Meşli otogreft uygulanan çocuk yanık hastalarında greft alanı ile boşluklardaki yara iyileşmesinin karşılaştırılması ve aselüler dermal matriksin kullanımının etkilerinin araştırılması
Küçük Resim Yok
Tarih
2025
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Çocuklarda meşli otogreft uygulamasının ağır yanık olgularında greft ile temas eden alanların greft ile temas etmeyen boşluklardaki yara iyileşmesinin klinik ve histopatolojik değerlendirilmesi ve Matriderm uygulamasının bu iyileşmeye katkısının araştırılması amacı ile bu çalışma yapıldı. Bu amaçla Matriderm uygulanan 12 hastadan oluşan bir grup ve Matriderm uygulanmayan 12 hastadan oluşan bir grup oluşturuldu. Her iki gruba da meşli kısmi kalınlıkta otogreft (mSTSG) uygulaması yapıldı. Bu 24 yanık olgusundan ayrıca rastgele 12 hasta seçildi ve yara kenarından iyileşmenin spontan nasıl ilerlediğini göstermek için bir alt grup daha oluşturuldu. Tüm yanık olgularında ilk andan itibaren standart sıvı, medikal ve pansuman tedavileri aynı şekilde yapıldı. Kontrol grubu olarak kliniğimizde sünnet edilen 12 çocuktan alınan sünnet derileri çalışmaya dahil edildi. Kontrol grubuyla birlikte toplamda 6 alt grup oluşturuldu. Hastalar, yanık sonrası 7. günde ameliyata alınarak debridman ve otogreft uygulaması yapıldı. Postoperatif 14. günde hem greft alanından hem de boşluklardan olmak üzere biyopsiler alındı. Çalışma, ADM kullanımının yalnızca daha hızlı iyileşmeyi kolaylaştırmakla kalmayıp aynı zamanda daha iyi kolajen üretimini ve fibroblast göçünü teşvik ederek dermal yapıyı desteklediğini ortaya koymuştur. Bu bulgular, ADM'nin hücresel süreçleri destekleyerek ve yara izini azaltarak dermal rekonstrüksiyona yardımcı olduğunu bildiren mevcut literatürle tutarlıdır. Ayrıca, ADM kullanımı kısmi kalınlıkta greftlere izin vererek, özellikle geniş yanık alanlarında donör saha sınırlamalarını azaltmıştır. Histopatolojik olarak epitel kalınlığı, keratinizasyon, dermal papilla sayısı, enflamatuvar hücre infiltrasyonu ve RPS-6H skorları incelendi. Sonuçlar incelendiğinde en başarılı tablo Matriderm ile kombine uygulanan otogreft uygulamasında greft ile temas eden bölgelerin olduğu görüldü. Detaylı incelendiği takdirde otogreft uygulamasının yara iyileşmesinde oldukça etkin olduğu görüldü fakat otogreft uygulanmada Matriderm eklenen uygulamaların daha başarılı olabileceği öngörüldü. Özetle, ağır yanık olgularında hem otogreft uygulaması hem de Matriderm uygulaması oldukça etkin bulunmuştur. İki uygulama kombine edildiğinde daha iyi sonuçların elde edildiği gözlemlenmiştir. Anahtar kelimeler: Çocuklar, Yanık, Aselüler dermal matriks, Otogreft
This study investigated the effects of autograft application and the use of acellular dermal matrix (ADM) Matriderm on wound healing in pediatric burn patients. The primary aim was to compare wound healing in grafted areas with untreated gaps and to explore the histopathological effects of ADM. The results demonstrated that ADM significantly enhanced the healing process, leading to improved dermal regeneration, faster epithelialization, and reduced inflammatory responses in burn wounds. For this purpose, a group of 12 patients who were applied Matriderm and a group of 12 patients who were not applied Matriderm were formed. Meshed split-thickness autograft (mSTSG) was applied to both groups. Twelve patients were also randomly selected from these 24 burn cases and a subgroup was formed to show how healing from the wound edge progressed spontaneously. Standard fluid, medical and dressing treatments were applied in the same way in all burn cases from the first moment. Twelve children who were circumcised in our clinic were included in the study for control purposes. A total of 6 subgroups were formed with the control group. They were taken to surgery on the 7th day after the trauma and debridement and autograft application were performed. On the 14th postoperative day, biopsies were taken from both the graft area and the gaps. The study found that the use of ADM not only facilitated faster healing but also promoted better collagen production and fibroblast migration, supporting dermal structure. These findings are consistent with existing literature, which reports that ADM aids in dermal reconstruction by supporting cellular processes and reducing scarring. Furthermore, ADM use allowed for partial-thickness grafts, reducing donor site limitations, especially in large burn areas. Histopathological examination revealed a notable increase in epithelial thickness and dermal papilla formation in areas treated with ADM, highlighting its positive impact on wound regeneration. The results also indicated that ADM use contributed to a more controlled inflammatory response, which is crucial for the successful healing of deep burn wounds. In conclusion, this study supports the use of ADM as a valuable adjunct in the treatment of pediatric burn injuries, demonstrating its potential to improve both the quality and speed of wound healing. Given its beneficial effects on dermal regeneration and graft stability, ADM may offer a significant advantage in managing burn wounds, particularly in cases with limited donor sites. Further studies with larger sample sizes and long-term follow-up are recommended to confirm these findings and expand its clinical application. Keywords: Children, Burn, Acellular dermal matrix, Autograft
This study investigated the effects of autograft application and the use of acellular dermal matrix (ADM) Matriderm on wound healing in pediatric burn patients. The primary aim was to compare wound healing in grafted areas with untreated gaps and to explore the histopathological effects of ADM. The results demonstrated that ADM significantly enhanced the healing process, leading to improved dermal regeneration, faster epithelialization, and reduced inflammatory responses in burn wounds. For this purpose, a group of 12 patients who were applied Matriderm and a group of 12 patients who were not applied Matriderm were formed. Meshed split-thickness autograft (mSTSG) was applied to both groups. Twelve patients were also randomly selected from these 24 burn cases and a subgroup was formed to show how healing from the wound edge progressed spontaneously. Standard fluid, medical and dressing treatments were applied in the same way in all burn cases from the first moment. Twelve children who were circumcised in our clinic were included in the study for control purposes. A total of 6 subgroups were formed with the control group. They were taken to surgery on the 7th day after the trauma and debridement and autograft application were performed. On the 14th postoperative day, biopsies were taken from both the graft area and the gaps. The study found that the use of ADM not only facilitated faster healing but also promoted better collagen production and fibroblast migration, supporting dermal structure. These findings are consistent with existing literature, which reports that ADM aids in dermal reconstruction by supporting cellular processes and reducing scarring. Furthermore, ADM use allowed for partial-thickness grafts, reducing donor site limitations, especially in large burn areas. Histopathological examination revealed a notable increase in epithelial thickness and dermal papilla formation in areas treated with ADM, highlighting its positive impact on wound regeneration. The results also indicated that ADM use contributed to a more controlled inflammatory response, which is crucial for the successful healing of deep burn wounds. In conclusion, this study supports the use of ADM as a valuable adjunct in the treatment of pediatric burn injuries, demonstrating its potential to improve both the quality and speed of wound healing. Given its beneficial effects on dermal regeneration and graft stability, ADM may offer a significant advantage in managing burn wounds, particularly in cases with limited donor sites. Further studies with larger sample sizes and long-term follow-up are recommended to confirm these findings and expand its clinical application. Keywords: Children, Burn, Acellular dermal matrix, Autograft
Açıklama
Anahtar Kelimeler
Çocuk Cerrahisi, Pediatric Surgery
