Artificial dermis combined with autologous scar epidermis composite transplantation in repair of joint site scar deformities in the later stage of extensive burns

doi:10.12307/2024.319

Abstract

Abstract: BACKGROUND: How to provide sufficient skin resources for scar plastic surgery and repair of extensive deep burn patients while avoiding the re-proliferation of scar tissue in the surgical area has always been an important topic in burn and wound repair research.
OBJECTIVE: To observe the clinical application effects of artificial dermis combined with autologous scar epidermis in the repair of scar after extensive burns.
METHODS: Retrospective analysis was performed on 73 patients with scar hyperplasia and contracture deformity after extensive burns in Bengbu Third People’s Hospital Affiliated to Bengbu Medical College from January 2021 to January 2023. The patients were divided into three groups according to the treatment method: Group A (n=21, artificial dermis combined with autologous scar epidermis transplantation was used for treatment), group B (n=27, scar epidermis was transplanted after scar release in the functional site), and group C (n=25, functional site scar release after transplantation of thick skin treatment). Skin survival and infection at the receiving site, wound healing time at the receiving site and the donor site were recorded in the three groups. The scar status and functional recovery of the recipient area and donor area were evaluated by the Vancouver Scar Scale and activities of daily living.
RESULTS AND CONCLUSION: (1) The skin infection rate was lower in group B than that in groups A and C (P < 0.05). The survival grade was higher in group B than that in groups A and C (P < 0.05). (2) The wound healing time at the receiving site was longer in group A than that in groups B and C (P < 0.05). The wound healing time at the receiving site was longer in group C than that in group B (P < 0.05). The wound healing time at the donor site was longer in group C than that in groups A and B (P < 0.05). (3) Vancouver Scar Scale score was higher in group B than that in groups A and C at 12 months postoperatively (P < 0.05). Vancouver Scar Scale score was higher in group C than that in groups A and B at 6 and 12 months postoperatively (P < 0.05). The excellent grade of activities of daily living in groups A and C was significantly higher than that of group B at 12 months postoperatively (P < 0.05). (4) The results showed that the application of artificial dermis combined with autologous scar epidermis composite transplantation in the treatment of scar contracture after extensive burn could not only achieve the same effect as that of intermediate-thickness skin, but also avoid postoperative scar re-hyperplasia at the donor site and shorten the time of complete wound healing at the donor site. Compared with scar epidermal transplantation, this treatment has obvious advantages.

Key words: artificial dermis, scar epidermis, extensive burns, scar hyperplasia and contracture deformity, plastic surgery, skin transplantation

CLC Number:

Fu Quanyou, Xing Fuxi, Li Lin, Li Yong, Liu Jisong. Artificial dermis combined with autologous scar epidermis composite transplantation in repair of joint site scar deformities in the later stage of extensive burns[J]. Chinese Journal of Tissue Engineering Research, 2024, 28(10): 1533-1539.

