201136625 六、發明說明： 【發明所屬之技術領域】 本發明大致上係關於醫用傷口護理系統，且更特定而 言，係關於使用減壓而上皮化之方法、敷件及系統。 本發明根據35 USC § 119(e)主張於2010年3月16日申請 之標題為「上皮化方法、敷件及系統（EpitheliaHzati〇n Methods，Dressings，and Systems)」之美國臨時專利申請案 第61/314,236號之權利，該申請案出於所有目的而以引用 之方式併入本文令，及於2010年3月16曰申請之標題為「圖 案化上皮化敷件、系統及方法（Patterned Ne〇 Epithelia丨 Dressings，Systems，and Methods)」之美國臨時專利申請案 第61/314,274號之權利，該申請案亦出於所有之目的而以 引用之方式併入本文中。 【先前技術】 根據醫學條件’減壓已尤其用於減壓療法中來促進組織 部位處之肉芽化。在傷口之正常癒合過程中，i皮化(由 於實際上上皮生長而取代脫落之上皮而再上皮化）在肉芽 化後發生且可能呈現一些問題。 【發明内容】 根據-闡釋性非限制實施例，一種用於治療在傷口床中 具有肉芽組織之傷口之方法，其包含下列步驟：在該傷口 床中之該肉芽組織附近部署_上皮化敷件，在該上皮化敷 牛上^•成Μ縮力，使得複數個突起碰撞於該肉芽組織 上’且容許上皮組織擁有充分的時間在該等突起附近形 154792.doc 201136625 成。上皮化敷件包含一敷件本體及複數個突起。每個突起 具有一近端及一遠端，且該近端係經耦合至該敷件本體之 一面對組織之第二側。 根據另一闡釋性非限制實施例，一種促進具有傷口床之 傷口之癒合之方法，其包含下列步驟：用一系統在該傷口 床中形成肉芽組織以促進肉芽生長，用一上皮化敷件在該 肉芽組織十產生複數個腔’且在上皮組織遷移進入該等孔 隙中時產生複數個上皮柱狀物。該上皮化敷件包含複數個 突起’其產生該肉芽組織中之該複數個腔。 根據另一闡釋性非限制實施例，一種在肉芽組織與上皮 之間之一傷口中形成模擬層膜柱之方法包含下列步驟：提 供複數個突起，將該複數個突起放置鄰近該肉芽組織，造 成該複數個突起碰撞於該肉芽組織上，且容許充分的時間 用於該複數個突起周圍之上皮遷移’從而形成模擬層膜 柱°該等模擬層膜柱有助於錨定相鄰之組織層。 根據另一闡釋性非限制實施例，一種用於在兩個相鄰組 織層之間形成錨定點之上皮化敷件包含一敷件本體及複數 個突起。該上皮化敷件具有一第一側及一面向組織之第二 側。每個突起具有一近端及一遠#，且每個近端係輕合至 該敷件本體的面向組織之第二側。該上皮化敷件進一步包 含形成於該敷件本體之一部分上之第一複數個孔隙及形成 於該複數個突起中之各者之該遠端上之若干子特徵部。 根據另一闡釋性非限制實施例，一種促進傷口之上皮化 之系統包含-上皮化敷件、一用於在該傷口及上皮化敷件 154792.doc 201136625 之上形成一流體密封之密封構件、一用於提供減壓至該上 皮化敷件之減壓介面及流體地耦合至該減壓介面之一減壓 源《該上皮化敷件包含一敷件本體及複數個突起。該敷件 本體具有一第一側及一面向組織之第二側。每個突起具有 尖4及一％端。每個近端係經躺合至該敷件本體之該面 向組織之第二側。該敷件本體亦具有形成於該敷件本體之 一部分上之複數個孔隙及形成於該複數個突起中之各者之 該遠端上之子特徵部。 根據另一闡釋性非限制實施例，一種一上皮化敷件之製 造方法包含由一醫用級聚合物形成具有一第一側及一第二 側之敷件本體，及由一醫用級聚合物形成複數個突起，其 縱橫比（該複數個突起中之一平均突起之較長尺寸除以該 複數個突起巾之平均突起之—較短尺寸）在1/1()錢之範圍 内。該等突起形成有一内部及複數個小孔，該等小孔流體 地搞合該突起之内部與一外部。該方法進一步包含將該複 數個突起耦合至該敷件本體之該第二側。 根據另一闡釋性非限制實施例，一種促進一傷口之上皮 化之上皮化敷件包含一大體平面構件’該構件係由一醫用 形成有複數個容許諸笛 /日 _1 你社工上 L· 一 v_ 級聚合物製成且具有一第一側及一 一面向組織之第二側，且201136625 VI. Description of the Invention: TECHNICAL FIELD OF THE INVENTION The present invention relates generally to medical wound care systems and, more particularly, to methods, dressings and systems for epithelialization using reduced pressure. U.S. Provisional Patent Application No. 3, entitled "Epithelia Hzati〇n Methods, Dressings, and Systems", filed on March 16, 2010, which is incorporated herein by reference. </ RTI> </ RTI> </ RTI> </ RTI> </ RTI> </ RTI> </ RTI> </ RTI> </ RTI> </ RTI> </ RTI> </ RTI> </ RTI> </ RTI> </ RTI> <RTIgt; </ RTI> </ RTI> <RTIgt; </ RTI> <RTIgt; </ RTI> <RTIgt; </ RTI> <RTIgt; </ RTI> <RTIgt; </ RTI> <RTIgt; [Prior Art] According to medical conditions, decompression has been particularly used in decompression therapy to promote granulation at a tissue site. During normal healing of the wound, i-dermatization (replacement of epithelial growth instead of exfoliation of the epithelium) occurs after granulation and may present some problems. SUMMARY OF THE INVENTION According to an illustrative non-limiting embodiment, a method for treating a wound having granulation tissue in a wound bed, comprising the steps of: deploying an epithelialized dressing adjacent the granulation tissue in the wound bed In the epithelialized cattle, the force is reduced so that a plurality of protrusions collide with the granulation tissue' and the epithelial tissue is allowed to have sufficient time to form a shape near the protrusions. The epithelialized dressing comprises a dressing body and a plurality of protrusions. Each projection has a proximal end and a distal end, and the proximal end is coupled to a second side of the body of the dressing that faces the tissue. According to another illustrative, non-limiting embodiment, a method of promoting healing of a wound having a wound bed, comprising the steps of: forming a granulation tissue in the wound bed with a system to promote granulation growth, using an epithelialized dressing The granulation tissue produces a plurality of lumens' and produces a plurality of epithelial pillars as the epithelial tissue migrates into the pores. The epithelialized dressing comprises a plurality of protrusions' which produce the plurality of cavities in the granulation tissue. According to another illustrative, non-limiting embodiment, a method of forming a simulated layer of membrane columns in a wound between a granulation tissue and an epithelium comprises the steps of providing a plurality of protrusions, placing the plurality of protrusions adjacent to the granulation tissue, resulting in The plurality of protrusions impinge on the granulation tissue and allow sufficient time for the epithelial migration around the plurality of protrusions to form a simulated layer of film columns. The simulated layer of film columns helps anchor adjacent tissue layers . According to another illustrative, non-limiting embodiment, an dermatological dressing for forming an anchor point between two adjacent tissue layers comprises a dressing body and a plurality of protrusions. The epithelialized dressing has a first side and a second side facing the tissue. Each projection has a proximal end and a distal end, and each proximal end is lightly coupled to the tissue-facing second side of the applicator body. The epithelialized dressing further includes a first plurality of apertures formed on a portion of the body of the dressing and a plurality of sub-features formed on the distal end of each of the plurality of protrusions. According to another illustrative, non-limiting embodiment, a system for promoting epithelialization of a wound comprises an epithelialized dressing, a sealing member for forming a fluid seal over the wound and epithelialized dressing 154792.doc 201136625, A reduced pressure interface for providing reduced pressure to the epithelialized dressing and fluidly coupled to a reduced pressure source of the reduced pressure interface. The epithelialized dressing comprises a dressing body and a plurality of protrusions. The dress body has a first side and a second side facing the tissue. Each protrusion has a tip 4 and a % end. Each proximal