Cultured composite skin grafts for burns.

نویسندگان

  • J Nanchahal
  • D Davies
چکیده

Banked allografts offer a prospect of immediate wound coverage Each year more than 10 000 people need admission to hospital in England and Wales for burns.' Immediate excision and grafting in patients with extensive burns is thought to improve survival-a hypothesis supported by retrospective studies of both children2 and adults,3 although not confirmed by a prospective study.4 Early grafting would be expected also to reduce pain and the morbidity associated with sepsis, fluid loss, and scarring. What methods of grafting are available? The commonest technique for resurfacing full thickness skin defects is with split thickness autografts, which may be expanded fourfold by meshing5 or 20-fold by dicing.6 Unfortunately, patients with extensive burns may have few donor sites, but meshed skin expanded sixfold may be used by overlaying it with allograft7 (which if used alone does not survive in the long term, even if the recipient has been immunosuppressed8 or the antigenicity of the donor skin reduced9). Fifteen years ago the problem of lack of graftable skin seemed close to solution with the description of a reliable technique for culturing large numbers of keratinocytes in vitro.'0 The first reports of the use of these cultured auto-logous keratinocytes were encouraging," with expansions of up to 10000-fold.'2 The most obvious disadvantage was the three week interval between taking the donor skin sample and getting large sheets of cultured keratinocytes for grafting. There is some evidence that cultured keratinocytes have attenuated antigenicity,'3 suggesting that cultured allogeneic keratinocytes might be used. These cells survive for less than a week, however, and may be acting as no more than elaborate dressings-albeit also secreting growth factors.'4 Keratin-ocyte grafts have been found to have several persistent problems: blistering and contracture due to lack of dermis'5 and an abnormal ultrastructure of the dermo-epidermal junction within seven months of grafting.'6 These have limited their clinical application and provided further stimulus to the production of skin substitutes with a dermal component. Cadaver skin allografts have given excellent results. 7 18 When these are used the dermis survives and the epidermis may later be replaced with cultured autologous keratinocytes. Unfortunately the demand for allograft skin outstrips supply in the United States by a factor of five to seven,'9 and there is a real risk of transmission of infection. In an effort to overcome these problems a composite artificial skin substitute has been developed, consisting of a dermal component of bovine collagen and …

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عنوان ژورنال:
  • BMJ

دوره 301 6765  شماره 

صفحات  -

تاریخ انتشار 1990