Boyce S T, Goretsky M J, Greenhalgh D G, Kagan R J, Rieman M T, Warden G D
Shriners Burns Institute, Cincinnati, Ohio, USA.
Ann Surg. 1995 Dec;222(6):743-52. doi: 10.1097/00000658-199512000-00008.
Comparison of cultured skin substitutes (CSSs) and split-thickness autograft (STAG) was performed to assess whether the requirement for autologous skin grafts may be reduced in the treatment of massive burns.
Cultured skin substitutes consisting of collagen-glycosaminoglycan substrates populated with autologous fibroblasts and keratinocytes have been demonstrated to close full-thickness skin wounds in athymic mice and to express normal skin antigens after closure of excised wounds in burn patients.
Data were collected from 17 patients between days 2 and 14 to determine incidence of exudate, incidence of regrafting, coloration, keratinization, and percentage of site covered by graft (n = 17). Outcome was evaluated on an ordinal scale (0 = worst; 10 = best) beginning at day 14, with primary analyses at 28 days (n = 10) and 1 year (n = 4) for erythema, pigmentation, epithelial blistering, surface roughness, skin suppleness, and raised scar.
Sites treated with CSSs had increased incidence of exudate (p = 0.06) and decreased percentage of engraftment (p < 0.05) compared with STAG. Outcome parameters during the first year showed no differences in erythema, blistering, or suppleness. Pigmentation was greater, scar was less raised, but regrafting was more frequent in CSS sites than STAG. No differences in qualitative outcomes were found after 1 year, and antibodies to bovine collagen were not detected in patient sera.
These results suggest that outcome of engrafted CSSs is not different from STAG and that increased incidence of regrafting is related to decreased percentage of initial engraftment. Increased rates of engraftment of CSSs may lead to improved outcome for closure of burn wounds, allow greater availability of materials for grafting, and reduce requirements for donor skin autograft.
对培养皮肤替代物（CSSs）和中厚自体皮片（STAG）进行比较，以评估在大面积烧伤治疗中自体皮肤移植的需求是否可以减少。
由填充有自体成纤维细胞和角质形成细胞的胶原-糖胺聚糖基质组成的培养皮肤替代物已被证明可闭合无胸腺小鼠的全层皮肤伤口，并在烧伤患者切除伤口闭合后表达正常皮肤抗原。
收集17例患者在第2天至第14天的数据，以确定渗出液发生率、再次移植发生率、色素沉着、角化以及移植覆盖部位的百分比（n = 17）。从第14天开始，按序贯量表（0 = 最差；10 = 最佳）评估结果，在第28天（n = 10）和第1年（n = 4）对红斑、色素沉着、上皮水疱形成、表面粗糙度、皮肤柔韧性和增生性瘢痕进行主要分析。
与STAG相比，用CSSs治疗的部位渗出液发生率增加（p = 0.06），移植成功率百分比降低（p < 0.05）。第一年的结果参数在红斑、水疱形成或柔韧性方面无差异。CSSs部位的色素沉着更明显，瘢痕增生较少，但再次移植比STAG更频繁。1年后定性结果无差异，且在患者血清中未检测到针对牛胶原蛋白的抗体。
这些结果表明，植入CSSs的结果与STAG无异，再次移植发生率增加与初始移植成功率百分比降低有关。CSSs移植成功率的提高可能会改善烧伤创面的闭合效果，增加移植材料的可用性，并减少对自体供皮的需求。
