Tanaka H, Takami Y, Tokunaga T, Takeda T, Shimazaki S
Kyorin University, School of Medicine, Department of Traumatology and Critical Care Medicine, Tokyo, Japan.
Nihon Geka Gakkai Zasshi. 1998 Jan;99(1):14-20.
In patients with massive burn injuries and very limited skin donor sites, both acute-phase and long-term problems of skin loss must be solved by the use of alternative wound closure materials. Alternative materials can be used for either temporary wound coverage or for permanent wound closure. Recently, allogenic skin grafts have most commonly been used as alternative wound closure material. However, research is ongoing on many new materials to provide a readily available substitute for skin allografts for permanent wound closure. The best approach to the development of alternative permanent wound closure materials is to incorporate the host's own cellular and structural components. Four general strategies have been devised so far based on the type of matrix structure and cellular content: allografts; cultured epidermal grafts; dermal matrix grafts; and cultured-dermal matrix composite grafts. Several approaches using combined alternative wound closure materials have been used, including transplantation of artificial dermal matrix with thin epidermal autografts, and transplantation of artificial dermal matrix containing human fibroblasts. Ultimately, the best candidate materials for permanent wound closure after extensive burn injury must be determined in prospective, randomized, controlled clinical trials.
对于大面积烧伤且皮肤供区非常有限的患者，必须通过使用替代伤口闭合材料来解决皮肤缺失的急性期和长期问题。替代材料可用于临时伤口覆盖或永久伤口闭合。最近，同种异体皮肤移植最常被用作替代伤口闭合材料。然而，目前正在对许多新材料进行研究，以提供一种可随时获得的替代同种异体皮肤移植用于永久伤口闭合的材料。开发替代永久伤口闭合材料的最佳方法是整合宿主自身的细胞和结构成分。到目前为止，根据基质结构和细胞成分的类型已设计出四种一般策略：同种异体移植；培养的表皮移植；真皮基质移植；以及培养的真皮基质复合移植。已经使用了几种联合替代伤口闭合材料的方法，包括人工真皮基质与薄自体表皮移植，以及含有人类成纤维细胞的人工真皮基质移植。最终，必须在前瞻性、随机、对照临床试验中确定大面积烧伤后永久伤口闭合的最佳候选材料。
