Mesenchymal stem cells: Potential role in corneal wound repair and transplantation

Corneal diseases are a major cause of blindness in the world. Although great progress has been achieved in the treatment of corneal diseases, wound healing after severe corneal damage and immunosuppressive therapy after corneal transplantation remain prob-lematic. Mesenchymal stem cells(MSCs) derived from bone marrow or other adult tissues can differentiate into various types of mesenchymal lineages, such as osteocytes, adipocytes, and chondrocytes, both in vivo and in vitro. These cells can further differentiate into specific cell types under specific conditions. MSCs migrate to injury sites and promote wound healing by secreting anti-inflammatory and growth factors. In ad-dition, MSCs interact with innate and acquired immune cells and modulate the immune response through their powerful paracrine function. Over the last decade, MSCs have drawn considerable attention because of their beneficial properties and promising therapeutic prospective. Furthermore, MSCs have been applied to various studies related to wound healing, autoim-mune diseases, and organ transplantation. This review discusses the potential functions of MSCs in protecting corneal tissue and their possible mechanisms in corneal wound healing and corneal transplantation.

A study on the activity of dermal multipotent stem cells in initiation of wound repair

Background: Wound healing is a process of cell-cell interaction and cell-extracellular matrix interaction. Dermal multipotent stem cells (dMSCs) have the abilities to promote survival and wound healing, but the potential function of dMSCs in wound healing, particularly in the initiation of wound repair, has not been fully understood. Methods: dMSCs and fibroblasts were isolated from neonatal rat dermis and were further purified and expanded. The cell cycles were determined with flow cytometry, while the radiosensitivity was measured by MTT assay. Rats were wounded with a 7-cm incision on the back skin and the wound fluids were collected by inserting two pieces of sterile polyvinyl alcohol sponge (1 cmin diameter and0.4 cmin thickness) subcutaneously into the dorsum of each rat through the midline of incision on the 1st, 2nd, 3rd and 4th day after incision. The effects of wound fluids on the proliferation of dMSCs and fibroblasts were measured with MTT assays. dMSC’s abilities of adhesion and attachment and its migration in response to wound fluids collected on the 1st day after incision were explored by measuring the percentage of floating cells and the cells migrated into wounding area in vitro, respectively. Results: The isolated dMSCs were morphologically homogenous and highly proliferative. Most of the cultured dMSCs were quiescent with few apoptotic cells. Compared with fibroblasts, dMSCs were more sensitive to radiation and more proliferative in response to wound fluids, especially to the wound fluids collected on the 1st day after wounding. Moreover, their abilities to attach, adhere and migrate were significantly enhanced with the early-phase wound fluids. Conclusions: As primitive stem cells, dMSCs are very responsive to wound fluids, which suggests dMSCs’ important role in wound healing, especially in initiating wound repair.

Endogenous bioelectric fields: a putative regulator of wound repair and regeneration in the central nervous system

Studies on a variety of highly regenerative tissues, including the central nervous system（CNS） in non-mammalian vertebrates, have consistently demonstrated that tissue damage induces the formation of an ionic current at the site of injury. These injury currents generate electric fields（EF） that are 100-fold increased in intensity over that measured for uninjured tissue. In vitro and in vivo experiments have convincingly demonstrated that these electric fields（by their orientation, intensity and duration） can drive the migration, proliferation and differentiation of a host of cell types. These cellular behaviors are all necessary to facilitate regeneration as blocking these EFs at the site of injury inhibits tissue repair while enhancing their intensity promotes repair. Consequently, injury-induced currents, and the EFs they produce, represent a potent and crucial signal to drive tissue regeneration and repair. In this review, we will discuss how injury currents are generated, how cells detect these currents and what cellular responses they can induce. Additionally, we will describe the growing evidence suggesting that EFs play a key role in regulating the cellular response to injury and may be a therapeutic target for inducing regeneration in the mammalian CNS.

