【Abstract】 Objective To evaluate the long-term effectiveness of composite grafts of acellular dermal matrix (ADM)and autologous spl it-thickness skin in repairing deep burn wounds. Methods Between June 2002 and December 2008, 30 patients (42 wound) were treated. There were 25 males and 5 females, aged 3-52 years with a median age of 31 years. Of them, 24 burned patients had 35 wounds, including 23 deep second degree and 12 third degree wounds with a mean disease duration of 24 days (range, 3-45 days); 6 patients with hyperplastic scar had 7 wounds with a mean disease duration of 16 days (range, 9-21 days). The wound locations were neck (2 wound), hand (4 wounds), forearm and elbow (8 wounds), shoulder (3 wounds), poples (6 wounds), laps (4 wounds), ankle and legs (15 wounds), and the area of wounds ranged from 10 cm × 10 cm to 30 cm × 20 cm. After thorough debridement, tangential excision, and scar excision, ADM and autologous spl it-thickness skin graft were used to repair the wounds by one-step method. Results After operation, composite skin graft survived completely in 39 wounds of 27 patients, with a survival rate of 92.9%; partial necrosis occurred in 3 wounds of 3 patients (7.1%), and healed after dressing change and secondary skin graft. The patients were followed up 30-34 months (mean, 32 months) postoperatively. The appearance of the composite grafts were smooth and soft with good elasticity and low pigmentation. The activity and function of limbs recovered well. No scar hyperplasia was observed at the donor sites. Conclusion It can achieve good outcomes in appearance and function to use ADM and autologous spl it-thickness skin graft for repairing deep burn wounds in functional regions.
Objective To evaluate the cl inical effect and the pathological characteristics of acellular allogeneic dermal matrix in repairing unstable burn scar. Methods From January 2007 to June 2008, 19 cases of unstable burn scars (24 parts) were treated, including 16 males (20 parts) and 3 females (4 parts) with a median age of 27 years (range, 3-58 years). Theinjury was caused by flame (14 cases, 18 parts), electricity (4 cases, 5 parts), and hot water (1 case, 1 part). The unstable burn scars located on hands (8 cases), forearms (2 cases), thighs (3 cases), legs (2 cases), feet (2 cases), chest (1 case), and abdomen (1 case). Scar formed for 3 months to 1 year. The area of defect varied from 7 cm × 5 cm to 22 cm × 15 cm after scar removal. Defects were covered with acellular allogeneic dermal matrix and autogenous spl it-thickness skin graft. At 6-18 months after operation, the pathological observations of the epidermis, the basal membrane, and structural components of the dermis were done. Results All wounds healed by first intention. Scar ulcer disappeared completely in 18 cases and the composite skin grafts all survived. Some bl isters occurred in 1 case and were cured after dressing changing. All patients were followed up 10 months to 2 years (18 months on average). The grafted-skin was excellent in the appearance, texture, and elasticity. The function recovered well. Only superficial scar was observed at skin donor sites. Pathological observation showed that the epidermis and the basal membrane of the skin grafts were similar to that of normal skin, and no significant difference was found in newly capillaries between them. Collagen fibers arranged regularly, and there were few inflammatory cells in the matrix. Conclusion Acellular allogeneic dermal matrix with autogenous spl it-thickness skin graft may effectivly repair the wound after removing the unstable burn scar, and its structure is similar to that of normal skin.
Objective To study cl inical effects of the graft material of allogenic cancellus combined with autologousred marrow in the treatment of traumatic bone defect. Methods From February 2002 to April 2006, 38 patients of traumaticbone defect, 25 males and 13 females, aged 21-68 years old (38 on average), were treated with allogenic cancellus combined with autologous red marrow. Among them, there were 11 cases of bone nonunion caused by failure of internal fixation, 13 of serious comminuted fracture, 9 of bone defect caused by open fractures or bone infection, 5 of old fracture in need of graft. Of these fractures, there were 8 cases of shaft of humerus, 4 of intercondylar comminuted fracture of humerus, 8 of intercondylar comminuted fracture of femur, 5 of shaft of femur, 4 of open tibia fracture (Gustilo I, II type) and 9 of tibial plateau fracture. They included 17 cases of fresh fracture and 21 of old fracture. There were 23 cases of l imitations of bone defect, and the range was 3 cm × 3 cm × 2 cm - 7 cm × 4 cm × 3 cm; and the range of the large bone defect was less than 3 cm in 15 cases. According to AO/ASIF classification, there were 5 cases of type B2, 10 of type B3, 16 of type C2 and 7 of type C3. The time from fresh fracture to operation was 5-17 days (8 days on average), and the time from old fracture to operation was 5-13 months (7.5 months on average). The amount of the allograft implantation was 20-50 g (28 g on average). Results The wounds in all 38 cases obtained heal ing by first intention. All the patients were followed up for 8 months to 4 years (3.2 years on average). The X-ray films at reexamination showed that 36 patients had bone heal ing, with fresh fracture heal ing time of 2-6 months (4 months on average) and old fracture heal ing time of 3-10 months (7 months on average). The allogenic cancellus particles began to be fused with autogenous bone through creeping substitution 6-8 weeks after operation. One case, which had delayed infection, had bone union by removing internal fixation, placing irrigating tube and grafting after local stabil ity. During the follow-up of 25 months, no relapse was found. Another case had nonunion because of plate loosening. According to the Mankin and Komender standard evaluation, there were 36 cases with satisfaction (94.7%) and 2 with dissatisfaction (5.3%). Conclusion The composite graft material of allogenic cancellus combined with autologous red marrow is safe and effective for repairing fractures and bone defect.
