Nuutila Kristo, Mistry Riyam, Broomhead Michael, Eriksson Elof
Department of Combat Wound Care, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA.
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.
Adv Wound Care (New Rochelle). 2024 Apr;13(4):176-186. doi: 10.1089/wound.2023.0020. Epub 2023 Dec 11.
Autologous skin transplantation is limited by donor site availability for patients with extensive burns. The objective of this study was to demonstrate the feasibility and efficacy of split-thickness skin (STS) and dermal pixel grafts (PG) in the treatment of burns. The study was divided into three arms of validation, expansion, and combination that all followed the same study design. Sixteen deep partial-thickness burns were created on the dorsum of anesthetized pigs. Three days postinjury the burns were debrided and grafted with STS and dermal PGs. The PGs were prepared by harvesting two skin grafts (split-thickness skin graft [STSG] and dermal graft) from the same donor site going down in depth. The grafts were minced to 0.3 × 0.3 × 0.3 mm PGs and suspended in a small volume of hydrogel. Healing was monitored for 6, 10, 14, or 28 days. In the validation study the PGs at 1:2 expansion ratio were transplanted and compared with STSG and untreated controls. The expansion study investigated the maximum expansion potential of the PGs and the combination of the benefits of transplanting STS and dermal PGs together. The validation study showed that when STS and dermal PGs were transplanted in a 1:2 ratio they fully re-epithelialized the wounds in 14 days. The expansion study demonstrated that using expansion ratios up to 1:500 the wounds were re-epithelialized by day 28. The combination study showed that there was no additional benefit to use STS and dermal PGs together. Pixel grafting provides expansion ratios greater than conventional STSG. The possibility to harvest both STS and dermal PGs from the same donor area further reduces the need for healthy skin. STSG and dermal grafts can be minced to PGs with preserved viability and expanded up to 500 times to re-epithelialize a wound.
对于大面积烧伤患者，自体皮肤移植受供皮区可用性限制。本研究的目的是证明中厚皮片（STS）和真皮像素移植物（PG）治疗烧伤的可行性和有效性。该研究分为验证、扩展和联合三个组，均遵循相同的研究设计。在麻醉猪的背部制造16处深Ⅱ度烧伤。受伤3天后，对烧伤创面进行清创，并移植STS和真皮PG。PG通过从同一供皮区按深度依次获取两块皮肤移植物（中厚皮片[STSG]和真皮移植物）制备而成。将移植物切成0.3×0.3×0.3mm的PG，并悬浮于少量水凝胶中。观察愈合6、10、14或28天。在验证研究中，移植1:2扩展比例的PG，并与STSG和未治疗的对照进行比较。扩展研究调查PG的最大扩展潜力以及将STS和真皮PG一起移植的益处组合。验证研究表明，当以1:2的比例移植STS和真皮PG时，创面在14天内完全重新上皮化。扩展研究表明，使用高达1:500的扩展比例，创面在第28天重新上皮化。联合研究表明，将STS和真皮PG一起使用没有额外益处。像素移植提供的扩展比例大于传统的STSG。从同一供皮区获取STS和真皮PG的可能性进一步减少了对健康皮肤的需求。STSG和真皮移植物可切成具有活力的PG，并扩展至500倍以重新上皮化创面。