Activin-Directed Differentiation of Human Embryonic Stem Cells Differentially Modulates Alveolar Epithelial Wound Repair via Paracrine Mechanism

Differentiated embryonic stem cells (ESC) can ameliorate lung inflammation and fibrosis in animal lung injury models;therefore, ESC, or their products, could be candidates for regenerative therapy for incurable lung diseases, such as idiopathic pulmonary fibrosis (IPF). In this study, we have investigated the paracrine effect of differentiated and undifferentiated human ESC on alveolar epithelial cell (AEC) wound repair. hESC line, SHEF-2 cells were differentiated with Activin treatment for 22 days in an embryoid body (EB) suspension culture. Conditioned media (CM) which contain cell secretory factors were collected at different time points of differentiation. CM were then tested onin vitro?wound repair model with human type II AEC line, A549 cells (AEC). Our study demonstrated that CM originated from undifferentiated hESC significantly inhibited AEC wound repair when compared to the control. Whereas, CM originated from Activin-directed hESC differentiated cell population demonstrated a differential reparative effect on AEC wound repair model. CM obtained from Day-11 of differentiation significantly enhanced AEC wound repair in comparison to CM collected from pre- and post-Day-11 of differentiation. Day-11 CM enhanced AEC wound repair through significant stimulation of cell migration and cell proliferation. RT-PCR and immunocytochemistry confirmed that Day-11 CM was originated form a mixed population of endodermal/mesodermal differentiated hESC. This report suggests a putative paracrine-mediated epithelial injury healing mechanism by hESC secreted products, which is valuable in the development of novel stem cell-based therapeutic strategies.

Nanosilver alleviates foreign body reaction and facilitates wound repair by regulating macrophage polarization

Foreign body reactions induced by macrophages often cause delay or failure of wound healing in the application of tissue engineering scaffolds.This study explores the application of nanosilver(NAg)to reduce foreign body reactions during scaffold transplantation.An NAg hybrid collagen-chitosan scaffold(NAg-CCS)was prepared using the freeze-drying method.The NAg-CCS was implanted on the back of rats to evaluate the effects on foreign body reactions.Skin tissue samples were collected for histological and immunological evaluation at variable intervals.Miniature pigs were used to assess the effects of NAg on skin wound healing.The wounds were photographed,and tissue samples were collected for molecular biological analysis at different time points post-transplantation.NAg-CCS has a porous structure and the results showed that it could release NAg constantly for two weeks.The NAg-CCS group rarely developed a foreign body reaction,while the blank-CCS group showed granulomas or necrosis in the subcutaneous grafting experiment.Both matrix metalloproteinase-1(MMP-1)and tissue inhibitor of metalloproteinase-1(TIMP-1)were reduced significantly in the NAg-CCS group.The NAg-CCS group had higher interleukin(IL)-10 and lower IL-6 than the blank CCS group.In the wound healing study,M1 macrophage activation and inflammatory-related proteins inducible nitric oxide synthase(iNOS),IL-6,and interferon-(IFN-)were inhibited by NAg.In contrast,M2 macrophage activation and proinflammatory proteins(arginase-1),major histocompatibility complex-II(MHC-II),and found in inflammatory zone-1(FIZZ-1)were promoted,and this was responsible for suppressing the foreign body responses and accelerating wound healing.In conclusion,dermal scaffolds containing NAg suppressed the foreign body reaction by regulating macrophages and the expression of inflammatory cytokines,thereby promoting wound healing.

Multi-layer-structured bioactive glass nanopowder for multistage-stimulated hemostasis and wound repair

Current treatments for full-thickness skin injuries are still unsatisfactory due to the lack of hierarchically stimulated dressings that can integrate the rapid hemostasis,inflammation regulation,and skin tissue remodeling into the one system instead of single-stage boosting.In this work,a multilayer-structured bioactive glass nanopowder(BGN@PTE)is developed by coating the poly-tannic acid andε-polylysine onto the BGN via facile layer-by-layer assembly as an integrative and multilevel dressing for the sequential management of wounds.In comparison to BGN and poly-tannic acid coated BGN,BGN@PTE exhibited the better hemostatic performance because of its multiple dependent approaches to induce the platelet adhesion/activation,red blood cells(RBCs)aggregation and fibrin network formation.Simultaneously,the bioactive ions from BGN facilitate the regulation of the inflammatory response while the poly-tannic acid and antibacterialε-polylysine prevent the wound infection,promoting the wound healing during the inflammatory stage.In addition,BGN@PTE can serve as a reactive oxygen species scavenger,alleviate the oxidation stress in wound injury,induce the cell migration and angiogenesis,and promote the proliferation stage of wound repair.Therefore,BGN@PTE demonstrated the significantly higher wound repair capacity than the commercial bioglass dressing Dermlin™.This multifunctional BGN@PTE is a potentially valuable dressing for full-thickness wound management and may be expected to extend to the other wounds therapy.

