Ikeda H, MD, Yoshimoto T, PhD, Suzuki H, MD, Hasebe M, MD, Endoh Y, MD, Kobayashi K, MD
池田 H 博士，吉本 T 博士，鈴木 H 博士，長谷部 M 博士，遠藤 Y 博士，小林 K 博士

Teikyo University School of Medicine and Terumo Corporation, Tokyo, Japan
帝京大學醫學部與日本東洋醫藥株式會社，東京

Introduction: Skin grafting with meshed autografts and meshed cryopreserved human cadaver skin grafts (CHCSG) overlay has been used for treatment of severe burns. Artificial dermis, Terudermis , is composed of bovine collagen matrix, and the standard use is similar to that of other artificial dermis. As an alternative use, we have applied meshed Terudermis overlay simultaneously with meshed autogrạts in 10 severely burned patients to examine if Terudermis can be used as a substitute of CHCSG.
介紹：使用網狀自體皮膚移植和網狀冷凍保存的人類屍體皮膚移植（CHCSG）覆蓋物來治療嚴重燒傷。人造真皮 Terudermis 由牛膠原基質組成，標準用法與其他人造真皮相似。作為替代用途，我們在 10 名嚴重燒傷患者中同時應用網狀 Terudermis 覆蓋物和網狀自體移植皮膚，以檢驗 Terudermis 是否可以作為 CHCSG 的替代品。

Methods: Skin biopsy samples were obtained from the grafted burn wounds of the severely burned patients with Terudermis overlay on 4, 7, 14 days, and at one month postoperatively. Histological examination was performed by stain, resorcin-fuchsin stain and immunohistochemical stain for anti bovine collagen. Gross appearances of the wounds were also observed at each wound dressing change.
方法：從嚴重燒傷患者移植燒傷傷口中取得皮膚活檢樣本，分別在手術後的第 4、7、14 天以及一個月進行 Terudermis 覆蓋。通過 染色、雷索青-紫染色和免疫組織化學染色進行組織學檢查，以檢測抗牛膠原蛋白。在每次換藥時還觀察了傷口的外觀。

Results: The grafted Terudermis was attached to the excised wound with cellular infiltration in the interstices between the autografts on day 4. Terudermis formed the dermislike structure, on which epithelization took place through migration from the autograft borders on day 7 . Autologous epithelium covered the dermis-like structure on day 14. Differences between dermis of the autograft and the dermis-like structure were identified by resorcin-fuchsin stain for native elastic tissue and immunohistochemical techniques for bovine collagen derived from Terudermis . The bovine collagen disappeared and was replaced by autologous collagen at one month postoperatively. Wound closure of those patients was satisfactory.
結果：在第 4 天，移植的 Terudermis 與自體移植物之間的間隙中有細胞浸潤，附著在切除傷口上。Terudermis 形成了類似真皮的結構，並在第 7 天從自體移植物邊緣遷移進行上皮化。自體上皮在第 14 天覆蓋了類似真皮的結構。通過 resorcin-fuchsin 染色原生彈性組織和免疫組織化學技術檢測，識別了自體移植物的真皮和類似真皮結構之間的差異，其中 bovine 膠原蛋白來自 Terudermis 。在手術後一個月，bovine 膠原蛋白消失，被自體膠原蛋白取代。這些患者的傷口癒合情況令人滿意。

Conclusions: Terudermis plays a role as a dermal template for epithelization in the interstices between the autografts a in allodermis of CHCSG overlay with meshed autografts. The alternative use of Terudermis may offer significant advantages for skin graft of severe burns with limited CHCSG.
結論：Terudermis 在 CHCSG 的網格自體移植物之間的間隙中作為表皮化的真皮模板的角色。 Terudermis 的替代使用可能為嚴重燒傷的皮膚移植提供顯著優勢，而 CHCSG 有限。

The Burn Center at Washington Hospital Center, Washington, DC
華盛頓醫院中心燒傷中心，華盛頓特區

Introduction: Burn surgeons are often called upon to manage extremity injuries that encompass significant soft tissue losses. Exposure of joints, tendons, and bone devoid of viable soft tissue threaten limbs. Traditional advancement, rotation, pedicle, or "free" flaps may not be desirable or feasible in these circumstances. Creative use of a recently available biosynthetic material (Integra ) has resulted in some unexpected successes in distal limb salvage at our institution. On several occasions, multiple layers of the material have been serially applied to act as an "anlage" for reconstitut ing and "sculpting" soft tissue coverage of vital deep structures.
簡介：燒傷外科醫生常常被要求處理包含重大軟組織損失的四肢傷害。暴露的關節、肌腱和缺乏活性軟組織的骨頭威脅著四肢。在這些情況下，傳統的前進、旋轉、蒂或“自由”皮瓣可能不是理想的或可行的。最近可用的生物合成材料（Integra ）的創造性使用在我們的機構已經取得了一些意想不到的成功，用於保存遠端肢體。在幾個場合，多層材料被連續應用，作為再構建和“雕塑”重要深層結構的軟組織覆蓋的“原基”。

Methods: Over an eighteen month period, seven separate patients with threatened distal extremities were treated with application of Integra over deep structures. Detailed photographic records of initial injury, midstream results, and fina outcome were kept as the technical considerations were learned over the course of the study. Where soft tissue defects were profound, serial applications of Integta were used to build up the defects. Cause of injury included electrical contact, snake bite, and crush injuries. Threatened limbs included fingers, hands, wrists, ankles, and. feet.
方法：在十八個月的時間裡，對七名不同的患有受威脅的末梢肢體的患者進行了 Integra 在深層結構上的應用治療。在研究過程中學習技術考慮時，對初始傷害、中途結果和最終結果進行了詳細的攝影記錄。在軟組織缺損嚴重的情況下，使用 Integra 的連續應用來填補缺損。傷害的原因包括電接觸、蛇咬和壓傷。受威脅的肢體包括手指、手部、腕部、踝部和腳部。

Resultst Fourteen distal extremities at risk of amputation were treated with this method. Collectively, there was loss of hand in each of two patients, with salvage of ail other limbs with varying degrees of functional outcome. As experience increased, exceedingly favorable functional and cosmetic. outcomes were realized.
這種方法治療了 14 個有截肢風險的末梢肢體。總體而言，有兩名患者每人失去 隻手，但其他肢體均以不同程度的功能結果得以挽救。隨著經驗的增加，功能和美容方面的結果變得極為有利。

Conclusion: Clearly not a panacea, the techniques gradually developed over the life of this investigation represent a nev and useful addition to the armamentarium of the burn surgeon.
結論：顯然並非萬靈藥，這項調查期間逐漸發展的技術代表了燒傷外科醫生武器庫中的一項新而有用的補充。