017 and 2018 were analysed. BroKerF was applied to up to 15% total body surface area (TBSA); larger injuries were combined with surgical excision and skin grafting. Exclusion criteria were age <18 or >70 years, I°, IIa°-only, III° burns and loss of follow-up. RESULTS: A total of 20 patients with burn injuries of 16.8% ± 10.3% TBSA and mean Abbreviated Burn Severity Score 5.45 ± 1.8 were identified. Of the patients, 65% (n = 13) were treated with PRF, while 35% (n = 7) were treated with fibrin glue. The mean area treated with BroKerF was 7.5% ± 0.05% TBSA, mean time to full epithelialization was 21.06 ± 9.2 days and mean hospitalization time was 24.7 ± 14.4 days. Of the patients, 35% (n = 7) needed additional STSG, 43% (n = 3) of whom had biopsy-proven wound infections. CONCLUSION: BroKerF is an innovative treatment strategy, which, in our opinion, will show its efficacy when higher standardization is achieved. The combination of selective debridement and autologous skin cells in a fibrin matrix combines regenerative measures for burn treatment. LAY SUMMARY: Patients suffering from large burn wounds often require the use of large skin grafts to bring burned areas to heal. Before the application of skin grafts, the burned skin must be removed either by surgery or using enzymatic agents. In this article, we describe a method where small areas of skin are taken and skin cells are extracted and sprayed on wound areas that were treated with an enzymatic agent. The cells are held in place by a substance extracted from patients' blood (PRF) that is sprayed on the wound together with the skin cells. We believe this technique can be helpful to reduce the need of skin grafts in burned patients and improve the healing process.
背景：传统上，深度部分厚度烧伤采用削痂和中厚皮片移植（STSG）覆盖治疗。STSG会造成供区损伤，并增加烧伤患者的创面面积。在此，我们提出一种新概念，即对深度部分厚度烧伤进行酶促清创，然后联合递送自体角质形成细胞悬液和富血小板纤维蛋白（PRF）或纤维蛋白胶。 材料与方法：在一项回顾性病例研究中，分析了2017年至2018年间接受酶促清创和自体细胞治疗联合PRF或纤维蛋白胶（BroKerF）治疗的深度部分厚度烧伤患者。BroKerF应用于高达15%的体表面积（TBSA）；较大面积损伤则联合手术切除和皮肤移植。排除标准为年龄<18岁或>70岁、仅为I°、IIa°烧伤、III°烧伤以及失访。 结果：共确定了20例烧伤患者，烧伤面积为16.8%±10.3%TBSA，平均简化烧伤严重程度评分5.45±1.8。其中，65%（n = 13）的患者接受了PRF治疗，35%（n = 7）的患者接受了纤维蛋白胶治疗。BroKerF治疗的平均面积为7.5%±0.05%TBSA，完全上皮化的平均时间为21.06±9.2天，平均住院时间为24.7±14.4天。其中，35%（n = 7）的患者需要额外的STSG，其中43%（n = 3）经活检证实有伤口感染。 结论：BroKerF是一种创新的治疗策略，我们认为，当实现更高的标准化时，它将显示出其疗效。在纤维蛋白基质中选择性清创和自体皮肤细胞的联合应用结合了烧伤治疗的再生措施。 简要概述：大面积烧伤患者通常需要使用大面积皮肤移植来促进烧伤部位愈合。在应用皮肤移植之前，必须通过手术或使用酶制剂去除烧伤皮肤。在本文中，我们描述了一种方法，即取小面积皮肤并提取皮肤细胞，然后将其喷洒在经酶制剂处理的伤口区域。细胞通过从患者血液中提取的物质（PRF）固定在原位，该物质与皮肤细胞一起喷洒在伤口上。我们相信这种技术有助于减少烧伤患者对皮肤移植的需求并改善愈合过程。
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