Mesenchymal stem cell-derived extracellular vesicles in skin wound healing:roles,opportunities and challenges

Skin wounds are characterized by injury to the skin due to trauma,tearing,cuts,or contusions.As such injuries are common to all human groups,they may at times represent a serious socioeconomic burden.Currently,increasing numbers of studies have focused on the role of mesenchymal stem cell(MSC)-derived extracellular vesicles(EVs)in skin wound repair.As a cell-free therapy,MSC-derived EVs have shown significant application potential in the field of wound repair as a more stable and safer option than conventional cell therapy.Treatment based on MSC-derived EVs can significantly promote the repair of damaged substructures,including the regeneration of vessels,nerves,and hair follicles.In addition,MSC-derived EVs can inhibit scar formation by affecting angiogenesis-related and antifibrotic pathways in promoting macrophage polarization,wound angiogenesis,cell proliferation,and cell migration,and by inhibiting excessive extracellular matrix production.Additionally,these structures can serve as a scaffold for components used in wound repair,and they can be developed into bioengineered EVs to support trauma repair.Through the formulation of standardized culture,isolation,purification,and drug delivery strategies,exploration of the detailed mechanism of EVs will allow them to be used as clinical treatments for wound repair.In conclusion,MSCderived EV-based therapies have important application prospects in wound repair.Here we provide a comprehensive overview of their current status,application potential,and associated drawbacks.

Heparinized PGA host-guest hydrogel loaded with paracrine products from electrically stimulated adipose-derived mesenchymal stem cells for enhanced wound repair

The microenvironment of the wound bed is essential in the regulation of wound repair.In this regard,strategies that provide a repairing favorable microenvironment may effectively improve healing outcomes.Herein,we attempted to use electrical stimulation(ES)to boost the paracrine function of adipose-derived stem cells from rats(rASCs).By examining the concentrations of two important growth factors,VEGF and PDGF-AA,in the cell culture supernatant,we found that ES,especially 5𝜇A ES,stimulated rASCs to produce more paracrine factors(5𝜇A-PFs).Further studies showed that ES may modulate the paracrine properties of rASCs by upregulating the levels of TRPV2 and TRPV3,thereby inducing intracellular Ca^(2+) influx.To deliver the PFs to the wound to effectively improve the wound microenvironment,we prepared a heparinized PGA host-guest hydrogel(PGA-Hp hydrogel).Moreover,PGA-Hp hydrogel loaded with 5𝜇A-PFs effectively accelerated the repair process of the full-thickness wound model in rats.Our findings revealed the effects of ES on the paracrine properties of rASCs and highlighted the potential application of heparinized PGA host-guest hydrogels loaded with PFs derived from electrically stimulated rASCs in wound repair.

Application of metal-based biomaterials in wound repair

Wound repair,as one of the most intricate biological mechanisms,is essential to ensure the formation and integrity of the skin barrier.However,multiple factors can cause delays and severe debilitating effects in wound repair,which bring serious challenges.Metal elements such as calcium,copper,iron,and zinc serve irreplaceable roles in various regulatory pathways of the human body and directly or indirectly affect the orderly wound repair process.Biomaterials have proven to be an attractive strategy that can be applied to wound repair and have excellent potential to induce skin regeneration.In recent decades,with in-depth research on the regulatory mechanisms of metal elements involved in wound repair,metal-based biomaterials have been widely reported.Metal-based zero-dimensional(0D)biomaterials such as Angstrom-scale metallic materials and metal quantum dots,metal-based one-dimensional(1D)biomaterials such as nanorods,nanowires and nanofibers,metal-based two-dimensional(2D)biomaterials such as nanofilms and nanosheets,and metal-based three-dimensional(3D)biomaterials such as nanoframes have achieved remarkable results,which provide great support for accelerated wound repair.In this review,we systematically investigated the advances and impacts of various metal-based biomaterial platforms for wound repair to provide valuable guidance for future breakthroughs in wound treatment.