end is draped to the second side of the facing body of the dressing body. The body of the dressing also has a plurality of apertures formed in a portion of the body of the dressing and sub-features formed on the distal end of each of the plurality of protrusions. According to another illustrative non-limiting embodiment, a method of making an epithelialized dressing comprises forming a dressing body having a first side and a second side from a medical grade polymer, and polymerizing by a medical grade The object forms a plurality of protrusions having an aspect ratio (the longer dimension of one of the plurality of protrusions divided by the average protrusion of the plurality of protrusions - the shorter dimension) is within 1/1 () of the money. The projections are formed with an inner portion and a plurality of small holes that fluidly engage the interior of the projection and an outer portion. The method further includes coupling the plurality of protrusions to the second side of the body of the dressing. According to another illustrative, non-limiting embodiment, an epithelialized epithelialization promoting a wound comprises a large planar member. The member is formed from a medical device having a plurality of vomiting/days. a v_ grade polymer made with a first side and a second side facing the tissue, and
(複數個柱中之一 -側之柱》該複數個柱之該等柱具有的一 长至5000微米之間’且具有之一縱橫比 平均柱之較長尺寸除以該複數個柱中之 154792.doc 201136625 該平均柱之一較短尺寸）在1/10至10之範圍間。 闡釋性實施例之其他及優點將可在參考下文之圖式與實 施内容而瞭解。 【實施方式】 在以下實施内容中，係參考形成本文之一部分之附圖。 充分詳盡地描述此等實施例目的在於致使熟悉此項技術者 實踐本發明，且應理解，在不脫離本發明之精神或範疇， 可採用其他實施例且做出邏輯結構'機械、電氣及化學變 化。為了避免熟悉此項技術者在實踐本文所述之實施例時 係不必要之細節，下文描述可能省略熟悉此項技術者所已 知之某些資訊。因此’下文之實施内容不應被解讀具有一 限制意義’且該等闡釋性實施例之範疇係僅由附加技術方 案所界定。 皮膚之最外或最表面層為表皮，表皮自身亦具有多個 層。表皮與真皮鄰接。表皮可能具有馬爾皮基氏 (Malpighian)層之與真皮乳頭交織之向内導向延伸部。此 專延伸部有時被稱為「層膜柱（rete peg)」。層膜柱可提供 抵抗鄰接層之經剪切引致分離之阻力。相反地，再上皮化 之傷口通常不具有抵抗剪切之如此多的阻力。 在傷口之癒合過程，表皮可能再生，但新近生成之上皮 通常（至少在初始時）缺之層膜柱。因此，新近生成之上皮 可能容易破裂或脫落。現主要參考圖丨至圖3，一上皮化敷 件100可用於促進層之更強連接或繋結從而有效地作用為 健康之層膜柱。上皮化敷件100可藉由在上皮化敷件1〇〇上 154792.doc • 6 - 201136625 使用表面架構而用表皮下方之組織層引致上皮之猫定點。 此外，上皮化敷件1〇〇可用下方之組織固持或緊固上皮 且從而防止上皮遭受剪切力之損害。此外，上皮化敷件 100可維持—障壁且無須對上皮進行重複修復。上皮化敷 件100亦可加速上皮化過程。 上皮化敷件1 00可實現多種功能。例如，上皮化敷件1 〇〇 可用作為幫助管理-傷口處之流體以促進上皮化。另舉一 例，上皮化敷件100係可使用其物理、化學或機械性質來 引導下方組織結構之生成，以促進再生表皮之強度。除非 另有指示，用在本文中時’「或者」並不要求相互排斥。 上皮化敷件100可形成有一敷件本體1〇2，其具有一第一 側104及一面向組織之第二側1〇6。該敷件本體1〇2可採取 多種形狀’但圖中顯示其為一層疊本體，即，其在縱截面 及側向截面二者中具有之一縱橫比（較長尺寸除以較短尺 寸）大於1。換言之，圖中顯示該敷件本體1〇2為一平坦或 大體平坦之構件。該敷件本體102亦可採用其他形狀，諸 如圓形之構件。 敷件本體102具有複數個突起1〇8，其可經耦合至該敷件 本體102之該面向組織之第二侧1〇6。每個突起1〇8具有一 近端110及一遠端112。每個突起1〇8之近端11〇係經耦合至 該敷件本體102之該面向組織之第二側1〇6。該敷件本體 102之一部分上可形成複數個孔隙114，諸如狹縫116或穿 孔。孔隙114可為狹縫116(縱向開口，且大體無材料經移 除）或可為圓形孔，正方形孔或經設置可轉移包含減壓之 154792.doc 201136625 流體之任何形狀之開口。 突起108或其他微特徵部係用於放置於肉芽組織上且作 用於幫助形成可作用如層膜柱之上皮柱狀物166(圖u)。突 起108可具有各種形狀及大小。突起108可為例如，桿圓 錐體、柱狀物、脊、凹槽、波紋或形成腔162(圖1〇)之其他 特徵部。例如’圖1至圖5呈現突起108為圓錐形構件，圖6 呈現突起108為三角形（在平面圖中），且圖7呈現突起1〇8之 一截面為圓柱形構件。圖8為呈現顯示形成如連續桿或正 交構件之突起108之一透視圖。突起ι〇8在敷件本體1〇2上 可隨機地間隔或以一圖案而間隔。如圖5中所示，突起内 可形成有一供應儲槽117。 現主要參考圖3,每個突起1〇8可具有一縱向長度118(自 該面向組織之第二側106而測量）及該近端u〇處之一側向 寬度或直徑120及位於該遠端i 12處之側向寬度或直徑 122。每個突起ι〇8具有之一縱橫比（縱向長度118除以平均 側向寬度）在1/10至10之範圍内’且更典型而言在1/2至2之 範圍内。該複數個突起1〇8之平均突起之一縱橫比（該複數 個突起中之一平均突起之較長尺寸除以該複數個突起中之 該平均突起之一較短尺寸）在1/1〇至1〇且更典型而言於1/2 至2之範圍内。在其他非限制實例中，該縱橫比可為 3/10、5/10、8/1〇、2、3、4、5、6、7、8或9。該縱橫比 係可調整以有助於控制放置於下方組織上之應變位準且有 助於控制應變梯度。控制經引致應變可有助於控制再模擬 該組織且可影響幹細胞分化。該突起丨〇8之該遠端丨12上之 154792.doc 201136625 一邊緣124或引導邊緣可尖銳（正交、9〇度或大體上為9〇度） 或可為圓形’亦有助於控制應變。突起1〇8之尺寸及性質 可均相同或可彼此不同。 如圖2中所示，該突起1〇8之該遠端112上可形成複數個 小孔126或小孔隙。小孔126亦可或替代地形成於該突起 1〇8或敷件本體102上之其他位置。小孔126可促進移除上 皮化敷件100附近之流體、傳送減壓、容許流體傳送或提 供預期之組織長入。小孔（圖中未顯示）亦可形成於該敷件 本體102的介於突起108之間之該面向組織之第二側ι〇6 上。參考圖4 ’小孔126可有助於流體或其他物質（例如， 生長因子）自該供應儲槽U 7傳送至該突起1〇8附近之—區 域。 現主要參考圖5，圖中顯示小孔126促進將減壓傳送至突 起108之附近及將流體自突起ι〇8之附近移除。貫穿該敷件 本體102之孔隙115容許將減壓自該敷件本體ι〇2之該第一 側1〇4傳送至該供應儲槽117。小孔126(在此實施例中位於 該突起108之該遠端上及一側部上）將來自該供應儲槽117 的減壓連通至該突起108的外部。在此實施例中，該敷件 本體102之該第一側1〇4與該突起1〇8之外部流體連通。在 另一實施例中，突起108可形成有一個雙容室式儲槽（圖中 未顯不），其具有用於供應物質之一部分及用於提供減壓 之另一部分。 如圖6中所示，在一些實施例中，可向該等突起1〇8(一 般係於該遠端112上）添加微米級或奈米級特徵部128或子 154792.doc -9- 201136625 特徵部。子特徵部128可為例如，凹槽130、脊或波紋。子 特徵部128 —般係與該等小孔126分離，但在其他實施例 中’可包含如子特徵部128上之小孔之開口。微米級或奈 米級特徵部128能夠圖案化吸收至該等子特徵部ι28之蛋白 質或促進細胞高度或引導定向且遷移。若子特徵部128為 凹槽（例如，凹槽13〇)，則纖維母細胞可根據該等特徵部而 附接且經定向，且以一類似之圖案分泌其基質蛋白質。此 可進一步容許組織產生之控制。 突起108之大小及形狀，小孔126或該等子特徵部128之 大小及間隔係可用於控制組織產生，以促進成熟且加強正 在癒合之傷口抵抗剪切力之強度。突起1〇8或其他微特徵 可引導組織生長及再模擬’包含細胞定向或組織化。突 起1 〇 8或微特徵部之幾何形狀係可經調變以引致該組織中 之特定負載及應變分佈及梯度《此等調變可涉及微米及子 特徵部128之縱橫比、大小、間隔、接觸面積（％) '接觸處 之曲率、交替特徵形狀及大小、生物模仿圖案及覆蓋層。 突起108之大小及縱橫比係可如需調變，以控制組織介面 處之應力及應變。 可使用各種材料來形成該上皮化敷件1〇〇，諸如’醫用 級聚合物（例如，聚矽氧或聚胺酯），或生物聚合物（例如’ 膠原）。其他可形成該上皮化敷件丨〇 〇之材料包含生物吸收 (或可再吸收）材料，生物材料或非可再吸收材料。如本文 所使用，「生物吸收（bi〇resorbabie)」包含可在活的生物體 中酶降解或化學降解成簡單的物種，且可藉由排泄或新陳 I54792.doc -10· 201136625 代謝而自體内排除之材料。材料可為吸合性材料。上皮化 敷件100可能非黏著至組織生長部。該上皮化敷件1〇〇可由 對於敷件本體102係不可吸收之材料製成。突起1〇8係可由 一生物吸收材料製成。在另一實施例中，整個上皮化敷件 100係可由生物吸收材料製成。該上皮化敷件1〇〇之該面向 組織之第二表面106可為一濕氣表面（除了該等突起108以 外），其較一發泡體表面相對光滑。參考圖3，該敷件1〇〇 具有之深度132可在1〇微米至5〇〇〇微米之範圍内，且更一 般而言介於400微米至600微米之間。舉例但不限制而言， 深度132可為400微米' 425微米、450微米、475微米、500 微米、525微米、550微米、575微米、000微米或另—深 度。 現 > 考圖8，其呈現上皮化敷件1 〇 〇之另一闡釋性非限制 實施例。圖8的上皮化敷件1〇〇可形成有一敷件本體1〇2， 其具有一第一側104及一面向組織之第二側丨〇6。複數個突 起108係可耦合至該敷件本體丨〇2之該面向組織之第二側 106。每個突起1〇8具有一近端11〇及一遠端112。每個突起 108之該近端110係耦合至該敷件本體1〇2之該面向組織之 第二側106。突起1〇8形成一係用於碰撞於肉芽組織上之格 柵。該敷件本體102之一部分上形成有複數個孔隙114且圖 中顯示其為圓形開口。 現主要參考圖9至圖11，其呈現用於治療傷口 134或其他 組織部位之一闡釋性非限制過程。首先參考圖9，傷口 134 係用系統103治療，以促進肉芽化。引流體136係設置得鄰 154792.doc -11· 201136625 近該傷口 134。術語「引流體」用於本文中大致上指經設 置可有助於施加減壓i或傳送流體至—組織部位或傷口 134或自該組織部位或傷口 134移除流體之物質 該引流體U6-般包含複數個流動通道或路徑^其將提 供至該組織部位或傷σ134或自該組織部位或傷口134移除 之流體圍繞該引流體136而分佈。在一閣釋性實施例中， 該等流動通道或路徑係互連，以改良提供至該傷口⑼或 自該傷nm移除之流體之分佈。該引流體136可為能夠放 置與傷口 134接觸且向該傷口 134分佈減壓之生物相容性材 料。 引流體136之實例可包含（舉例但不限制而言）具有經配 置以形成流動通道之結構元件之裝置，諸如，結構元件爲 例如，包含或@)化而包含流體通道之胞式發泡體、開放胞 發泡體、多孔組織集合體、液體、凝膠及發泡體。引流體 136可為多孔且可係由發泡體、紗網、歸或任何其他適 〇於特疋生物學應用之材料製成。在一實施例中，該引 々α體136為一多孔發泡體且包含作為流動通道之複數個互 連之胞或小孔。