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Title: [Influence of different inner dressings in negative-pressure wound therapy on escharectomy wound of full-thickness burn rabbits].
Author: Lin JH, Chen J, Xue DJ, Huang WX, Su GL.
Journal: Zhonghua Shao Shang Za Zhi; 2017 Jul 20; 33(7):431-436. PubMed ID: 28763910.
Abstract:
Objective: To explore the influence of different inner dressings in negative-pressure wound therapy (NPWT) on escharectomy wound of full-thickness burn rabbits. Methods: Eighteen Japanese white rabbits were inflicted with full-thickness burn on unilateral back. They were divided into polymer dressing group (PD), biological dressing group (BD), and silver biological dressing group (SBD), according to the random number table, with 6 rabbits in each group. On 3 days post burn, the wounds were performed with escharectomy, and then wounds of rabbits in group PD were covered with polyurethane foam. Wounds of rabbits in group BD were covered with porcine acellular dermal matrix (ADM) and wounds of rabbits in group SBD were covered with silver porcine ADM. Then continuous NPWT was performed on rabbits of the three groups for 7 days. Immediately after surgery and on post surgery day (PSD) 7, general observation of wound was conducted and tissue around the wound was harvested for determination of dry to wet weight ratio. The content of bacteria was counted and the content of tumor necrosis factor α (TNF-α), interleukin-1β (IL-1β), and IL-6 in wound was determined by enzyme-linked immunosorbent assay. Fibroblasts in wound were counted after Masson staining and number of microvessels was counted after CD31 antibody immunohistochemical staining. Data were processed with analysis of variance for repeated measurement, LSD-t test, paired samples t test, and Bonferroni correction. Results: (1) Immediately after surgery, there was no granulation tissue in basal wound of rabbits in the three groups, with rich blood supply and obvious edema. On PSD 7, much granulation tissue was found in basal wound of rabbits in the three groups, with no or mild edema and no obvious redness and swelling in wound edge. (2) There were no significant differences in dry to wet weight ratios of tissue around the wound among and within the three groups immediately after surgery and on PSD 7 (with F values respectively 0.70 and 0.09, t values from 0.17 to 0.52, P values above 0.05). (3) Immediately after surgery, the content of bacteria in wounds of rabbits in groups PD, BD, and SBD was respectively (603.0±146.0) ×10(4,) (573.0±63.0) ×10(4,) and (590.0±100.0)×10(4) colony-forming unit (CFU)/g, with no significant difference among them (F=0.13, P>0.05). On PSD 7, the content of bacteria in wounds of rabbits in groups PD, BD, and SBD were respectively (5.4±0.8) ×10(4,) (4.6±0.9) ×10(4,) and (3.5±0.9)×10(4) CFU/g. Among them, the content of bacteria in wounds of rabbits in group SBD was lower than that in groups PD and BD, respectively (with t values respectively 3.78 and 2.29, P<0.05 or P<0.01). The content of bacteria in wounds of rabbits in the three groups on PSD 7 was decreased compared with that immediately after surgery (with t values from 10.05 to 21.81, P values below 0.01). (4) There was no significant difference in content of TNF-α, IL-1β, and IL-6 in wounds of rabbits in the three groups immediately after surgery and on PSD 7 (with F values from 0.10 to 1.89, P values above 0.05). The content of TNF-α in wounds of rabbits in the three groups on PSD 7 was significantly higher than that immediately after surgery (with t values from 2.93 to 5.01, P<0.05 or P<0.01). (5) There was no significant difference in amount of fibroblasts in wounds of rabbits in the three groups immediately after surgery and on PSD 7 (with F values respectively 0.01 and 0.81, P values above 0.05). The amount of fibroblasts in wounds of rabbits in the three groups on PSD 7 was larger than that immediately after surgery (with t values from 4.78 to 11.58, P values below 0.01). (6) There was no significant difference in number of microvessels in wounds of rabbits in the three groups immediately after surgery and on PSD 7 (with F values respectively 2.42 and 2.49, P values above 0.05). The number of microvessels in wounds of rabbits in the three groups on PSD 7 was larger than that immediately after surgery (with t values from 7.17 to 11.14, P values below 0.01). Conclusions: SBD is better at inhibiting the growth of bacteria. PD, BD, and SBD have almost the same effects on reducing tissue edema and inflammatory reaction, and on promoting the accumulation of collagen fibers and tissue vascularization. 目的： 探讨负压伤口疗法中不同的内层敷料对Ⅲ度烧伤兔切痂创面的影响。 方法： 将18只日本大耳白兔单侧背部造成Ⅲ度烧伤，按随机数字表法分为高分子敷料组、生物敷料组和含银生物敷料组各6只，伤后第3天行切痂术后，高分子敷料组兔创面覆盖聚氨酯泡沫、生物敷料组兔创面覆盖猪ADM敷料、含银生物敷料组兔创面覆盖含银猪ADM敷料，均行持续负压治疗7 d。于术后即刻和7 d，分别观察各组兔创面大体情况，测定创周组织干湿比，计算创面细菌量，ELISA法测定创面TNF－α、IL－1β、IL－6含量，Masson染色后行创面Fb计数，CD31染色后行创面微血管计数。对数据行重复测量方差分析、LSD－t检验、配对样本t检验及Bonferroni校正。 结果： (1)术后即刻，3组兔创面基底无肉芽组织，血供丰富，水肿明显。术后7 d，3组兔创面基底均有较多肉芽组织，无或轻度水肿，创缘未见明显红肿。(2)3组兔创面术后即刻及7 d创周组织干湿比组间及组内比较，差异均无统计学意义(F值分别为0.70和0.09，t值为0.17～0.52，P值均大于0.05)。(3)术后即刻，高分子敷料组、生物敷料组、含银生物敷料组兔创面细菌量分别为(603.0±146.0)×10(4)、(573.0±63.0)×10(4)、(590.0±100.0)×10(4) CFU/g，总体比较差异无统计学意义(F＝0.13，P>0.05);术后7 d创面细菌量分别为(5.4±0.8)×10(4)、(4.6±0.9)×10(4)、(3.5±0.9)×10(4) CFU/g，其中含银生物敷料组创面细菌量明显少于高分子敷料组和生物敷料组(t值分别为3.78和2.29，P<0.05或P<0.01)；3组兔术后7 d创面细菌量均较术后即刻明显减少(t值为10.05～21.81，P值均小于0.01)。(4)3组兔术后即刻和7 d创面TNF－α、IL－1β及IL－6含量组间总体比较，差异均无统计学意义(F值为0.10～1.89，P值均大于0.05)。3组兔术后7 d创面TNF－α含量均明显高于术后即刻(t值为2.93～5.01，P<0.05或P<0.01)。(5)3组兔术后即刻和7 d创面Fb数组间总体比较，差异均无统计学意义(F值分别为0.01和0.81，P值均大于0.05)。3组兔术后7 d创面Fb数均明显高于术后即刻(t值为4.78～11.58，P值均小于0.01)。(6)3组兔术后即刻和7 d创面微血管数量组间总体比较，差异均无统计学意义(F值分别为2.42和2.49，P值均大于0.05)。3组兔术后7 d创面微血管数量均明显多于术后即刻(t值为7.17～11.14，P值均小于0.01)。 结论： 在抑制创面细菌增殖方面含银生物敷料具有一定优势，但在抑制局部组织水肿和创面炎症反应、促进胶原纤维沉积及组织血管化方面，高分子敷料、生物敷料及含银生物敷料作用基本相同。.

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