Chronic activation of MUC1-C in wound repair promotes progression to cancer stem cells

The mucin 1(MUC1)gene emerged in mammals to afford protection of barrier epithelial tissues from the external environment.MUC1 encodes a transmembrane C-terminal(MUC1-C)subunit that is activated by loss of homeostasis and induces inflammatory,proliferative,and remodeling pathways associated with wound repair.As a consequence,chronic activation of MUC1-C promotes lineage plasticity,epigenetic reprogramming,and carcinogenesis.In driving cancer progression,MUC1-C is imported into the nucleus,where it induces NF-κB inflammatory signaling and the epithelial-mesenchymal transition(EMT).MUC1-C represses gene expression by activating(i)DNA methyltransferase 1(DNMT1)and DNMT3b,(ii)Polycomb Repressive Complex 1(PRC1)and PRC2,and(iii)the nucleosome remodeling and deacetylase(NuRD)complex.PRC1/2-mediated gene repression is counteracted by the SWI/SNF chromatin remodeling complexes.MUC1-C activates the SWI/SNF BAF and PBAF complexes in cancer stem cell(CSC)models with the induction of genome-wide differentially accessible regions and expressed genes.MUC1-C regulates chromatin accessibility of enhancer-like signatures in association with the induction of the Yamanaka pluripotency factors and recruitment of JUN and BAF,which promote increases in histone activation marks and opening of chromatin.These and other findings described in this review have uncovered a pivotal role for MUC1-C in integrating lineage plasticity and epigenetic reprogramming,which are transient in wound repair and sustained in promoting CSC progression.

负压封闭引流联合保留臀上动脉浅支的臀大肌肌皮瓣修复骶尾部IV期压疮的临床效果

目的:探讨负压封闭引流联合保留臀上动脉浅支的臀大肌旋转肌皮瓣修复骶尾部压疮的临床效果。方法:选取2019年6月—2023年10月温州医科大学附属第一医院收治的12例骶尾部压疮患者,其中男7例,女5例,年龄31~86岁。入院后I期予行负压封闭引流术,4~7 d后行保留臀上动脉浅支的臀大肌肌皮瓣修复创面。观察术后皮瓣成活情况、并发症发生情况,随访观察皮瓣外形、压疮复发情况。结果:本组12例患者,均因长期卧床致骶尾部受压出现IV期压疮,压疮病因:截瘫患者5例,各种原因所致的长期卧床患者7例,其中脑梗死后遗症患者2例,帕金森病患者3例,老年痴呆症患者1例,股骨颈骨折患者1例。病程2周至8年,清创后创面面积为5.0 cm×5.0 cm~10.0 cm×12.0 cm。12例患者术后皮瓣均完全成活,无皮瓣坏死、静脉淤血、创缘开裂等发生。术后随访2~6个月,皮瓣外形较佳、骶尾部软组织饱满、压疮无复发。结论:保留臀上动脉浅支的臀大肌旋转肌皮瓣血运可靠,设计、操作简单,皮瓣可修复面积大,切取不需要离断臀上动脉浅支,供瓣区一般能直接缝合,修复骶尾部压疮效果较佳。

重组贻贝粘蛋白在点阵CO_(2)激光治疗面部痤疮萎缩性瘢痕术后创面修复中的应用研究

目的:探究重组贻贝粘蛋白水凝胶敷料(Recombined mussel adhesive protein hydrogel dressing,Rmaphd)在点阵CO_(2)激光治疗面部痤疮萎缩性瘢痕术后创面修复中的应用效果。方法:选择2022年6月-2023年2月面部痤疮萎缩性瘢痕患者117例,分为Rmaphd组、重组人表皮生长因子(Recombinant human epidermal growth factor,rhEGF)组和对照组,每组39例,三组均给予点阵CO_(2)激光术治疗,术后分别给予Rmaphd、rhEGF及生理盐水处理,比较三组疗效、ECCA评分、症状持续时间以及生活质量评分。结果:Rmaphd组和rhEGF组总有效率分别为92.31%和94.87%,均高于对照组76.92%(P<0.05),术后ECCA评分低于对照组(P<0.05),术后疼痛、红斑、痂皮持续时间短于对照组(P<0.05),Acne-QoL各指标得分优于对照组(P<0.05);上述各临床Rmaphd组与rhEGF组差异无统计学意义(P>0.05)。结论:Rmaphd用于点阵CO_(2)激光治疗面部痤疮萎缩性瘢痕术后创面修复疗效显著,具备在临床上辅助激光治疗术后修复的应用潜力。

Design of axial flaps with color Doppler flow imaging technique for repairing deep wounds of heels

