Orgill D P, Butler C, Regan J F, Barlow M S, Yannas I V, Compton C C
Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Mass 02115, USA.
Plast Reconstr Surg. 1998 Aug;102(2):423-9. doi: 10.1097/00006534-199808000-00020.
Cultured epithelial autografts are an important adjunct in treating severely burned patients, greatly expanding the epidermis using a small donor site. Problems with cultured epithelial autografts include the time delay to culture cells to confluence and variable take on full-thickness wounds. Dermal allografts have been used as a substrate to improve the take of cultured epithelial autografts. This study examined the effect of a vascularized collagen-glycosaminoglycan matrix as a substrate for cultured epithelial autografts. The matrix was grafted onto 12 full-thickness wounds in Yorkshire pigs and allowed to vascularize for 10 days. The cultured epithelial autografts were applied over the vascularized collagen-glycosaminoglycan matrix (n = 12) or onto freshly excised full-thickness wounds (n = 10). Gross and histologic observations were made over a 3-week period. Gross observations at 7 days indicated cultured epithelial autografts to have nearly complete confluence when applied to wounds treated by collagen-glycosaminoglycan, whereas cultured epithelial autografts applied to freshly excised wounds did not take. Gross determination of epithelial confluence was verified by histologic analysis of randomly selected wounds. Histologic epithelial confluence of cultured epithelial autografts on collagen-glycosaminoglycan (98 +/- 4 percent) was significantly greater than that on full-thickness wounds (4 +/- 10 percent). Electron microscopy of the cultured epithelial autografts/collagen-glycosaminoglycan construct demonstrated anchoring fibrils at the dermal-epidermal junction at day 7. The neoepidermis of wounds treated by cultured epithelial autografts/collagen-glycosaminoglycan was hyperplastic at day 7 but developed a normal maturation sequence by 21 days. Results from this study suggest that vascularized collagen-glycosaminoglycan matrices produce a favorable substrate for cultured epithelial autografts and may improve cultured epithelial autografts take in burn patients.
培养的上皮自体移植片是治疗严重烧伤患者的重要辅助手段，可利用较小的供皮区极大地扩展表皮。培养的上皮自体移植片存在的问题包括培养细胞至汇合所需的时间延迟以及在全层伤口上的成活率不一。异体真皮移植片已被用作一种基质来提高培养的上皮自体移植片的成活率。本研究检测了血管化胶原 - 糖胺聚糖基质作为培养的上皮自体移植片基质的效果。将该基质移植到约克郡猪的12个全层伤口上，并使其血管化10天。将培养的上皮自体移植片覆盖在血管化的胶原 - 糖胺聚糖基质上（n = 12）或覆盖在新鲜切除的全层伤口上（n = 10）。在3周时间内进行大体和组织学观察。7天时的大体观察表明，当将培养的上皮自体移植片应用于经胶原 - 糖胺聚糖处理的伤口时，其几乎完全汇合，而应用于新鲜切除伤口的培养的上皮自体移植片未成活。通过对随机选择的伤口进行组织学分析验证了上皮汇合的大体判定。培养的上皮自体移植片在胶原 - 糖胺聚糖上的组织学上皮汇合率（98±4%）显著高于在全层伤口上的汇合率（4±10%）。培养的上皮自体移植片/胶原 - 糖胺聚糖构建体的电子显微镜检查显示，在第7天时真皮 - 表皮交界处有锚定原纤维。经培养的上皮自体移植片/胶原 - 糖胺聚糖处理的伤口的新表皮在第7天时增生，但到21天时发育出正常的成熟序列。本研究结果表明，血管化胶原 - 糖胺聚糖基质为培养的上皮自体移植片提供了有利的基质，并可能提高烧伤患者培养的上皮自体移植片的成活率。