該多孔發泡體可為聚胺醋、開放胞、網格 式發泡體，諸如，美國德克薩斯州聖安東尼奥市之Kinetic(one of the plurality of columns - the column of the side) the columns of the plurality of columns having a length of up to 5000 microns ' and having a longer aspect ratio of the average column of the average column divided by the plurality of columns 154792.doc 201136625 One of the average columns has a shorter dimension) between 1/10 and 10. Other advantages and advantages of the illustrative embodiments will be apparent from the following description and drawings. [Embodiment] In the following embodiments, reference is made to the accompanying drawings which form a part of this document. The embodiments are described in sufficient detail to enable those skilled in the art to practice the invention. It is understood that other embodiments may be employed and logical structures, mechanical, electrical, and chemical, may be employed without departing from the spirit or scope of the invention. Variety. To avoid unnecessary details in practicing the embodiments described herein, the following description may omit certain information that is known to those skilled in the art. Therefore, the following examples are not to be interpreted as limiting, and the scope of such illustrative embodiments is defined solely by the appended claims. The outermost or outermost layer of the skin is the epidermis, and the epidermis itself has multiple layers. The epidermis is adjacent to the dermis. The epidermis may have an inwardly directed extension of the Malpighian layer interwoven with the dermal papilla. This extension is sometimes referred to as a "rete peg." The film column provides resistance to shear-induced separation of adjacent layers. Conversely, re-epithelialized wounds typically do not have as much resistance to shearing. During the healing process of the wound, the epidermis may regenerate, but the epithelium is newly formed (usually at least initially). Therefore, the newly formed epithelium may be easily broken or detached. Referring now primarily to Figures 3 through 3, an epithelialized applicator 100 can be used to promote stronger attachment or tying of the layers to effectively act as a healthy film column. The epithelialized dressing 100 can be used to position the epithelial cat with a tissue layer beneath the epidermis by using a surface texture on the epithelialized dressing 1 154792.doc • 6 - 201136625. In addition, the epithelialized dressing 1 can hold or fasten the epithelium with the underlying tissue and thereby protect the epithelium from shear forces. In addition, the epithelialized dressing 100 can maintain a barrier and eliminate the need for repeated repairs to the epithelium. The epithelialized dressing 100 can also accelerate the epithelialization process. The epithelialized dressing 100 can perform a variety of functions. For example, an epithelialized dressing 1 可用 can be used to help manage the fluid at the wound site to promote epithelialization. As another example, the epithelialized dressing 100 can use its physical, chemical or mechanical properties to direct the formation of the underlying tissue structure to promote the strength of the regenerated epidermis. The use of "or" in this document does not require mutual exclusion unless otherwise indicated. The epithelialized dressing 100 can be formed with a dressing body 1 2 having a first side 104 and a second side facing tissue 6 . The dressing body 1 2 can take a variety of shapes 'but it is shown as a laminated body, ie it has one aspect ratio in both the longitudinal section and the lateral section (longer dimension divided by shorter dimension) Greater than 1. In other words, the figure shows that the dressing body 1〇2 is a flat or substantially flat member. The dressing body 102 can also take other shapes, such as a circular member. The dressing body 102 has a plurality of protrusions 1 〇 8 that can be coupled to the tissue-facing second side 1 〇 6 of the dress body 102. Each projection 1 8 has a proximal end 110 and a distal end 112. The proximal end 11 of each protrusion 1 〇 8 is coupled to the tissue-facing second side 1 〇 6 of the dress body 102. A plurality of apertures 114, such as slits 116 or perforations, may be formed in one portion of the body 102. The apertures 114 can be slits 116 (longitudinally open and substantially free of material removed) or can be circular apertures, or apertures that are configured to transfer any shape containing a reduced pressure 154792.doc 201136625 fluid. The protrusions 108 or other microfeatures are used to be placed on the granulation tissue and serve to aid in the formation of an epithelial column 166 (Fig. u) that can act as a lamellar column. The protrusions 108 can have a variety of shapes and sizes. The protrusions 108 can be, for example, rod cones, posts, ridges, grooves, corrugations or other features forming the cavity 162 (Fig. 1A). For example, 'Fig. 1 to Fig. 5 show that the protrusion 108 is a conical member, Fig. 6 shows that the protrusion 108 is triangular (in plan view), and Fig. 7 shows that a section of the protrusion 1〇8 is a cylindrical member. Figure 8 is a perspective view showing one of the protrusions 108 forming a continuous rod or an orthogonal member. The protrusions ι 8 may be randomly spaced or spaced apart in a pattern on the dressing body 1〇2. As shown in Fig. 5, a supply reservoir 117 can be formed in the projection. Referring now primarily to Figure 3, each protrusion 1 〇 8 can have a longitudinal length 118 (measured from the second side 106 facing the tissue) and a lateral width or diameter 120 of the proximal end u and located at the distal end The lateral width or diameter 122 at end i 12 . Each of the protrusions ι 8 has an aspect ratio (longitudinal length 118 divided by average lateral width) in the range of 1/10 to 10' and more typically in the range of 1/2 to 2. One aspect ratio of the average protrusions of the plurality of protrusions 1〇8 (the longer dimension of one of the plurality of protrusions divided by the shorter dimension of one of the plurality of protrusions) is 1/1〇 To 1〇 and more typically in the range of 1/2 to 2. In other non-limiting examples, the aspect ratio can be 3/10, 5/10, 8/1 〇, 2, 3, 4, 5, 6, 7, 8, or 9. The aspect ratio can be adjusted to help control the level of strain placed on the underlying tissue and to help control the strain gradient. Controlling the induced strain can help control the re-simulation of the tissue and can affect stem cell differentiation. 