To report the methods and effect of axial pattern flap on lower limb in repairing deep wounds of heels by using color Doppler flow imaging (CDFI) technique so as to solve the ever before problems that the vessel can not be displayed in designing axial flap.Methods Suitable axial flaps on lower limbs were selected according to the character of the wounds.There were 25 flaps including 10 cases of the distal-based sural neurovascular flap,nine medial sole flap and six medial leg flap.All the axial pattern flaps were designed on the basis of traditional design ways before operation;then,CDFI appliance with high resolution was used to examine the starting spot,exterior diameter,trail and length of the flap’s major artery.The flaps were redesigned according to the results of CDFI and transferred to cover the wounds.In the meantime,both the results of operation and examination were compared.Results The major artery’s starting spot,exterior diameter,trail and anatomic layers were displayed clearly,in consistency with the results of operation.The flaps survived completely and recovered well,with perfect appearance,color and arthral function.Conclusion CDFI is a simple,macroscopic and atraumatic method for designing the axial pattern flap on lower limb,can provide more scientific and accurate evidence for preoperative determination of flap transplantation and is worthy of clinical application.10 refs,4 figs,2 tabs.

V型折叠颏下皮瓣修复口腔缺损的临床应用

目的:口腔中小型缺损修复一直是一个难题,游离皮瓣和远位带蒂组织瓣难以满足临床需求,传统颏下皮瓣存在供区损伤风险。本研究旨在探讨V型折叠颏下皮瓣修复口腔中小型缺损的疗效。方法:回顾性分析2019年3月至2022年12月中南大学湘雅三医院口腔科收治的28例口腔黏膜病变患者的临床资料。根据颏下皮瓣手术方式的不同将患者分为V型折叠组(17例)和传统组(11例),V型折叠组采用V型折叠颏下皮瓣进行术后软组织修复,传统组采用传统颏下皮瓣进行修复,患者术后随访6~48个月。比较2组皮瓣存活情况、皮瓣修复时间以及皮瓣修复效果。结果:2组皮瓣存活率、皮瓣大小、制瓣时间、修复手术时间和术后住院时间差异均无统计学意义(均P>0.05)。术后6个月,V型折叠组无抬头困难和下唇外翻,无皮肤“猫耳”畸形,疤痕隐藏于下颌骨下缘处,创面美观度、功能评分均明显高于传统组(均P<0.05)。结论:V型折叠颏下皮瓣具有设计灵活、制备简单、血供可靠、保护供区等优点,可以有效维持颏部美观和避免功能障碍。

基于透射电镜下超微结构探讨不同温度悬起灸干预对压疮创面修复的影响

目的 观察不同温度悬起灸干预对大鼠压疮创面组织超微结构的影响,明确悬起灸促进压疮创面修复的最佳干预温度,以期为临床艾灸治疗压疮及慢性难愈性创面提供理论依据。方法 取133只雌性健康SD成年大鼠,随机选择3只大鼠作为空白对照组,其余130只大鼠通过缺血再灌注损伤方式建立2~3期压疮模型。将模型制备成功的125只大鼠随机分为模型对照组、水凝胶组、低温艾灸干预组、中温艾灸干预组及高温艾灸干预组,每组25只。模型对照组和空白对照组仅进行碘伏常规处理;水凝胶组用碘伏处理压疮创面后将水凝胶伤口敷料覆盖于创面处;低、中、高温艾灸干预组给予碘伏处理后分别对压疮创面中心施以38~41℃、43~46℃、48~51℃的悬起灸干预(通过红外热像仪检测创面皮肤表面温度),艾灸干预1次/d,每次持续15 min。分别于干预1,3,5,7,10 d后取各造模组大鼠压疮创面组织,透射电镜下观察压疮组织超微结构;空白对照组大鼠一并取材以观察正常皮肤组织镜下超微结构。结果 与空白对照组相比,各造模组大鼠造模后干预前均出现表皮脱落或损伤及真皮层损伤。(1)表皮修复情况:模型对照组压疮创面中基底细胞结构及功能恢复相对较慢,干预10 d后才可见大部分基底细胞基本恢复正常,但细胞器相对较少,功能较低下。低、中温艾灸干预组干预5 d后可见大部分基底细胞基本恢复正常,中温艾灸干预组可见绝大部分基底细胞基本恢复正常,绝大部分基底细胞的线粒体状态较好,结构较清晰,10 d后基底细胞线粒体数目增多,胶原纤维致密,新生表皮完整,更优于低温艾灸干预组。水凝胶组干预5 d后可见部分基底细胞线粒体肿胀;7 d后可见大部分基底细胞细胞器增多,线粒体结构逐渐恢复正常。高温艾灸干预组干预7 d后可见少部分有线粒体自噬产生,相对略差于水凝胶组。(2)真皮修复情况:模型对照组干预5 d后可见真皮层炎性细胞高度浸润,成纤维细胞变性;7 d后真皮层尚有少量炎性细胞,真皮成纤维细胞增生并有功能恢复,少部分胶原纤维相对较致密;10 d后真皮成纤维细胞增生明显,真皮有淋巴细胞,真皮损伤有恢复,部分胶原纤维相对较致密。中温艾灸干预组干预1 d后真皮层出现大量的炎性细胞浸润;5 d后可见真皮层不新鲜的粒细胞浸润,大量的成纤维细胞增生活跃,大部分胶原纤维较致密;7 d后绝大部分真皮成纤维细胞数目增多,功能活跃,且胶原纤维较致密;10 d后真皮成纤维细胞功能旺盛,胶原纤维致密。低温艾灸干预组可见上述类似大体趋势;水凝胶组及高温艾灸干预组干预5,7,10 d后亦可见真皮成纤维细胞不同程度的增生,其功能亦逐渐恢复,胶原纤维排列逐渐致密,但修复情况均较中温艾灸干预组差。结论 不同温度悬起灸干预及水凝胶处理能够整体上提前压疮创面急性炎症浸润的高峰,促进压疮创面由炎症损伤阶段向增殖修复阶段的顺利转变,继而加快压疮创面修复进程。不同温度悬起灸干预后压疮创面修复存在一定差异,其中38~41℃、43~46℃温度下悬起灸更有利于促进压疮组织残存表皮修复、新生表皮生成及真皮浅层修复,且43~46℃温度下悬起灸更具优势。

