| Research background:The treatment of deep second degree burn wounds is the key and difficult point for clinical practioners in the field of burn surgery.The conventional treatment of deep partial-thickness burn wounds is to prevent the wounds from infection by topically or systematically administrated antimicrobial agents and cover the wounds with varouis dressings until spontaneous wound healing occurs.In recent years,the comprehensive study of growth factors(GFs)and many clinical trials have confirmed that GFs play critical role in the process of wound repairs.Since then,GFs have been widely used in the treatment of various wounds,sunch as burns,diabetic feet,pressure sores etc,but the guidline and long-term safety of GFs in clinical application are still to be determined.Therefore,the first part of this study was to observe the clinical efficacy and safety of two kinds of GF by topical application for deep second degree burn wounds.The excised scar wounds and deep skin wounds are usually repaired by full-thickness skin sheet or skin flap transfer,the scar hyperplasia or larger tissue defect subsequently occurs in the donor site.Therefore,many artificial dermis matrices have been developed for reducing these harmful effects to donor sites and applied to animal experiments and clinical trials.When artificial dermis is grafted on the wounds,its effect on wound repair would be a similar to the full-thickness skin graft,more time would be needed for its complete vascularization.In addition,the fibroblast growth factor(FGF)has a significant promoting effect on wound healing.Therefore the second part of this clinical study was carried out to repair the excised scar wounds and deep skin wounds with artificial dermis combined with basic fibroblast growth factor(bFGF).Objective:1.In compared with conventional therapy,the therapeutic effects of epidermal growth factor(EGF),acidic fibroblast growth factor(aFGF)and combined application of EGF and a FGF on deep second degree burn wounds were observed.Their safeties of topical application on the deep second degree burn wounds were also investigated.2.To observe the efficacy of artificial dermis combined with bFGF on the treatment of scars contracture deformity and skin deep wounds.Methods:1.Sixty patients with deep second degree burn wounds were enrolled in this study during the period of September 2013 to January 2016 in the Institute of Burns Research,Southwest Hospital,Third Military Medical University,Chongqing,China.At the time of admission,the patients were randomly divided into 4 groups,i.e.group A(conventional therapy group,i.e.only iodophor was applied),group B(EGF therapy group),group C(aFGF therapy group),group D(a FGF and EGF combined therapy group).The foreign bodies and contaminated blister skin were removed from wounds after the wounds were routinely disinfected by iodophor solution.Then residual foreign bodies and iodophor disinfectant were washed thoroughly by normal saline.According to the different groups,the gauze was respectively presoaked with corresponding agents,and applied on the disinfected wounds.Then the wounds were covered with several layers of dressings and well bandaged.The dressings were changes every another day and the wound healing rate was also recorded at this time.The endpoints of this study were 28 days after thermal injury.Observation and Statistics:(1)general indicators and related test results;(2)wound healing,including the rate of wound healing,the wound healing rate(%)in 2 weeks and the wound healing time(d)completely;(3)scar hyperplasia(evaluation of Vancouver Scar score);(4)safety.T test for comparison between two groups and Kruskal-Wallis H test for comparison among multiple samples.2.A retrospective analysis of 72 cases with artificial dermis applied to scars and deep skin wounds was performed during the period of October 2010 to April 2015 in the Institute of Burns Research,Southwest Hospital.Total of 102 wound were categoried into three types,i.e.scar excised wounds,deep burn wounds without exposure of tendon or bone,wounds with small area tendon or bone exposure.According to whether artificial dermis was combined with bFGF,these patients divided into artificial dermis group(60 wounds)and artificial dermis + bFGF group(42 wounds).In the artificial dermis group,artificial dermis was directly grafted to surgically resected scar wounds or thoroughly debrided deep skin wounds.After it was vascularized,thin split-thickness skin autograft was transplanted during the second stage operation.In the artificial dermis + bFGF group all the procedures were exactly the same except that artificial dermis had been soaked for 30 min with b FGF during the first stage surgery.The operation areas,the time of artificial dermis vascularization,the take rate of autologous skin graft and the follow-up in these 2 groups were recorded.The data were analyzed by t test or Fisher's exact test.Result:1.Clinical observation of GFs in deep second degree burn wounds showed that:(1)there was no difference between the groups in general indicators and related test results(except for breathing,heart rate,creatinine,total bilirubin),comparable(P values above 0.05).(2)The wound healing rate of all groups was extremely low within 1 week.But it became significantly faster during 2 to 3 weeks.Healing rate of group B and C group were faster than that in group A;group D was the fastest in all groups.The wound healing rates(%)in 2 weeks of A,B,C,D group were(33.8±7.0),(47.9±15.8),(45.3±13.7)and(60.9±11.0).Statistical analysis showed that group B and group C were higher than group A(t values were-3.158,-2.878,P values were 0.004 and 0.008,respectively);group D was significantly higher than group A,group B and group C(t values were-8.081,-2.617 and-3.389,P values were 0.000,0.014 and 0.002,respectively);there was no statistical difference between group B and group C(t value was 0.468,P value was 0.644).The wound healing times of group A,B,C,D were respectively(25.2±1.7),(20.5±2.3),(20.7±3.7)and(17.9±1.7)d.The statistical results showed that group B and group C were less than group A(t values were 6.222 and 4.112,P values were 0.000 and 0.000,respectively);group D was least in all groups(t values were 11.535,3.488 and 2.778,P values were 0.000,0.002 and 0.010,respectively);no significant difference was found between group B and group C(t value was-0.286,P value was 0.777).(3)There was no significant difference in Vancouver scar score among four groups either in the 4 weeks after injury or at the time of discharge(?2 values were 4.024,2.668,P values were 0.259 and 0.446,respectively).(4)All patients did not appear systemic and local adverse reactions during this study.Wound ulceration,blister formation,cancer and other complications were not observed during the long-term follow-up.2.Artificial dermis combined with b FGF on the treatment of scars and skin deep wounds showed that:(1)Two groups of patients with scars,deep burn wounds without exposure of tendon or bone,and wounds with small area tendon or bone exposure of operation areas had no significant difference in baseline data(with t value from-1.853 to-0.200,P values above 0.05).The completely vascularization times of artificial dermis + b FGF group were(15.6±2.9),(14.7±2.7),and(20.3±4.4)d,for scar wounds,deep burn wounds without exposure of tendon or bone,wounds with small area tendon or bone exposure respectively compared with corresponding wounds of artificial dermis group [(18.3±4.7),(18.7±4.2),and(27.7±8.8)d],they were respectively less than 2.7,4.0,7.3 d(with t value from-2.779 to-2.383,P values below 0.05).(2)In all the 102 wounds of these two groups,89 were very good take rate outcomes,12 relatively good and 1 produced poor outcome.No matter what kind of the wound it was,the take rates of the skin graft in the artificial dermis + b FGF group was higher than that in the artificial dermis group,but no significant differences were found(P values above 0.05).(3)The patients in two groups after surgery were followed up for 1 to 48 months,the skin autografts survived well and the scars in skin graft sites and the donor sites were all mild in these two groups.Conclusions:1.Topical application of either EGF or aFGF can promote wound healing in patiens with deep partial-thickness burn wounds.The topical combination of EGF and aFGF would heal faster than either alone.There are no significant changes in scaring and safety parameters among these four groups during this study.2.Artificial dermis combined with bFGF can effectively accelerate the vascularization of artificial dermis,and provide a novel method to shorten the time of vascularization of artificial dermis in scars and skin deep wounds. |
PDF Full Text Request