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Erfahrungen mit porcinen Haut-Heterotransplantaten

Experiences with porcine skin heterografts

Summary

Temporary skin replacement is often necessary in patients with 3rd degree burns in order to save their lives by preventing fluid loss and bacterial infection. Homografts are ideally suited for this purpose; however it is difficult to procure sufficient amounts. Since homografts cause a rejection phenomenon with lymphocytic infiltration and thrombocyte aggregation in the capillaries, they have to be replaced every 4 to 5 days before the rejection sets in. For this reason the search for other materials to replace human skin is still justified. Snydermann was the first to use pig skin heterografts. Utilizing his satisfactory experience we performed pig skin heterografts on 700 A heston and C 57 black mice. We tested fresh pig skin, irradiated pig skin, freeze-dried pig skin and pig skin (Fig. 1), which was treated with a salt solution and sterilized by cobalt irradiation. Biopsies were taken every 2nd day. Vascularization was examined with i. v. Evans blue injection (Fig. 2). We found that pig skin does not become vascularized but is nourished by diffusion and does not cause a rejection phenomenon. Only a very minor leukocytic infiltration was noticed, beginning on the 6th day. Drying of the edges started about the same time. The grafts did not reallay take, but functioned as a biological dressing for approximately three weeks. Based on these good results of the animal experiments we first tested pig skin heterografts besides homografts and autografts on the same patient (Fig. 7). The histological findings were the same as in animal experiments (Fig. 8). We therefore started to use pig skin on 3rd degree burn patients (Figs. 3–6). Since 1962 this type of heterograft has been used in 153 patients as temporary dressing in 3rd degree burns, with very good results. Second and third set grafts were used without any adverse results. Within the first 2 weeks after the removal of the grafts only moderate antibody titers against pig could be measured. When the grafts were removed, clean granulation tissue well suited for autografting was present. As a side effect, the pig skin diminishes the pain (which is caused by sulfamylon application) if the drug is applied on top of the pig skin (Figs. 9 and 10). This was especially utilized in children.

Zusammenfassung

Bei 700 A Heston und C 57 Mäusen wurden Schweinehaut-heterotransplantate getestet. Untersucht wurden frische Schweinehaut, bestrahlte Schweinehaut, gefriergetrocknete Schweinehaut und Schweinehaut, die mit einer Salzlösung vorbehandelt und mit Kobaltbestrahlung sterilisiert war. Jeden 2. Tag wurden Biopsien entnommen. Die Vascularisierung wurde mit Evans-Blue-Injek-tionen untersucht. Wir fanden, daß Schweinehaut nicht vascularisiert und durch Diffusion ernährt wird, sie versucht daher keine Abstoßungsreaktion. Nur eine ganz leichte Leukocyteninfiltration am 6. Tage beginnend fiel auf. Die Transplantate wuchsen nicht an, sondern wirkten etwa 3 Wochen lang als biologischer Verband. Die histologischen Befunde konnten beim Menschen bestätigt werden. Seit 1962 wurde Schweinehaut bei 153 Patienten mit drittgradigen Verbrennungen mit sehr guten Ergebnissen als Platzhalter verwendet. Nur geringe Antikörpertiter gegen Schwein konnten während der ersten 2 Wochen nach der Entfernung der Transplantate festgestellt werden. Als günstiger Nebeneffekt setzt Schweinehaut die Schmerzen, die durch Sulfamylon verursacht werden, herab, wenn das Sulfamylon auf die Schweinehaut aufgetragen wird.

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Literatur

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Köhnlein, H.E., Song, I. & Bromberg, B. Erfahrungen mit porcinen Haut-Heterotransplantaten. Chir Plastica 1, 323–332 (1973). https://doi.org/10.1007/BF00265521

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