Figures/Tables 10

References

[1] HENDRIKS T, BOTMAN M, DE HAAS L, et al. Burn scar contracture release surgery effectively improves functional range of motion, disability and quality of life: A pre/post cohort study with long-term follow-up in a Low- and Middle-Income Country. Burns. 2021; 47(6):1285-1294.
[2] ZAHOREC P, SARKOZYOVA N, FERANCIKOVA N, et al. Autologous mesenchymal stem cells application in post-burn scars treatment: a preliminary study. Cell Tissue Bank. 2021;22(1):39-46.
[3] KONDO A, DOHI T, IZUMI N, et al. Anterior Neck-scar Contracture Reconstruction Using a Long Skin-pedicled Flap. Plast Reconstr Surg Glob Open. 2021;9(2):e3404.
[4] XIAO H, LIU R, LIU X, et al. Reconstruction of Severe Neck Scar Contracture After Electrical Injury. J Craniofac Surg. 2022;33(1):203-205.
[5] DE FRANCESCO F, BUSATO A, MANNUCCI S, et al. Artificial dermal substitutes for tissue regeneration: comparison of the clinical outcomes and histological findings of two templates. J Int Med Res. 2020;48(8):1220745060.
[6] DI HP, MU XL, SHI JJ, et al. [A prospective randomized controlled study of the effectiveness of artificial dermis combined with split-thickness skin for repairing wounds with bone and tendon exposure in hands and feet]. Zhonghua Shao Shang Za Zhi. 2021;37(12):1130-1136.
[7] CHEN L, WU YT, GU XY, et al. Magnolol, a natural aldehyde dehydrogenase-2 agonist, inhibits the proliferation and collagen synthesis of cardiac fibroblasts. Bioorg Med Chem Lett. 2021;43: 128045.
[8] SARKOZYOVA N, DRAGUNOVA J, BUKOVCAN P, et al. Preparation and processing of human allogenic dermal matrix for utilization in reconstructive surgical procedures. Bratisl Lek Listy. 2020;121(6): 386-394.
[9] SONMEZ ES. A New Splint for Dorsal Foot Burns. J Burn Care Res. 2018; 39(2):308-310.
[10] 靳雪义,张宏,张岿.人工真皮联合瘢痕断层皮片修复治疗在烧伤后四肢大关节部位瘢痕增生挛缩畸形患者中的应用[J].中国医疗美容,2020,10(12):49-53.
[11] 刘洋,张宜澜,黄亚兰,等.人工真皮联合碱性成纤维细胞生长因子在瘢痕和皮肤深度创面整复中的临床应用[J].中华烧伤杂志, 2016,32(4):198-203.
[12] 高磊,秦新愿,李天博,等.脱细胞同种异体真皮与自体刃厚皮联合移植修复糖尿病足创面[J].中国组织工程研究,2022,26(14): 2138-2143.
[13] 刘继松,宋德恒,赵刚宏,等.新型生物敷料Ⅱ型在二度烧伤创面中的应用[J].中华全科医学,2018,16(5):740-743.
[14] KANAPATHY M, MOSAHEBI A. Comparative study on the donor site aesthetic outcome between epidermal graft and split-thickness skin graft. Int Wound J. 2019;16(2):354-359.
[15] 王建强,刘江月.脱细胞异体真皮与PELNAC分别联合表皮移植治疗烧伤瘢痕的效果对比[J].中国实用医刊,2022,49(3):39-42.
[16] POWELL HM, NEDELEC B. Mechanomodulation of Burn Scarring Via Pressure Therapy. Adv Wound Care (New Rochelle). 2022;11(4): 179-191.
[17] WANG J, WU J, XU M, et al. A comprehensive reconstruction strategy for moderate to severe faciocervical scar contractures. Lasers Med Sci. 2021;36(6):1275-1282.
[18] 席云峰,张斌,苏伟,等.微粒皮移植异种脱细胞真皮基质敷料覆盖术治疗大面积烧伤创面的效果[J]. 临床医学研究与实践,2019, 4(31):6-8.
[19] CHANG LS, KIM YH, KIM SW. Reconstruction of burn scar contracture deformity of the extremities using thin thoracodorsal artery perforator free flaps. ANZ J Surg. 2021;91(9):E578-E583.
[20] SCUDERI N, FIORAMONTI P, FANELLI B, et al. The use of dermal regeneration template (Pelnac(R)) in a complex upper limb trauma: the first Italian case report. Eur Rev Med Pharmacol Sci. 2019;23(13): 5531-5534.
[21] MEULI JN, PANTET O, BERGER MM, et al. Massive Burns: Retrospective Analysis of Changes in Outcomes Indicators Across 18 Years. J Burn Care Res. 2022;43(1):232-239.
