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Introduction: Chronic wounds represent a frequent cause of consultation for plastic and reconstructive surgeons. The use of epidermal culture stands out because they provide complete epithelialization, adequate aesthetic-functional results, and no morbidity for the patient. Epifast® is a pre-manufactured cultured epidermal allograft derived from the amplification in vitro of human keratinocytes. Materials and Methods: A prospective longitudinal multicenter study was carried out in four chronic wound reference centers, which were in charge of plastic and reconstructive surgery services. For a standardized wound bed preparation, the protocol synthesized by the acronym "TIME" was used. At the end of the "TIME" protocol, the pre-fabricated allograft was applied and removed 7 days after its application. Results: A total of 133 patients with diagnosis of chronic wound were included in the study. The median age was 69.3 ± 13.6 years. The most common comorbidity found was diabetes mellitus type 2 in 71.4% of the patients (n = 95) and systemic arterial hypertension in 60.2% of the patients (n = 80). The most frequent location of chronic wounds was seen in the lower extremity with 45.1% (n = 60). The mean duration for it to close was 46 ± 14 days, in which they closed within the first 3 months in 93% (n = 125) of the cases. About 91.7% (n = 122) of the wounds achieved total closure. Conclusion: Cultured epidermal allograft, combined with a meticulous technique and an adequate selection of patients, represents a safe and effective tool for chronic wounds.
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Introducción y Objetivos. En la actualidad existen una gran cantidad de apósitos y coberturas para el tratamiento de las heridas de espesor parcial; la elección depende de la experiencia del cirujano y sobre todo de la disponibilidad y recursos existentes. Las estatinas (inhibidores de la Hidroxi-Metil-CoA reductasa) se usan en el tratamiento de la hipercolesterolemia, aunque recientemente se han encontrado propiedades antinflamatorias, estimulantes de la angiogénesis y linfangiogénesis, antifibróticas, y especialmente estimuladoras de los queratinocitos. Nos proponemos comparar la epitelización e inflamación de las heridas en un modelo animal con la aplicación de simvastatina tópica, inyectable y apósito de hidrocoloide. Material y Método. Empleamos 20 ratas Wistar en 4 grupos, cada uno con 5 ratas, a las que practicamos heridas de espesor parcial por dermoabrasión en el dorso. A cada grupo se le aplicó gasa de organza, apósito de hidrocoloide, simvastatina tópica y simvastatina inyectada, respectivamente. Descubrimos las heridas a los 7 días y sacrificamos a los animales. Tomamos biopsias de las heridas y comparamos el grado de epitelización de cada grupo. Resultados. Al comparar la simvastatina en preparación tópica con el grupo de gasa de organza y el grupo de apósito de hidrocoloide, encontramos un mayor porcentaje de epitelización en el grupo tratado con simvastatina tópica, con una diferencia estadísticamente significativa (p<0.05). Las heridas tratadas con simvastatina tópica demostraron menor inflamación, menor fibrosis, mayor epitelización (queratinocitos), mayor cantidad de fibroblastos y no presentaron costra, de forma estadísticamente significativa. Conclusiones. La cobertura de heridas de espesor parcial con simvastatina tópica es más efectiva en epitelización y efecto antinflamatorio, en comparación con la simvastatina inyectable, los apósitos de hidrocoloide y las gasas de organza (AU)
Background and Objective. There are various alternatives and dressings for split thickness skin wounds, the choice depends on the experience and training of each surgeon. Statins, which are normally used for the treatment of hypercholesterolemia, have proven to induce and antinflammatory effect on wound keratinocytes, which provokes a faster re-epithelialization on in vitro studies. Our aim was to compare epithelialization and anti-inflammatory properties in split thickness wounds of rats, using hydrocolloid dressings versus a simvastatin based emulsion or simvastatin injected. Methods. We used 20 Wistar rats divided in 4 groups in which split thickness wounds were induced in the dorsum by dermoabrasion. Each group was treated with organza gauze, hydrolloid dressings, simvastatin cream and injectable simvastatin in the wound, respectively. Seven days later, the wounds were exposed and the animals where sacrificed. The wounds were analyzed with digital photographs and biopsies where taken in order to compare the epithelization percentage in each group. Results. There was a statistically significant improvement (p<0.05) in wound rate epithelialization in the rats treated with topic simvastatin. The wounds treated with topic simvastatin had less inflammation, less fibrosis, no evidence of crusting and a higher number of fibroblast. Conclusions. Split thickness skin wounds coverage with topical simvastatin is most effective in epithelialization and antinflamatory effect compared with injectable simvastatin, organza gauze dressings and hydrocolloid dressings (AU)
