Kjolseth D, Frank J M, Barker J H, Anderson G L, Rosenthal A I, Acland R D, Schuschke D, Campbell F R, Tobin G R, Weiner L J
Division of Plastic and Reconstructive Surgery, University of Louisville, KY 40292.
J Am Coll Surg. 1994 Sep;179(3):305-12.
The primary effect sought with most topical wound therapy is antimicrobial. Topical wound agents are thought to promote normal healing by protecting the wound from infection. In this study, we examined the effect of six commonly used topical wound agents (bacitracin, sodium hypochlorite, silver nitrate, silver sulfadiazine, mafenide acetate, and povidone-iodine) on epithelialization and neovascularization in noninfected wounds. For this study, a new wound model was used in which direct visualization and quantification of wound epithelialization and neovascularization were carried out throughout the entire healing process.
We measured the effect which 500 U per g of bacitracin, 0.25 percent of sodium hypochlorite, 0.5 percent silver nitrate, 1 percent silver sulfadiazine, 8.5 percent mafenide acetate, and 10 percent povodione-iodine had on the rate of wound epithelialization and neovascularization. The agents were applied topically to 99 circular full-thickness wounds (2.25 mm diameter, 0.125 mm depth) created on the dorsum of male hairless mouse ears. This model enabled us to visualize and measure directly wound epithelialization and neovascularization repeatedly throughout healing, using intravital video microscopy and computerized digitized planimetry.
Control wounds and wounds treated with silver sulfadiazine (n = 18) and mafenide acetate (n = 14) epithelialized in 7.2 +/- 0.7, 7.1 +/- 0.3, and 7.3 +/- 0.3 days, respectively. This was significantly (p < 0.01) faster than the wounds treated with povidone-iodine (n = 10), sodium hypochlorite, (n = 8), and bacitracin (n = 13). Wounds treated with povidone-iodine epithelialized the slowest (11.8 +/- 0.55 days). Wound neovascularization was completed most rapidly in the groups treated with povidone-iodine and silver sulfadiazine (15.0 +/- 0.4 and 15.3 +/- 0.7 days, respectively). This was significantly (p < 0.05) faster than wounds treated with silver nitrate (n = 15), which neovascularized in 18.4 +/- 0.56 days. One-half of the wounds treated with sodium hypochlorite (eight of 16) did not epithelialize or neovascularize.
The various antimicrobial agents studied in our in vivo model affect wound epithelialization and neovascularization differently. These effects on these two very important aspects of healing should be taken into consideration when indicating a specific agent for treatment of different types of wounds.
大多数局部伤口治疗所追求的主要效果是抗菌。局部伤口用药被认为可通过保护伤口免受感染来促进正常愈合。在本研究中，我们检测了六种常用局部伤口用药（杆菌肽、次氯酸钠、硝酸银、磺胺嘧啶银、醋酸磺胺米隆和聚维酮碘）对未感染伤口上皮化和新血管形成的影响。对于本研究，使用了一种新的伤口模型，在整个愈合过程中对伤口上皮化和新血管形成进行直接可视化和定量分析。
我们测量了每克含500单位杆菌肽、0.25%次氯酸钠、0.5%硝酸银、1%磺胺嘧啶银、8.5%醋酸磺胺米隆和10%聚维酮碘的药物对伤口上皮化和新血管形成速率的影响。将这些药物局部应用于雄性无毛小鼠耳背部创建的99个圆形全层伤口（直径2.25毫米，深度0.125毫米）。该模型使我们能够在愈合过程中使用活体视频显微镜和计算机数字化平面测量法反复直接可视化和测量伤口上皮化和新血管形成。
对照伤口以及用磺胺嘧啶银（n = 18）和醋酸磺胺米隆（n = 14）治疗的伤口分别在7.2±0.7、7.1±0.3和7.3±0.3天实现上皮化。这明显（p < 0.01）快于用聚维酮碘（n = 10）、次氯酸钠（n = 8）和杆菌肽（n = 13）治疗的伤口。用聚维酮碘治疗的伤口上皮化最慢（11.8±0.55天）。在聚维酮碘和磺胺嘧啶银治疗组中伤口新血管形成完成得最快（分别为15.0±0.4和15.3±0.7天）。这明显（p < 0.05）快于用硝酸银治疗的伤口（n = 15），其新血管形成时间为18.4±0.56天。用次氯酸钠治疗的伤口中有一半（16个中的8个）未实现上皮化或新血管形成。
我们在体内模型中研究的各种抗菌药物对伤口上皮化和新血管形成的影响不同。在为不同类型伤口指明特定治疗药物时，应考虑这些药物对愈合这两个非常重要方面的影响。