154792.doc 201136625 on the distal end 12 of the protrusion 8 can be sharp (orthogonal, 9 或 or substantially 9 )) or can be rounded Control strain. The size and properties of the protrusions 1〇8 may be the same or may be different from each other. As shown in Fig. 2, a plurality of small holes 126 or small holes may be formed in the distal end 112 of the protrusion 1〇8. The aperture 126 can also or alternatively be formed at other locations on the projection 1〇8 or the applicator body 102. The aperture 126 can facilitate removal of fluid in the vicinity of the epithelialized dressing 100, delivery of reduced pressure, allow for fluid delivery, or provide for anticipated tissue ingrowth. A small hole (not shown) may also be formed on the second side ι 6 of the dressing body 102 between the protrusions 108 facing the tissue. Referring to Figure 4, the aperture 126 can facilitate the transfer of fluid or other material (e.g., growth factor) from the supply reservoir U7 to the region adjacent the protrusion 1〇8. Referring now primarily to Figure 5, the aperture 126 is shown to facilitate the transfer of reduced pressure to the vicinity of the protrusion 108 and the removal of fluid from the vicinity of the protrusion ι8. The aperture 115 extending through the body 102 of the applicator allows for the transfer of reduced pressure from the first side 1〇4 of the body of the device to the supply reservoir 117. An aperture 126 (on the distal end and one side of the projection 108 in this embodiment) communicates the reduced pressure from the supply reservoir 117 to the exterior of the projection 108. In this embodiment, the first side 1〇4 of the dress body 102 is in fluid communication with the exterior of the protrusion 1〇8. In another embodiment, the projection 108 can be formed with a dual chamber reservoir (not shown) having a portion for supplying a substance and another portion for providing reduced pressure. As shown in FIG. 6, in some embodiments, micro-scale or nano-scale features 128 or sub-154792.doc -9-201136625 may be added to the protrusions 1〇8 (generally on the distal end 112). Feature section. Sub-features 128 can be, for example, grooves 130, ridges, or corrugations. Sub-features 128 are generally separate from the apertures 126, but in other embodiments ' may include openings as small apertures in sub-features 128. The micron or nanoscale features 128 are capable of patterning the protein absorbed into the sub-features ι 28 or promoting cell height or guiding orientation and migration. If the sub-features 128 are grooves (e.g., grooves 13A), the fibroblasts can be attached and oriented according to the features and secrete their matrix proteins in a similar pattern. This can further allow the control generated by the organization. The size and shape of the projections 108, the size and spacing of the apertures 126 or the sub-features 128 can be used to control tissue production to promote maturity and enhance the strength of the wound being healed against shear forces. Protrusions 1〇8 or other microfeatures can guide tissue growth and re-simulation' including cell orientation or organization. The geometry of the protrusions 1 〇 8 or microfeatures can be modulated to cause specific loads and strain distributions and gradients in the tissue. "The modulation can involve the aspect ratio, size, spacing of the micro and sub-features 128, Contact area (%) 'The curvature of the contact, alternating feature shape and size, biological imitation pattern and cover layer. The size and aspect ratio of the protrusions 108 can be modulated as needed to control the stress and strain at the tissue interface. Various materials can be used to form the epithelialized dressing, such as a medical grade polymer (e.g., polyoxyl or polyurethane), or a biopolymer (e.g., 'collagen). Other materials that can form the epithelialized dressings include bioabsorbable (or resorbable) materials, biomaterials or non-resorbable materials. As used herein, "bi〇resorbabie" includes enzymatic or chemical degradation into a simple species in living organisms and can be metabolized by excretion or metabolism. Materials excluded from the body. The material can be a pull-in material. The epithelialized dressing 100 may not adhere to the tissue growth section. The epithelialized dressing 1 can be made of a material that is non-absorbable to the dressing body 102. The projections 1 8 can be made of a bioabsorbent material. In another embodiment, the entire epithelialized dressing 100 can be made of a bioabsorbable material. The tissue-facing second surface 106 of the epithelialized dressing 1 can be a moisture surface (other than the protrusions 108) which is relatively smoother than the surface of the foam. Referring to Figure 3, the dressing 1 〇〇 has a depth 132 that can range from 1 〇 microns to 5 〇〇〇 microns, and more typically between 400 microns and 600 microns. By way of example and not limitation, depth 132 can be 400 microns '425 microns, 450 microns, 475 microns, 500 microns, 525 microns, 550 microns, 575 microns, 000 microns, or another depth. Now > Figure 8, which presents another illustrative, non-limiting embodiment of an epithelialized dressing 1 . The epithelialized dressing 1 of Figure 8 can be formed with a dressing body 1 2 having a first side 104 and a second side gusset 6 facing the tissue. A plurality of protrusions 108 can be coupled