Objective To study the effects of dermal template on the biological behaviors of fibroblasts during wound healing. Methods A total of 120 rats were made fullthickness wound modes on the dorsum and divided into 4 groups,in group 1, the wounds were allowed to heal by contraction（ConT）；in group2, the wounds covered with fullthickness skin grafts( FTSG); in group 3, the wounds were with split thickness skin grafts (STSG); and ingroup 4, the wounds were covered by dermal regeneration template with overlying thin splitthickness autograft (ADMT).The specimens were obtained at one week, two weeks, four weeks, six weeks,and twelve weeks respectively. The expressions of α smooth muscle actin(αSMA，characteristic of MFB）,fibronectin(FN),integrin α2,β1 and transforming growth factor β1(TGF-β1) were examined by immunohistochemical analysis. Results Positive expression of α-SMA、FN、integrin α2β1 and TGF-β1 in ADMT groups was significantly lower than that in STSG group and ConT group, but higher than that in FTSG group（P＜0.05）. Conclusion Dermal regeneration template can inhibit the transformation of FB to MFB and restrain the expressionof FN,integrin α2,β1,and TGF-β1 in fibroblasts which might reduce thepossibility of hypertrophyic scaring, and improve wound healing.
Objective To investigate the outcome and histological changes of transplantation of acellular xeno-dermis combined with suspended keratinocytes.Methods Forty-two nude mice with full-thickness skin defect on the back were randomly divided into 2 groups, then acellular xeno-dermisand and suspended keratinocytes were adopted to cover the skin defect in the experimental group, pure suspended keratinocytes in the control group. The area of wound healing was calculated2, 3 and 5 weeks after transplantation, and the rates of wound contraction werealso calculated,and biopsy for histological examination was performed 3, 6and 12 weeks after transplantation. Results Compared with the experimental group,the control group showed delayed wound healing (P＜0.05), intensive wound contraction (P＜0.05), poor durability, elasticity, and cosmetic appearances as well asdisordered collagen fibers. In contrast, it was observed that the proliferationof collagen fibers was regularly organized, with no obvious acute immuno-rejection responses in the experimental group. Conclusion The composite transplantation of acellular xenodermis and suspended keratinocytes could promote the woundhealing with a satisfactory outcome.
OBJECTIVE This experimental study was aim to investigate the osteogenesis of ceramic-like xenogeneic bone (CXB) combining with bone marrow (BM). METHODS The CXB combining BM was implanted into the sacrospinalis muscle of rabbits, and CXB implanted alone was used as control. Eighteen Japanese rabbits with long ear were used. The size of CXB was 5 mm x 5 mm x 5 mm, and the implanted materials were taken out at 2, 4, 8, 12, 16 and 24 weeks after implantation. The histological and histochemical characteristics were investigated. RESULTS There existed cartilage and new bone in the groups of CXB combining BM in 2 weeks. Later, be cartilage turned out to the bone and in eight weeks the medullary cavity appeared. However, as the time went on, new bone formation increased and typical osteogenesis could be found. While in the groups of CXB alone, no formation of new bone or cartilage was found. CONCLUSION The implantation of CXB combined with BM could result in new bone formation in the way of osteoconduation, osteoinduction, and providing, osteoblasts or chondroblasts. It could be an ideal bone substitute, and its clinical use in future seemed very hopeful.
Ceramiclike xenogeneic bone (CXB) was obtained from the fresh bone of pig ribs being treated by physical and chemical methods to deprive of its organic substance. The CXB possessed the same natural porous network system as that of the human. The CXB was cultured with the bone marrow stromal cells of rabit. When the marrow cells had integrated with the CXB, thus a new material was obtained. (CXB-BM), and was implanted sacro-spinal muscle of rabbit. The specimens were observed under phase microscope, light microscope and electronic scanning microscope. The results showed that: at the 2nd week after the implantation of CBX-BM composite material there began the new bone formation, and the rate of bone formation was increased with time. There was evident new bone formation after 24 weeks. The process of the new bone formation were quite similar to the composite graft of HAP red autogenous and marrow, but the former degraded faster and formed typical cancellous structure earlier. There was no new bone formation when CXB was implanted alone in the control. Both the mechanism of osteogenetic potential and its clinical application were discussed.