随着人口老龄化，与老年病相关的慢性伤口护理越来越受重视。1962年，Winter［1］提出了“湿润环境促进伤口愈合”，为伤口换药奠定了现代创面换药的理论基础。20世纪80年代以来，针对各型创面研发了大量的新型敷料，如高分子薄膜敷料、泡沫敷料、水凝胶和水胶体敷料、海藻酸盐敷料、生物活性药物敷料等。正确选用敷料能加快创面修复、减少感染机会、缩短住院时间及降低医疗费用。现结合下肢静脉性溃疡的创面换药问题就如何选用各种医用敷料作一讨论……
目的 探讨瘢痕或皮肤肿瘤切除后创面使用皮能快愈敷料（PELNAC，商品名：皮耐克）结合自体刃厚皮覆盖的治疗效果。 方法 回顾分析2010年1月－2013年1月收治的两组瘢痕或皮肤肿瘤切除术后创面分别使用不同皮片覆盖的治疗效果。A组6例，采用PELANC与自体刃厚皮片复合移植；B组10例，采用自体中厚皮片移植修复。随访近期、远期，对比评估两组创面存活的皮片外观，弹性；供皮区愈合情况。 结果 两组患者皮片完全成活，外观好，弹性佳，较术前明显改善。与B组相比，A组供皮区愈合时间短，愈合后色素沉着轻微，无明显疤痕形成。 结论 采用PELNAC与自身刃厚皮片复合移植修复瘢痕或肿瘤切除后创面，既能够显著改善外观、功能，达到理想的创面修复效果，又不会造成供皮区的继发性瘢痕增生，是一种理想的创面修复方式。
Objective To compare the clinical effect between alginate calcium dressing and radix yarn dressing after anal fistula surgery. Methods A survey of 128 patients with anal fistula from April to October 2008 were studied. Patients were divided into two groups using a simple random method: 64 cases in therapy group which were treated with alginate calcium dressing and 64 cases in control group which were treated with traditional radix yarn dressing. The difference of the wound recovery indexes between two groups was compared.Results With regard to age, gender, anal fistula type, the proportion of preoperative diabetes and the diameter of wound, there was no statistical significance between therapy group and control group (Pgt;0.05). The proportion of slight pain during dressing change in therapy group (45.32%, 29/64) was more than control group (25.00%, 16/64), which had statistical significance (Pgt;0.05). The incidence of skin allergy was significantly different between two groups (29.69% vs. 60.94%, P＜0.05). Also, the rotten tissue and the soakage disappears with a shorter period, which both had statistical significance 〔(8.60±2.37) d vs. (12.22±3.29) d， (16.96±5.83) d vs. (22.02±5.90) d〕， Plt;0.05.Conclusion With the shorten of inflammatory and increment stage of the wound recovery, alginate calcium dressing is an ideal material for the postoperative duration of surgery of anal fistula.
ObjectiveTo observe the growth characteristics of human umbilical cord mesenchymal stem cells (hUCMSCs) cultured on the alginate gel scaffolds and to explore the feasibility of hUCMSCs-alginate dressing for wound healing. MethodshUCMSCs were separated from human umbilical cords and cultured in vitro. After the 4th passage cells were co-cultured with alginate gel (experimental group), the cell growth characteristics were observed under the inverted phase contrast microscope. Vascular endothelial growth factor (VEGF) content was measured and the number of cells was counted at 0, 3, 6, and 9 days after culture; and the cell migration capacity was observed. The hUCMSCs were cultured without alginated gel as control. The model of full-thickness skin defects was established in 32 8-weekold Balb/c male mice and they were randomly divided into 4 groups (n=8): wounds were covered with hUCMSCsalginate gel compound (MSC-gel group), cell supernatants-alginate gel compound (CS-gel group), 10% FBS-alginate gel compound (FBS-gel group), and 0.01 mol/L PBS-alginate compound (PBS-gel group), respectively. Wound healing rates at 5, 10, and 15 days were observed and calculated; and the wound tissues were harvested for histological and immunohistochemical staining to assess new skin conditions at 15 days after operation. ResultshUCMSCs grew well with grape-like proliferation on the alginate gel, but no cell migration was observed at 7 days after cultivation. VEGF expression and cell number in experimental group were significantly less than those in control group at 3 days（P<0.05）; then they gradually increased, and VEGF expression and cell number were significantly more than those in control group at 9 days (P<0.05). The wound healing rates of MSC-gel and CS-gel groups were significantly higher than those of FBSgel and PBS-gel groups at 5, 10, and 15 days (P<0.05). The squamous epithelium, fibroblasts, sebaceous glands, capillaries and VEGF expression of the new skin in MSC-gel and CS-gel groups were significantly more than FBS-gel and PBS-gel groups (P<0.05). But there was no significance between MSC-gel and CS-gel groups (P>0.05). ConclusionhUCMSCs can continuously express VEGF in alginate gel, which is necessary for wound healing. The hUCMSCs-alginate compound is probably a good wound dressing.
Three-dimensional (3D) printing is a low-cost, high-efficiency production method, which can reduce the current cost and increase the profitability of skin repair material industry nowadays, and develop products with better performance. The 3D printing technology commonly used in the preparation of skin repair materials includes fused deposition molding technology and 3D bioprinting technology. Fused deposition molding technology has the advantages of simple and light equipment, but insufficient material selection. 3D bioprinting technology has more materials to choose from, but the equipment is cumbersome and expensive. In recent years, research on both technologies has focused on the development and application of materials. This article details the principles of fused deposition modeling and 3D bioprinting, research advances in wound dressings and tissue engineering skin production, and future developments in 3D printing on skin tissue repair, including cosmetic restoration and biomimetic tissue engineering. Also, this review prospects the development of 3D printing technology in skin tissue repairment.