to the second side 106 of the dressing body 2 that faces the tissue. Each protrusion 1 〇 8 has a proximal end 11 〇 and a distal end 112. The proximal end 110 of each projection 108 is coupled to the tissue-facing second side 106 of the dressing body 1〇2. The protrusions 1〇8 form a series of grids for impinging on the granulation tissue. A plurality of apertures 114 are formed in one portion of the body 102 and are shown as circular openings. Referring now primarily to Figures 9-11, an illustrative non-limiting procedure for treating a wound 134 or other tissue site is presented. Referring first to Figure 9, wound 134 is treated with system 103 to promote granulation. The fluid 136 is placed adjacent to the wound 134792.doc -11· 201136625. The term "priming fluid" as used herein generally refers to a substance that is configured to assist in the application of reduced pressure i or to deliver fluid to or remove fluid from the tissue site or wound 134. A plurality of flow channels or paths are generally included that are distributed around the tissue site or lesion σ 134 or fluid removed from the tissue site or wound 134 around the fluid guide 136. In a preferred embodiment, the flow channels or paths are interconnected to improve the distribution of fluid provided to or removed from the wound (9). The introducer fluid 136 can be a biocompatible material that can be placed in contact with the wound 134 and distributed to the wound 134 for decompression. Examples of the pilot fluid 136 can include, by way of example and not limitation, a device having structural elements configured to form a flow channel, such as a structural element, for example, a cellular foam comprising or containing a fluid channel , open cell foam, porous tissue assembly, liquid, gel and foam. The fluid guide 136 can be porous and can be made of a foam, gauze, or any other material suitable for use in a particular biological application. In one embodiment, the 々α body 136 is a porous foam and comprises a plurality of interconnected cells or pores as flow channels. The porous foam may be a polyamine vinegar, an open cell, or a mesh foam such as Kinetic of San Antonio, Texas, USA.
Concepts a司所製造之v a c⑧⑧材料。其他實 施例可包含「閉合胞」。在一些情形下，該引流體⑼亦可 用於向傷口 134分佈流體，諸如藥水、抗菌劑、生長因子 及各種溶液。引流體136中或上可包含其他層，諸如吸收 材料、芯吸材料、疏水性材料及親水性材料。 154792.doc •12· 201136625 一減壓介面i38(例如’一連接件）係設置於該引流體i36 之附近且延伸穿過一密封構件142中之—孔隙刚。該密封 構：142在傷口 134上形成一流體密封。「流體密封」或 :密封」意味著對於所涉及之給定之一個特定減壓源或子 系統，足以維持一希望位置處之減壓之密封。 該密封構件142可為提供—流體密封之任何材料。密封 構件可為例如，不可滲透或半滲透彈性體材料。「彈性」 意味著具有彈性體之性質。彈性物材料大致上指具有類似 橡膠之性質之聚合物材料。更明確而言’大多數彈性體具 有超過100%之極限伸度且明顯數量之彈性。材料之彈性 係指材料自彈性變形恢復之能力。彈性體之實例包含但不 限於天㈣膠、聚異戊二烯、苯乙稀丁二稀橡膠、氣丁二 稀橡膠、聚丁二烯、腈腈橡膠、τ基橡膠、乙烯丙烯橡 I烯丙婦~~烯單體、氯4化聚乙烯、聚硫橡膠、聚胺 酯(二)、EVA膠膜、共聚酯及聚矽氧。此外，密封構件之 實’^3聚石夕氧覆布、3M 丁啡如爪⑧覆布或聚胺酯 (PU)覆布(諸如美國加利福尼亞州帕薩迪納市之 繼公司有售）。密封構件】42具有一第一側i44及一面 向組織之第二側146。 附接裝置148係可用於抵於病患表皮15〇或另-層（諸如 墊片或額外密封構件)固持密封構件142。附接裝置148可 私取多種形式。例如，該附接裝置148可為醫學上可接受 之麼力敏感黏合劑’其圍繞該密封構件M2之周邊而延 伸。作為額外實例，附Μ置148可為雙側覆布帶 '衆、 154792.doc •13- 201136625 水狀膠質、水凝膠或其他密封裝置或元件。 減壓傳送導管152可流體地耦合該減壓介面138至一提供 減壓之減壓源154。減壓源154可為任何提供減壓之裝置， 諸如真空泵、壁式引流器、微型泵或其他來源。雖然施加 至一組織部位或傷口 134之減壓之量及本質一般將根據應 用而變化，減壓一般將介於_5 mm Hg (_667 Pa)與_5〇〇爪瓜 Hg (-66.7 kPa)之間，且更一般而言，介於_75 mm Hg (_9 9 kPa)與-3 00 mm Hg (-3 9.9 kPa)之間。舉例但不限制而言， 壓力可為·12 kPa、-12.5 kPa、-13 kPa、-14 kPa、-14.5 kPa、-15 kPa、-15.5 kPa、-16 kPa、·16·5 kPa、-17 kPa、-17.5 kPa、-18 kPa、-18.5 kPa、-19 kPa、-19.5 kPa、-20 kPa、-20.5 kPa、-21 kPa、-21.5 kPa、-22 kPa、-22.5 kPa、-23 kPa、-23.5 kPa、-24 kPa、-24.5 kPa、-25 kPa、-25·5 kPa、-26 kPa、-26.5 kPa或另一壓 力。 如本文所使用，「減壓」大致上指低於正接受治療之一 組織部位處之環境壓力之壓力。在大多數情形下，此減壓 將小於该病患所處之大氣壓力。或者，該減壓係可小於該 組織部位處之一流體靜壓力。除非另有指示，本文所述之 壓力值為計示壓力。所傳送之减壓係可恆定或變化（模式 或隨機）且係可連續地或間歇地傳送。儘管術語「真空」 及「負壓」可用於描述施加至該組織部位之壓力，施加至 該組織部位之實際壓力可能高於通常與— 壓力。為了與在本文中之用法統一，除非另有^關二 154792.doc -14· 201136625 或真空Μ力之增加通常係指絕對壓力之—相對減小。 該減壓導官152上可包含一個或多個裝置，諸如裝置 156。例如，裝置156可為用於固持經移除的渗出物及其他 流體之流體儲槽或收集構件。可包含於該減_送導管 1 52上或以其他方式流體地耦合至該減壓傳送導管152之裝 置156之其他實例包含下列非限制性實例：壓力回饋裝 置、體積谓測系統、Α液偵測系統、感染该測系統、流動 監測系統或溫度監測系統。此等裝置中之一些可與該減虔 源154成一體地形成。 傳送至傷口 134的減壓有助於用新組織填充傷口缺陷。 減壓可促進纖維母細胞合成且生成細胞外基質組分。肉芽 組織纖維母細胞產生用於膠原沈積之基質。在充分至時間 之後，肉芽組織158(圖10)係沈積於傷口 134之一傷口床 上。在該肉芽組織158已適當地生成之後，該密封構件142 係可移除且引流體136亦可移除，在圖9及圖1〇所示的實例 中。該肉芽組織158已自真皮層151之附近或真皮層151處 長出至表皮150之一下部之上方。 現主要參考圖10，呈現用於促進上皮化之一系統1〇1。 上皮化敷件100可放置鄰近該肉芽組織158，且該面向組織 之第一側1 與突起108大體上抵於該肉芽組織1 58。接著 部署一密封構件142，以在該上皮化敷件1〇〇上提供一流體 密封。在一實施例（圖中未明顯顯示）中，該引流體136(見 圖9)係可放置於該上皮化敷件100(見圖1〇)與密封構件142 之間，以促進減壓分佈及流體自遠離減壓介面13 8之傷口 154792.doc 201136625 區域之移除。 再次參考圖10之實施例，在減壓介面138及密封構件 142(此包含新的介面及密封構件）經部署後，再次致動減麗 源1 54。供應至該上皮化敷件1 〇〇之減壓可達成若干結果。 傳送至該上皮化敷件100之減壓可有助於自傷口 134之一 表面160移除過多之流體，表面160已部分再生。一些流體 可保留以有助於發出訊號且或者促進再上皮化。減壓可在 該敷件100上施加一壓縮力，以幫助維持且控制該敷件1〇〇 與該肉芽組織1 5 8或其他組織之間之接觸。減壓係可用於 造成或控制造成突起108碰撞該肉芽組織158或其他組織上 之力之量值。在一些實施例中，壓力係可變化（模式化或 隨機），以提供由該上皮化敷件1〇〇傳送之一可變化力且因 而可進一步強化上皮化。 現主要參考圖10及圖11，纖維母細胞可與該敷件1 〇 〇之 面向組織之第二側106相互作用且形成圖案化細胞外基 質。經致動之角質細胞自傷口邊緣16 4在突起1 〇 8之周圍及 之間遷移且向下進入由突起1〇8形成之腔162中且形成上皮 168或新上皮組織（圖11)。該基質之進入該等腔162中之部 分將逐漸形成上皮柱狀物166，其可採用任何形狀，大體 上對應於突起108之形狀。隨著上皮168移動進入該等腔 162中’上皮168在該突起108周圍具有x_y圖案且在且在z 方向上具有一圖案’以形成上皮柱狀物166。由該等突起 1〇8形成之腔162將延伸進入肉芽組織158中之鄰接層中且 有助於形成上皮柱狀物166❶上皮柱狀物i 66之功能類似於 154792.doc •16- 201136625 表皮150與真皮151之間之層膜柱之功能且因而可提供抵抗 外力之錨定點來保持所涉及之組織層黏結。上皮柱狀物 166形成模擬之層膜柱。 現主要參考圖11，圖中顯示該傷口 134在敷件1〇〇已被移 除之情形。（上皮168之表面與完整表皮15〇之齊平程度可 比圖中所示的更大或更小）。敷件丨〇〇可於任何持續時間内 之一設定時間内停留於傷口上之原位且一般為一天至六 天。在此闡釋性非限制實施例中，上皮168覆蓋肉芽組織 158。上皮柱狀物166填充該等腔162且延伸進入肉芽組織 158中。在一些實施例中（圖中未明顯顯示），上皮柱狀物 166延伸進入真皮151之一部分中。上皮柱狀物we為上皮 168提供額外之|切阻力。 應注意，雖然圖9至圖U中的過程顯示使用減壓治療來 促進肉芽組織158之形成，敷件i⑼可獨立於此—步驟而使 用。此外，雖然已使用減屋而描述了過程及系統1〇〇，應 理解敷件1GG可於不存在減塵下使^在此闡釋性過程 中’該敷件100可進-步在該第一側1〇4上包含―親水性材 料例如，親水性發泡體或膠原，以有助於經由孔隙丨14 而移除流體且一概墊、膠帶、壓縮包紮或其他裝置係可用 於在敷件1GG上提供—壓縮力，以確保該敷件⑽與該組織 之間之接觸》 對於闡釋性非限制敷件1〇〇、系統1〇1或該過程，可涉及 ^多種替代或增添。一些已提及且現將提及其他非窮盡性 實例。在另-闡釋性過程中’該敷件1〇〇係可由可降解之 154792.doc •17- 201136625 可再吸收材料製成。突起1G8可包含供應儲槽ιΐ7，其固持 有膜幹細胞、角質細胞、生長因子、可溶解因子或其他物 質。隨著降解達到某一位準，供應儲槽117中之㈣_ 送至該等腔162及組織。接著該物質填充或有助於填充腔 162且有助促進進一步癒合。 在另一闡釋性非限制實施例中，該敷件1〇〇、系統ι〇ι或 該等過程係可與其他組織配合使用。