Clinical Prospective Study Of Burn Scar Epidermis Combined With Tissue Engineered Dermis For Scar Treatment

Aim and background:In order to provide a reliable source of skin grafts for the treatment of largearea burn scar patients.The comparisons of the effects of two tissue engineering dermis(acellular allogeneic dermis and Pelnac)combined with scar epidermal grafting and autologous medium thick skin graft in scar repair,and the feasibility and effectiveness of using tissue engineered dermis combined with scar epidermal grafting to replace autologous moderate-thickness skin graft in patients with large-area burn scars were explored.Methods:A total of 90 patients with scars who were treated in The Fourth Affiliated Hospital of Guangxi Medical University hospital from September 2016 to December 2018 were randomly divided into three groups: the acellular allogeneic dermal combined with scar epidermal transplantation group(group A);the artificial dermis combined with scar epidermal transplantation treatment group(group B)and the autologous medium thickness skin graft treatment group(group C).30 patients in each group.The patients each group were followed up,and the wound healing time each groups were compared.Furthermore,the scars were evaluated using the Vancouver scar scale(VSS).The joint function was evaluated according to the ADL grading standard.The tissue was excised for pathological biopsy examination,and the morphological changes of the scar were calculated.Results:1.The average of wound healing time in each group: group A(12.07±2.01)days,group B(22.23±1.76)days,and group C(11.33±2.05)days.There were significant differences between groups(A and B)and(B and C),(p<0.01).There was no significant difference between groups A and C(p>0.05).The wound healing time of group B patients was longer than that of group A and C;2.The scar VSS scores were evaluated after following up forhalf a year: group A(4.10 ± 1.67),group B(4.40 ± 1.94),group C(5.07 ± 2.35).There was no significant difference in the scores of scars between the groups(p>0.05),suggesting that there was no significant difference in the repair of scars between the groups.The scar VSS scores results at the time of admission and at followup were compared between the three groups,all showed statistically significant difference(p<0.05),suggesting that the three treatment methods have significant effects on scar plastic surgery;3.ADL joint function assessment after half a year: group A(5 cases,12 cases,10 cases,3 cases were separately evaluated in order with excellent,good,meddle and poor;the same annotation for the following groups),group B(4 cases,11 cases,10 cases,5 cases),group C(7 cases,14 cases,6 cases,and 3 cases).There was no significant difference in the results of ADL joint function evaluation between the groups(p>0.05),suggesting that there was no significant differences in joint function recovery between the three groups.The results of ADL joint function evaluation at the time of admission and at follow-up were compared between the three groups.The results showed that p<0.05,the difference was statistically significant,suggesting that the three operation strategies have significant curative effect on joint dysfunction caused by scar hyperplasia;4.The number 10 cases in group A,9 cases in group B,and 10 cases in group C were separately chosen for scar tissue pathological biopsy.The histological morphology of the three groups was similar: all of the treatment strategies showed that the dermatitis cells disappeared,the blood vessels decreased,and the collagen fibers were light-moderately hypertrophic,and no keloids were formed.Conclusion and significance:1.Implanted artificial dermis(Pelnac)combined with scar epidermal transplantation group had longer wound healing time,and there was no significant difference in wound healing time between acellular allogeneic dermis combined with scar epidermal grafting and autologous moderate thick skin grafting.2.The methods have significant effects on scar repair and joint function recovery.There is no significant difference in the efficacy between the groups.3.For patients with large-area burn scars,such as autologous moderatethickness skin,acellular allogeneic dermis combined with scar epidermal graft or implanted artificial dermis(Pelnac)combined with scar epidermal graft treatment.Tissue engineering dermis combined with scar epidermal graft can avoid new scars and achieve the same therapeutic efficacy as autologous thick skin.Among them,acellular allogeneic dermis combined with scar epidermal transplantation can shorten the treatment cycle.