Hickerson W L, Compton C, Fletchall S, Smith L R
Department of Surgery, University of Tennessee, Memphis.
Burns. 1994;20 Suppl 1:S52-5; discussion S55-6. doi: 10.1016/0305-4179(94)90091-4.
Cultured epidermal autografts (CEA) have been shown to be an effective permanent skin replacement for major burn injuries, but are more sensitive to adverse conditions than split thickness grafts (Clarke et al., 1988). Cuono et al. (1986, 1987) have described the successful use of engrafted allodermis as a wound bed for cultured grafts. We report on a method of preparing allodermis and grafting CEA in five patients with major burns (48-70 per cent TBSA, average 59.6 per cent). The average age was 38.8 years (20-60 years). All full thickness wounds were excised down to fat within 7 days of admission, and covered with meshed split thickness cryopreserved homograft. Over the ensuing 2-3 weeks, the homograft became engrafted. At surgery, the allo-epidermis was removed, leaving the dermal components as a viable bed for the CEA. Keratinocytes derived from a full thickness biopsy were grown to confluence by the method of Rheinwald and Green (1975), and 25 cm2 sheets were stapled to Vaseline gauze backings and applied to freshly excised wounds. Seven to 10 days after surgery, the gauze backings were removed. The average take ranged from 87-100 per cent (average 93.6 per cent). Follow-up for up to 4 years shows supple skin that has been durable, and resistant to trauma and infection.
培养的自体表皮移植片（CEA）已被证明是治疗大面积烧伤的一种有效的永久性皮肤替代物，但比中厚皮片对不良条件更敏感（Clarke等人，1988年）。Cuono等人（1986年、1987年）描述了成功使用植入的同种异体真皮作为培养移植片的创面床。我们报告了一种制备同种异体真皮并将CEA移植到5例大面积烧伤患者（烧伤面积占总体表面积的48%-70%，平均59.6%）的方法。平均年龄为38.8岁（20-60岁）。所有全层创面在入院后7天内切除至脂肪层，并用网状中厚冷冻保存同种异体皮覆盖。在随后的2-3周内，同种异体皮发生植入。手术时，去除同种异体表皮，留下真皮成分作为CEA的存活创面床。通过Rheinwald和Green（1975年）的方法，将取自全层活检的角质形成细胞培养至汇合，将25平方厘米的皮片用订书钉固定在凡士林纱布背衬上，并应用于新切除的创面上。术后7-10天，去除纱布背衬。平均成活率为87%-100%（平均93.6%）。长达4年的随访显示，皮肤柔软、耐用，且耐创伤和感染。