例如，除了上皮組織 之外，内纟及黏膜内襯亦受益。其他實施例亦可用於治療 鍵、動帶、肌肉或軟骨，以增加有效作用而分離此等組織 之力之固有阻力。 在另一闡釋性非限制實例中，該敷件1〇〇可用作促進肉 芽生長及上皮化之一態樣。該敷件1〇〇可包含遠端ιΐ2上具 有小孔126之突起1〇8且亦全沿該等突起1〇8之側壁。可促 進肉芽組織158長入該等小孔126中。若使用減壓，則減壓 可有助於將組織拉動進入該等小孔126中。一旦該肉芽組 織158已長入該等突起108中及周圍，則正在推進之角質細 胞可遵循該肉芽組織158且覆蓋該肉芽組織158。此外或作 為一分開之替代，該敷件100可隨著時間經過而生物吸收 或降解。降解不應不利地影響角質細胞分裂。此外，該等 突起108可具有包含強化局部角質細胞分化之活性可溶解 因子之供應儲槽117。此區域中之角質細胞之增厚可填充 由該％•突起108所形成之腔162。 儘官已在某些闡釋性非限制實施例之上下文中揭示了本 發明及其優點’應理解，在不脫離隨附中請專利範圍之基 154792.doc •18· 201136625 礎上，可做出各種變化、子替代、置換及 钛紅一 文勒。應理解， ’ 一霄施例所述之任何特徵亦可適用於任何 — 例。 /、他貫施 個實施例或關 —」項係指參 應理解，上文所述之益處及優點可關於— 於若干實施例。應進一步理解，參考術語「 考該等項之一項或多項。 本文所述之步驟係可以任何其他合適之順序 合適之情形下同時執行。 5 s適之情形下，本文所述之任何實例之態樣係可盘所 述之任何其他實例之態樣組合，以形成具有可比^ 性質且解決相同或不同問題之其他實例。 —° 應理解，上文對較佳實施例之描述係僅藉由舉例之方式 給出且熟悉此項技術者可做出各種修改。上述之說明書、 貫例及資料提供對本發明之示例性實施例之結構及用途之 王面彳田述。儘官上文已描述之本發明具有一定程度之特定 生或參考一個或實施例，熟悉此項技術者在不脫離申請 專利範圍之範疇下可對所揭示之實施例做出各種改變。 【圖式簡單說明】 圖1係一上皮化敷件之一闡釋性非限制實施例之一示意 性透視圖； 圖2係圖1之該上皮化敷件之一部分之一平面圖，其顯示 一突起之一遠端； 圖3係圖1之該上皮化敷件之一部分之一示意圖截面圖； 圖4係一闡釋性上皮化敷件之一闡釋性突起之一示意性 154792.doc •19- 201136625 截面圖’其顯示一供應儲槽； 圖5係-闡釋性上皮化敷件之__性突起之—示意性 截面圖； 圖6係-閣釋性上皮化敷件之一閣釋性突起之一示意性 平面圖； 圖7係-闡釋性i皮化敷件之—閣釋性突起之一示意性 截面圖； 圖8係一闡釋性上皮化敷件之一示意性透視圖； 圖9係用於促進肉芽化之一闡釋性系統之一示意圖，且 δ玄系統之一部分係以截面圖顯示； 圖10係用於促進上皮化之一闡釋性系統之一示意圖，且 該系統之一部分係以截面圖顯示；及 圖11係一傷口在已經過治療以促進用根據一闡釋性實施 例之上皮化敷件來上皮化下之示意性截面圖。 【主要元件符號說明】 100 上皮化敷件 101 上皮化促進系統 102 敷件本體 103 系統 104 第一側 106 第二側 108 突起 110 近端 112 遠端 154792.doc 201136625 114 孔隙 116 狹縫 117 供應儲槽 118 縱向長度 120 直徑 122 直徑 124 邊緣或引導邊緣 126 小孔 128 微米級或奈米級特徵 130 凹槽 132 深度 134 組織部位或傷口 136 引流體 138 減壓介面 140 孔隙 142 密封構件 144 第一側 146 面對組織之第二側 148 附接裝置 150 病患之表皮 151 真皮層 152 減壓傳送導管 154 減壓源 156 儲存裝置 154792.doc •21 - 201136625 158 肉芽組織 160 表面 162 腔 164 傷口邊緣 166 上皮柱狀物 168 上皮 -22· 154792.docV a c88 material manufactured by Concepts a. Other embodiments may include "closed cells." In some cases, the priming fluid (9) can also be used to distribute fluids to the wound 134, such as syrup, antiseptics, growth factors, and various solutions. Other layers may be included in or on the fluid 136, such as absorbent materials, wicking materials, hydrophobic materials, and hydrophilic materials. 154792.doc • 12· 201136625 A decompression interface i38 (e.g., 'a connector) is disposed adjacent the priming fluid i36 and extends through a pore in a sealing member 142. The seal: 142 forms a fluid seal on the wound 134. "Fluid seal" or "sealed" means a seal sufficient to maintain a reduced pressure at a desired location for a given particular reduced pressure source or sub-system involved. The sealing member 142 can be any material that provides a fluid seal. The sealing member can be, for example, an impermeable or semi-permeable elastomeric material. "Flexibility" means having the properties of an elastomer. Elastomeric materials generally refer to polymeric materials having properties similar to rubber. More specifically, most elastomers have an ultimate elongation of more than 100% and a significant amount of elasticity. The elasticity of a material refers to the ability of a material to recover from elastic deformation. Examples of elastomers include, but are not limited to, Tian (4) rubber, polyisoprene, styrene butadiene rubber, gas butyl rubber, polybutadiene, nitrile rubber, τ based rubber, ethylene propylene rubber乙妇~~ene monomer, chloro-4-polyethylene, polysulfide rubber, polyurethane (II), EVA film, copolyester and polyfluorene. In addition, the sealing member is a solid 3O polybutoxide, 3M butane, such as a claw 8 or a polyurethane (PU) cloth (such as available from the company of Pasadena, California, USA). The sealing member 42 has a first side i44 and a second side 146 facing the tissue. Attachment device 148 can be used to hold sealing member 142 against a patient's epidermis 15 or another layer, such as a gasket or an additional sealing member. Attachment device 148 can take a variety of forms. For example, the attachment means 148 can be a medically acceptable force sensitive adhesive' that extends around the periphery of the sealing member M2. As an additional example, the attachment 148 can be a double-sided overlay tape, 154792.doc • 13-201136625 watery gelatin, hydrogel or other sealing device or component. The reduced pressure delivery conduit 152 can fluidly couple the reduced pressure interface 138 to a reduced pressure source 154 that provides reduced pressure. The reduced pressure source 154 can be any device that provides reduced pressure, such as a vacuum pump, wall drain, micropump, or other source. Although the amount and nature of the decompression applied to a tissue site or wound 134 will generally vary depending on the application, the decompression will generally be between _5 mm Hg (_667 Pa) and _5 Claw melon Hg (-66.7 kPa). Between, and more generally between, _75 mm Hg (_9 9 kPa) and -300 mm Hg (-3 9.9 kPa). By way of example and not limitation, the pressure may be .12 kPa, -12.5 kPa, -13 kPa, -14 kPa, -14.5 kPa, -15 kPa, -15.5 kPa, -16 kPa, ·16·5 kPa, -17 kPa, -17.5 kPa, -18 kPa, -18.5 kPa, -19 kPa, -19.5 kPa, -20 kPa, -20.5 kPa, -21 kPa, -21.5 kPa, -22 kPa, -22.5 kPa, -23 kPa, - 23.5 kPa, -24 kPa, -24.5 kPa, -25 kPa, -25.5 kPa, -26 kPa, -26.5 kPa or another pressure. As used herein, "decompression" generally refers to a pressure that is lower than the environmental pressure at one of the tissue sites being treated. In most cases, this decompression will be less than the atmospheric pressure at which the patient is exposed. Alternatively, the reduced pressure system can be less than one of the hydrostatic pressures at the tissue site. Unless otherwise indicated, the pressure values described herein are the gauge pressures. The reduced pressure transmitted can be constant or varied (mode or random) and can be transmitted continuously or intermittently. Although the terms "vacuum" and "negative pressure" can be used to describe the pressure applied to the tissue site, the actual pressure applied to the tissue site may be higher