扩张器周围构建自体复合皮修复原位皮肤缺损

Constructing autologous composite skin around the expander for the repair of skin defects

背景:目前组织工程皮肤构建时间长,价格贵,修复效果不佳,而且抗原的消除以及疾病传播问题也没有彻底解决。在理想的组织工程皮肤诞生之前,如何利用现有的成熟技术来解决自体皮源奇缺患者的创面修复难题?目的:观察扩张器周围构建的自体复合皮用于修复皮肤缺损创面的效果。方法:取大耳白兔10只,于其背部中线两侧对称部位皮下各埋植一球形硅胶扩张器,待扩张器周围形成纤维包囊后,分别向其中注入原代培养的自体皮肤上皮细胞悬液(实验组)或生理盐水(对照组),4周后取出扩张器,可见实验组形成上皮化的纤维包囊,即自体复合皮。沿扩张囊周边切除扩张器顶部皮肤及部分纤维包膜,而扩张器底面和顶部周边的纤维包囊予以保留,形成自体复合皮覆盖的创面,而对照组创面为非上皮化的纤维包囊覆盖,每日观察创面的愈合状况直至痊愈。结果与结论:实验组创面红润洁净,分泌物少,平均愈合时间为(14.0±0.4)d,镜下可见上皮层厚而规整;对照组创面分泌物较多,平均愈合时间为(27.0±0.7)d,镜下见上皮层薄且细胞排列不规整。说明应用扩张器周围构建的自体复合皮能明显促进创面愈合。

BACKGROUND：The construction of tissue engineered skin needs a long time and high price, and the repair effects are poor. Moreover, the problems such as antigen elimination and disease propagation are not thoroughly solved. How to solve the tough problem of wound surface repair in patients lacking of autologous skin using current mature technology before the occurrence of ideal tissue engineered skin. OBJECTIVE：To investigate the effects of autologous composite skin constructed around expanders on the repair of the wound surface. METHODS：A total of 10 rabbits were selected. Two globular silica gel expanders were embedded subcutaneously in the symmetrical sites on the back of rabbits. After the expanders were covered by fiber kystis, cellsuspension of primary cultured skin epithelial cells （experimental group） or physiological saline （control group） were infused into lacuna between the expander. Four weeks later, the expanders were obtained. Experimental group presented epithelization, i.e., autologous composite skin. The skin and some fiber members on the top of the expanders were resected around the encystations. The fiber kystis on the bottom and surrounding the expanders was left to form the wound surface covered by autologous composite skin. However, the wound surface was covered by non-epithelization fiber kystis in the control group. The healing of wound surface was observed until recovered. RESULTS AND CONCLUSION：In the experimental group, the wound surface was ruddy and pure, with less＆nbsp;secretion;the average healing time was （14.0±0.4） days;the microscopic appearance indicated that epithelial layer was thick and regular. In the control group, there was more secretion on wound surface;the average healing time was （27.0±0.7） days;the microscopic appearance indicated that epithelial layer was thin and irregular. These results suggested that the construction of autologous composite skin around the expanders could noticeably promote the healing of wound surface.