经皮针刺筋膜切开自体脂肪移植术修复瘢痕的研究及应用进展

Research and application progress of percutaneous aponeurotomy and lipofilling in scar repair

脂肪来源干细胞(ADSCs)在创面修复、组织重塑和损伤后抑制病理性纤维形成等方面发挥重要作用,在改善瘢痕组织挛缩、粘连和功能障碍方面已显示出巨大潜力。自体脂肪的应用能够改善瘢痕范围、颜色和柔韧性,是治疗创伤、放疗和手术瘢痕的重要方法。经皮针刺筋膜切开自体脂肪移植术是通过锐针直接穿刺瘢痕及腱膜,松解纤维组织,使限制性瘢痕转化为可接受脂肪移植的疏松三维受体再生基质,能够简单安全地对成熟瘢痕的质地、外观、弹性等多种特性进行改善,或可替代皮瓣修复术成为修复广泛瘢痕的重要手段。该文综述了经皮针刺筋膜切开自体脂肪移植术在瘢痕矫正中的研究和应用进展,这种应用了组织工程原理将瘢痕扩张为ADSCs移植的三维支架的方法,为临床提供了皮瓣修复瘢痕的替代方案。

Adipose-derived stem cells(ADSCs)are considered to play important roles in wound repair,tissue remodeling and suppression of pathological fibrogenesis after injury and thus have shown a great potential in the improvement of contracture,adhesion and dysfunction caused by scar tissue.The application of autologous fat can decrease scar size and provides better color quality and scar pliability,thus has been an important treatment of scar caused by trauma,radiotherapy,and surgery.Based on that,the percutaneous aponeurotomy and lipofilling(PALF)loosens restrictive fibers by puncturing cicatrix and endogenous aponeurosis directly,making a transformation of a restrictive cicatrix into a regenerative matrix that expands a tight scar or constriction into a loose,three-dimensional recipient scaffold that is receptive to fat grafts.It improves the texture,color,elasticity,and many other properties of mature scar in a safe and simple way and represents a regenerative alternative to reconstructive flap surgery.This study reviews the progress of research and application regarding PALF in scar correction to provide new insight into the therapeutic potential of ADSCs.