than the usual - pressure. In order to be consistent with the usage in this article, unless there is a separate 154792.doc -14·201136625 or an increase in vacuum force usually refers to the relative pressure - the relative decrease. One or more devices, such as device 156, may be included on the reduced pressure pilot 152. For example, device 156 can be a fluid reservoir or collection member for holding removed exudates and other fluids. Other examples of devices 156 that may be included on or otherwise fluidly coupled to the reduced pressure delivery conduit 152 include the following non-limiting examples: pressure feedback devices, volume prediction systems, sputum detection Test system, infection test system, flow monitoring system or temperature monitoring system. Some of these devices may be formed integrally with the source 154. The reduced pressure delivered to the wound 134 helps to fill the wound defect with new tissue. Decompression promotes fibroblast synthesis and produces extracellular matrix components. Granulation Tissue fibroblasts produce a matrix for collagen deposition. After sufficient time, granulation tissue 158 (Fig. 10) is deposited on one of the wound beds 134. After the granulation tissue 158 has been properly formed, the sealing member 142 is removable and the fluid 136 is also removable, in the example shown in Figures 9 and 1A. The granulation tissue 158 has been elongated from near the dermis layer 151 or from the dermis layer 151 to a lower portion of one of the epidermis 150. Referring now primarily to Figure 10, one system 1〇1 for promoting epithelialization is presented. The epithelialized dressing 100 can be placed adjacent to the granulation tissue 158 and the first side 1 and protrusion 108 facing the tissue generally abut the granulation tissue 158. A sealing member 142 is then deployed to provide a fluid seal on the epithelialized dressing 1 . In an embodiment (not explicitly shown), the introducer fluid 136 (see FIG. 9) can be placed between the epithelialized dressing 100 (see FIG. 1A) and the sealing member 142 to promote reduced pressure distribution. And the removal of fluid from the wound 154792.doc 201136625 area away from the decompression interface 13 8 . Referring again to the embodiment of Fig. 10, after the reduced pressure interface 138 and sealing member 142 (which includes the new interface and sealing member) are deployed, the source 1 54 is again actuated. The decompression supplied to the epithelialized dressing 1 can achieve a number of results. The reduced pressure delivered to the epithelialized dressing 100 can help remove excess fluid from one surface 160 of the wound 134, which has been partially regenerated. Some fluids may be retained to help signal and promote re-epithelialization. The reduced pressure exerts a compressive force on the dressing 100 to help maintain and control the contact between the dressing 1〇〇 and the granulation tissue 1 58 or other tissue. The reduced pressure system can be used to cause or control the amount of force that causes the protrusion 108 to impact the granulation tissue 158 or other tissue. In some embodiments, the pressure system can be varied (patterned or randomized) to provide a variable force transmitted by the epithelialized dressing 1 and thus can further enhance epithelialization. Referring now primarily to Figures 10 and 11, fibroblasts can interact with the tissue-facing second side 106 of the dressing 1 and form a patterned extracellular matrix. The actuated keratinocytes migrate from the wound edge 16 4 around and between the protrusions 1 〇 8 and down into the cavity 162 formed by the protrusions 1 〇 8 and form epithelial 168 or neoepithelial tissue (Fig. 11). The portion of the substrate that enters the cavities 162 will gradually form epithelial pillars 166, which may take any shape, generally corresponding to the shape of the protrusions 108. As the epithelium 168 moves into the cavities 162, the epithelium 168 has an x-y pattern around the protrusions 108 and a pattern in the z-direction to form epithelial pillars 166. The cavity 162 formed by the protrusions 1 8 will extend into the adjacent layer in the granulation tissue 158 and contribute to the formation of the epithelial column 166. The function of the epithelial column i 66 is similar to that of the 154792.doc • 16-201136625 epidermis The function of the lamellar column between 150 and the dermis 151 and thus provides an anchor point against external forces to maintain the tissue layer adhesion involved. The epithelial column 166 forms a simulated layer of membrane. Referring now primarily to Figure 11, the wound 134 is shown with the dressing 1 removed. (The surface of the epithelium 168 is flush with the intact epidermis 15 更大 larger or smaller than shown in the figure). The dressing 停留 can remain in place on the wound for a set period of time, typically one to six days. In this illustrative, non-limiting embodiment, epithelium 168 covers granulation tissue 158. Epithelial pillars 166 fill the lumens 162 and extend into the granulation tissue 158. In some embodiments (not explicitly shown), the epithelial column 166 extends into a portion of the dermis 151. The epithelial column we provide additional resistance to the epithelium 168. It should be noted that while the process of Figures 9 through U shows the use of reduced pressure therapy to promote the formation of granulation tissue 158, dressing i (9) can be used independently of this step. In addition, although the process and system have been described using a reduced house, it should be understood that the dressing 1GG can be used in this illustrative process in the absence of dust reduction. The side 1〇4 contains a hydrophilic material such as a hydrophilic foam or collagen to facilitate removal of fluid via the pores 14 and a pad, tape, compression wrap or other device