Olerud J E, Odland G F, Burgess E M, Wyss C R, Fisher L D, Matsen F A
Department of Medicine (Dermatology), University of Washington, Seattle 98195, USA.
J Surg Res. 1995 Sep;59(3):349-60. doi: 10.1006/jsre.1995.1175.
The purpose of the study was to test the hypothesis that significant delays in cutaneous wound healing could be demonstrated using standard wounds and high quality histological methods in patients with severe peripheral vascular disease (PVD) and/or diabetes mellitus (DM) compared to healthy elderly controls. Additionally, we proposed that standard wounds on the arms of elderly controls would heal more rapidly than comparable wounds on the legs. In order to test these hypotheses we developed and characterized a partial thickness wound model which could be used safely in human subjects. The study population consisted of 25 elderly normal volunteers, 17 patients with PVD, and 24 patients with DM. Standard wounds were created using a Simplate II bleeding-time device. A total of 309 wounds ranging in age from 1 to 25 days were determined to be suitable for analysis. A global index of wound maturity was developed based on selected epidermal and dermal events of repair which could be scored histologically. The superficial component (within 0.1 mm of the epidermis) and deep components of dermal wounds were analyzed separately. Simultaneously created arm and leg wounds were studied in 15 of the elderly controls. Transcutaneous partial pressure of oxygen (TcPO2) measurements were used to estimate the severity of cutaneous ischemia. Data analysis revealed that the most striking differences observed were in dermal events of repair. Control wounds were more mature than dermal wounds from patients with PVD (P < 0.05). A significant reduction in the number of neutrophils and macrophages (P < 0.05) was demonstrated in 7-day-old wounds of patients with PVD compared to controls. Patients with DM showed a similar trend of reduced wound maturity but it did not reach statistical significance. Wounds created in skin with TcPO2 > 20 were more mature than wounds with TcPO2 < or = 20 (P < 0.05) and arm wounds were more mature than leg wounds (P < 0.01). The most significant difference noted in this wound model was that the superficial compartment of dermal wounds was significantly more mature than the deep compartment (P < 0.001). Good agreement was observed between two independent scorers of wound histology and no complications were noted in either patients or controls when using this human wound model. We conclude that the model described allows evaluation of both epidermal and dermal events of repair with relative safety even in patients with PVD and DM.(ABSTRACT TRUNCATED AT 400 WORDS)
与健康老年对照组相比，使用标准伤口和高质量组织学方法能够证明，患有严重外周血管疾病（PVD）和/或糖尿病（DM）的患者皮肤伤口愈合存在显著延迟。此外，我们提出老年对照组手臂上的标准伤口比腿部的类似伤口愈合更快。为了验证这些假设，我们开发并描述了一种可安全用于人体受试者的部分厚度伤口模型。研究人群包括25名老年正常志愿者、17名PVD患者和24名DM患者。使用Simplate II出血时间装置创建标准伤口。总共309个年龄在1至25天的伤口被确定适合进行分析。基于选定的表皮和真皮修复事件制定了伤口成熟度的整体指数，可通过组织学进行评分。分别分析真皮伤口的浅表部分（距表皮0.1毫米以内）和深部部分。在15名老年对照组中研究了同时创建的手臂和腿部伤口。使用经皮氧分压（TcPO2）测量来评估皮肤缺血的严重程度。数据分析显示，观察到的最显著差异在于真皮修复事件。对照组伤口比PVD患者的真皮伤口更成熟（P < 0.05）。与对照组相比，PVD患者7日龄伤口中的中性粒细胞和巨噬细胞数量显著减少（P < 0.05）。DM患者显示出伤口成熟度降低的类似趋势，但未达到统计学意义。TcPO2 > 20的皮肤中创建的伤口比TcPO2 < 或 = 20的伤口更成熟（P < 0.05），手臂伤口比腿部伤口更成熟（P < 0.01）。在此伤口模型中注意到的最显著差异是真皮伤口的浅表部分比深部部分显著更成熟（P < 0.001）。在两名独立的伤口组织学评分者之间观察到良好的一致性，并且在使用这种人体伤口模型时，患者或对照组均未出现并发症。我们得出结论，所描述的模型即使在PVD和DM患者中也能相对安全地评估表皮和真皮的修复事件。（摘要截断于400字）