[22] CHEN XD, RUAN SB, LIN ZP, et al. Effects of porcine acellular dermal matrix treatment on wound healing and scar formation: Role of Jag1 expression in epidermal stem cells. Organogenesis. 2018;14(1):25-35.
[23] HAHN HM, COOK KH, LEE IJ, et al. Use of Acellular Dermal Matrix in Treatment of Congenital Muscular Torticollis in Patients Over Eight Years of Age. J Craniofac Surg. 2017;28(3):610-615.
[24] MATSUMURA H, MATSUSHIMA A, UEYAMA M, et al. Application of the cultured epidermal autograft “JACE((R)”) for treatment of severe burns: Results of a 6-year multicenter surveillance in Japan. Burns. 2016;42(4):769-776.
[25] CHENG G, HARDY M, ZIELONKA J, et al. Mitochondria-targeted magnolol inhibits OXPHOS, proliferation, and tumor growth via modulation of energetics and autophagy in melanoma cells. Cancer Treat Res Commun. 2020;25:100210.
[26] 李兵园,许明火,宋慧锋,等.瘢痕表皮角蛋白的变化规律及正常表皮细胞培养液对成纤维细胞胶原合成的影响[J].感染、炎症、修复,2013,14(2):80-83.
[27] 周杰,罗艺,徐刚,等.脱细胞真皮基质加自体瘢痕表皮在瘢痕挛缩畸形整复中的应用[J].中国美容医学,2012,21(11):1498.
[28] 崔泽龙.烧伤瘢痕表皮结合组织工程真皮治疗瘢痕的临床研究[D].南宁:广西医科大学,2019.
[29] HUANG W, CHEN Y, WANG N, et al. The Efficacy and Safety of Acellular Matrix Therapy for Diabetic Foot Ulcers: A Meta-Analysis of Randomized Clinical Trials. J Diabetes Res. 2020;2020:6245758.
[30] KLAMA-BARYLA A, KITALA D, LABUS W, et al. Is Transgenic Porcine Skin as Good as Allogeneic Skin for Regenerative Medicine? Comparison of Chosen Properties of Xeno- and Allogeneic Material. Transplant Proc. 2020;52(7):2208-2217.
[31] 贾晓明.异种(体)生物材料与创面修复[J].中华损伤与修复杂志(电子版),2020,15(5):341-346.
[32] KASHIMURA T, NAGASAKI K, HORIGOME M, et al. Selection of Artificial Dermis for Shortening Treatment Period: Integra versus Pelnac. Plastic and reconstructive surgery. Global Open. 2021;9(6):e3599.
[33] LV Z, YU L, WANG Q, et al. Dermal regeneration template and vacuum sealing drainage for treatment of traumatic degloving injuries of upper extremity in a single-stage procedure. ANZ J Surg. 2019;89(7-8): 950-954.
[34] HALL C, HARDIN C, CORKINS CJ, et al. Pathophysiologic Mechanisms and Current Treatments for Cutaneous Sequelae of Burn Wounds. Compr Physiol. 2017;8(1):371-405.
[35] LV Z, WANG Q, JIA R, et al. Pelnac(R) Artificial Dermis Assisted by VSD for Treatment of Complex Wound with Bone/Tendon Exposed at the Foot and Ankle, A Prospective Study. J Invest Surg. 2020;33(7):636-641.
[36] ZHAO F, YANG X, LI W, et al. Classification of Obviously Asymmetric Palpebral Fissures and Correction Based on Double Eyelid Surgery of the Primary Type. J Craniofac Surg. 2020;31(2):404-407.
[37] MA Z, MO R, CHEN C, et al. Surgical treatment of joint burn scar contracture: a 10-year single-center experience with long-term outcome evaluation. Ann Transl Med. 2021;9(4):303.
[38] MURRAY RZ, WEST ZE, COWIN AJ, et al. Development and use of biomaterials as wound healing therapies. Burns Trauma. 2019;7:2.
[39] HAO Z. Application of Pelnac(R) Artificial Dermis Combined with VSD in the Repair of Limb Wounds. J Invest Surg. 2020;33(7):642-643.
[40] CHEN S, ZHENG LW, LIU W, et al. [Clinical effects of artificial dermis combined with vacuum sealing drainage and autologous split-thickness skin graft in repair of scar contracture deformity after extensive burn]. Zhonghua Shao Shang Za Zhi. 2019;35(8):608-610.