can be used in the dressing 1GG A compressive force is provided to ensure contact between the dressing (10) and the tissue. For an illustrative non-limiting dressing, system 1〇1 or the process, a variety of alternatives or additions may be involved. Some other non-exhaustive examples have been mentioned and will now be mentioned. In a further explanatory process, the dressing 1 can be made of a biodegradable material 154792.doc • 17-201136625 resorbable material. The protrusion 1G8 may comprise a supply reservoir ΐ7 which holds membrane stem cells, keratinocytes, growth factors, soluble factors or other substances. As the degradation reaches a certain level, the (4) _ in the supply reservoir 117 is sent to the chambers 162 and the tissue. This material then fills or helps to fill the cavity 162 and helps promote further healing. In another illustrative, non-limiting embodiment, the dressing, system ι, or such process can be used in conjunction with other tissues. For example, in addition to epithelial tissue, internal hemorrhoids and mucosal linings also benefit. Other embodiments may also be used to treat bonds, kinetic bands, muscles or cartilage to increase the inherent resistance of the forces separating the tissues. In another illustrative, non-limiting example, the dressing 1 can be used as one of the modes that promote granulation growth and epithelialization. The dressing 1 can include a protrusion 1 〇 8 having a small hole 126 in the distal end ι 2 and also a side wall of the protrusion 1 〇 8. The granulation tissue 158 can be promoted into the apertures 126. If reduced pressure is used, reduced pressure can help pull tissue into the apertures 126. Once the granulation tissue 158 has grown into and around the protrusions 108, the keratinocytes being advanced can follow the granulation tissue 158 and cover the granulation tissue 158. Additionally or alternatively, the dressing 100 can be bioabsorbed or degraded over time. Degradation should not adversely affect keratinocyte division. Moreover, the protrusions 108 can have a supply reservoir 117 comprising an active soluble factor that enhances local keratinocyte differentiation. The thickening of the keratinocytes in this region fills the cavity 162 formed by the % protrusions 108. The present invention and its advantages have been disclosed in the context of certain illustrative non-limiting embodiments. It should be understood that various modifications can be made without departing from the scope of the appended claims 154792.doc • 18· 201136625 Change, sub-substitution, replacement, and Titanium red. It should be understood that any of the features described in the embodiments may be applied to any of the examples. It is understood that the benefits and advantages described above may be related to several embodiments. It should be further understood that reference is made to the term "taking one or more of the items. The steps described herein can be performed simultaneously in any other suitable order. 5 s where appropriate, any of the examples described herein The aspects are combinations of any of the other examples described herein to form other examples having comparable properties and solving the same or different problems. - It should be understood that the above description of the preferred embodiments is only by Various modifications can be made by those skilled in the art, and the above description, examples and materials provide a description of the structure and use of the exemplary embodiments of the present invention. The present invention has a certain degree of specificity or reference to one or more embodiments, and various changes can be made to the disclosed embodiments without departing from the scope of the invention. A schematic perspective view of one of the illustrative non-limiting embodiments of the epithelialized dressing; FIG. 2 is a plan view of one of the portions of the epithelialized dressing of FIG. Figure 3 is a schematic cross-sectional view of one of the epithelialized dressings of Figure 1; Figure 4 is an illustrative elevation of one of the illustrative epithelialized applicators 154792.doc • 19-201136625 Sectional view 'shows a supply reservoir; Figure 5 is a schematic cross-sectional view of the __ sexual protrusion of the elaboration of the epithelialized dressing; Figure 6 is a one of the cleavage of the epithelialized appendage Figure 7 is a schematic cross-sectional view of the interpretive i-derived dressing; Figure 8 is a schematic perspective view of an illustrative epithelialized dressing; Figure 9 is used A schematic diagram of one of the interpretive systems for promoting granulation, and a portion of the δ meta-system is shown in cross-section; Figure 10 is a schematic diagram of one of the illustrative systems for promoting epithelialization, and a portion of the system is sectioned Figure 11 is a schematic cross-sectional view of a wound having been treated to promote epithelialization with a percutaneously applied dressing according to an illustrative embodiment. [Main Symbol Description] 100 Epithelialized Dressing 101 Epithelium Chemical promotion system 102 dressing body 10 3 system 104 first side 106 second side 108 protrusion 110 proximal end 112 distal end 154792.doc 201136625 114 aperture 116 slit 117 supply reservoir 118 longitudinal length 120 diameter 122 diameter 124 edge or leading edge 126 aperture 128 micron or Nanoscale feature 130 Groove 132 Depth 134 Tissue site or wound 136 Catheter 138 Decompression interface 140 Pore 142 Sealing member 144 First side 146 Facing the second side of the tissue 148 Attachment device 150 Patient's epidermis 151 Dermis 152 Reduced pressure delivery catheter 154 Decompression source 156 Storage device 154792.doc •21 - 201136625 158 Granulation tissue 160 Surface 162 Cavity 164 Wound edge 166 Epithelial column 168 Epithelial-22· 154792.doc