| Background:Extensive burns patients, for lacking of autologous skin source, are prone to the serious general infection and various visceral complications, which severely affect their cure rate. Scholars have conducted massive researches on the problem, such as culture of epidermal cell membrane , mixed culture of autologous and allogenous keratinocyte , composite skin, etc. But overall, the recent technology that can be selected in clinic is extremely limited, besides minor autologous skin embedded grafting in a holed large allo-skin (allogenous skin), large allo-skin (allogenous skin) covered autologous microskin grafting and so on, all of which have deficiencies respectively, with difficulty in sealing the injured area promptly and effectively. Therefore, what material can be used to seal the wound is an unceasingly being explored yet not adequately resolved problem in clinic.The healing of burn wound is a complex biological and also an ordered metabolic process , which can be divided into three stages--inflammatory response stage, granulation tissue formation stage and re-epithelialization and moulding stage after wound closure. Recently, researches have demonstrated that fat tissues can influence burn wound healings through participating in energy storage, catabolism and synthesis of lipid protein and release of leptin, IL-6 and other signal hormones .Objective:To observe the effects of autologous fat particle in mixed grafting with autologous microskin on wound healing in severe burn patients,and to primarily explore the possible mechanism. The aim of the study is to provide some evidence for the application of a new effective method for improving wound healing in clinic .Methods:Based on the time of hospitalization, 20 eligible patients were coded and recruited into this study with self-control design. These patients were randomly divided into experimental group or control group. Autologous microskin grafting method was performed in control group, while autologous microskin and autologous fat particle (volume ratio 1:1) mixed transplantation in experimental group. Wound healing rates were measured on 30th, 45th, and 60th after operation, wound contraction rates were measured on 14th, 35th and 70th day after operation, and the ranges of motion of elbow and knee on 30th, 60th, and 90th day after operation were observed. Differences between these two groups were compared with SPSS software. And wound biopsy was done on some cases followed by histological section on 7th, 14th, 21st, and 28th day after operation. Then HE dying and PCNA immunohistochemistry was performed.Observation indexes:1.Wound healing rates:Respectively on the 30th, 45th and 60th day after grafting, the wound surface was covered with a transparent membrane and the healed part was circled with a marker pen. Shearing off the surplus part along the wound edge, the wound healing rate could then be obtained by comparing the healed part to the total part of a wound using image manipulation.2.. Motion ranges of joints:Respectively on the 30th, 60th and 90th day after grafting, the maximal angle of joint autonomic activities and the activity number within 30 seconds when the joint amounted to the maximal angle were determined. The maximal angle of joint autonomic activities is the angle when the joint extends from the most straightened state to the bentest state.3. Wound contraction rates: Respectively on the 14th, 35th and 70th day before and after operation, wound areas were measured. The wound was covered with a transparent membrane. The membrane was drawn and sheared along the wound edge and marked with measuring scale. The wound area was then measured using imaging analysis software. Wound contracture rates = (primary wound area-the measured wound area )÷primary wound area×100%.4. Histology: Respectively on the 7th, 14th, 21st and 28th day, part of anterior median wound tissues was cut into sections with the permission of the patients. After fixed with 4% formalin and imbedded in paraffin, they were stained with HE and PCNA histochemical assay and observed under optical microscope.Results:1. Wound healing rateAllogeneic skins began to break off in 3-4 weeks after grafting. Newborn epidermis covered some of the wounds while the other aeras still naked. In this clinical research, the mean wound healing rates on 30th, 45th, and 60th after operation in experimental group were higher than them in control group(p<0.01),indicating that autologous fat particle in mixed grafting with autologous microskin speed up the wound healing significantly.2. Motion ranges of joints(1) The mean largest angle of the range of auto motion of knee and elbow on 30th, 60th, and 90th day after operation were (38.3±4.62)°,(55.37±7.07)°and(61.57±8.12)°in experimental group, which were larger than in control group(20.1±2.83)°,(37.00±6.33)°and(46.00±8.25)°(p<0.01 ).(2)The activity times of largest angle of the range of auto motion of elbow and knee on 30th, 60th, and 90th day after operation were 2.25±0.25,5±1.89 and 6.43±0.81, in experimental group, which were larger than in control group1.25±0.16,2.0±1.89 and 3.43±0.20 respectively(p<0.01 ).3. Wound contraction ratesThe wound contraction rates on 14th and 35th day after operation were(5.67+0.48)% and (6.64±0.78)% in experimental group, (5.51+0.38)%and (7.90+1.65)% in control group ,and there were no significant differences between these two groups(p>0.05 ).They were (9.14+0.82)% on 70th day in experimental group, (11.25+1.25)% in control group,and significant differences were observed between these groups(p<0.05 ).4. HistologyEpithelization was earlier and arrangement of collagen fibers was more regular in experimental group compared with control group by HE dying. PCNA immunohistochemistry showed PCNA positive cells in experimental group were more than those in control group, which were mainly expressed in basal epithelium.Conclusions:1. Mixed grafting of autologous fat partical and microskin can speed up the wound healing.2. Mixed grafting of autologous fat partical and microskin can increase the function after healing,and improve the joint movement.
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