Re. Horch et al., RECONSTITUTION OF BASEMENT-MEMBRANE AFTER SANDWICH TECHNIQUE SKIN-GRAFTING FOR SEVERE BURNS DEMONSTRATED BY IMMUNOHISTOCHEMISTRY, The Journal of burn care & rehabilitation, 19(3), 1998, pp. 189-202
Citations number
67
Categorie Soggetti
Surgery,Rehabilitation,"Emergency Medicine & Critical Care
Reconstitution of basement membrane structures after ''sandwich-techni
que'' grafting of severe deep burns is demonstrated with use of immuno
histochemical techniques. Cryosections of human skin after epifascial
burn wound excision and sandwich grafting were stained with monoclonal
antibodies against type IV and VII collagen, polyvalent antiserum aga
inst type VI collagen, and polyvalent antibody against laminin. Standa
rd hematoxylin and eosin histologies were performed for morphologic co
rrelation. Reorganization of the mesenchymal border zone (basement mem
brane), after transplantation of extremely expanded split-thickness sk
in autografts overlaid with glycerolized split-thickness skin allograf
ts onto debrided human full-thickness wounds, occurred from day 5 to d
ay 35. The autografts reepithelize the spaces between the mesh structu
re, which has been covered primarily exclusively with allogenic skin,
and form a layered squamous epithelium, with an underlying three-dimen
sional basket-weave array of collagen in the remodeled neodermis after
epifascial excision. Immunochemical techniques detect the reconstitut
ion of a basement membrane zone with a typical architecture and distri
bution of laminin, type IV, and type VII collagen being built up 1 wee
k to 5 weeks after sandwich grafting. These structures can be seen in
the autografts during the first 2 weeks and are consistent in the whol
e reconstituted skin after day 35. To our knowledge this is the first
report of the expression of type VI collagen in these types of wounds.
The findings are compared with the expression of type VI collagen in
healthy skin. The results indicate that the modified sandwich-grafting
technique is an adequate means for early burn wound closure and resur
facing of third-degree burn wounds and leads to the reconstitution of
dermal qualities.