第4腰动脉穿支蒂臀上皮神经营养血管皮瓣解剖与设计应用

目的解剖观察并设计第4腰动脉穿支蒂臀上皮神经营养血管皮瓣。为临床应用提供解剖学、形态学依据。方法解剖成人国人腰臀区标本,观测第4腰动脉后支、臀上皮神经及分支走行、分布区域,在深筋膜穿出点的位置;测量第4腰动脉的后支外径,及臀上皮神经前支的粗壮中间支的长度等数据;在应用解剖学基础上,设计第4腰动脉穿支蒂臀上皮神经营养血管皮瓣并应用于修复骶尾部巨大创面12例。结果第4腰动脉后支穿出深筋膜处外径:(1.16±0.43)mm,30侧中19侧为单干,占63.3%。11例穿出深筋膜前分为2~3支后再穿出深筋膜,占27.7%。臀上皮神经前支的粗壮中间支长度(147.82±16.37)mm。皮瓣可切取范围:上界在旋转点上方2~4 cm,内侧达后正中线,外侧至腋后线,下界至臀中部。皮瓣切取面积17.4cm×12.5cm~25.4cm×18.3cm,皮瓣长宽比:(3~5):1。设计第4腰动脉穿支蒂臀上皮神经营养血管皮瓣修复骶尾部巨大创面12例。皮瓣全部成活,效果满意。结论该皮瓣血供主要来自第4腰动脉后支,臀上皮神经及分支支配,具有一定的规律性和可预测性。此皮瓣设计容易,解剖恒定、清晰,覆盖面积大,手术操作简便,是修复骶尾部巨大创面较理想的方法。

Repairing small wounds around ankle by medial planta island flaps pedicled with anterior tibial artery perforator in front of inner malleolus

Objective To discuss the application of medial planta island flaps pedicled with anterior tibial artery perforator in front of inner malleolus for repairing small wounds around ankle Methods From Jan. 2005 to Jun. 2009,10 cases with small wounds around ankle

指固有动脉背侧支血管链蒂逆行岛状皮瓣修复指端缺损的近期疗效分析及治疗体会

目的分析指固有动脉背侧支血管链蒂逆行岛状皮瓣修复指端缺损的近期疗效,并总结治疗体会。方法回顾性分析21例(21指)指端缺损患者的临床资料,患者均行指固有动脉背侧支血管链蒂逆行岛状皮瓣修复。随访评估患者的主观满意度、皮瓣感觉恢复情况、患指活动功能。结果术后19例患者皮瓣完全成活并顺利拆线,1例因术后私自吸烟致皮瓣严重发绀延迟愈合,1例因术后私自开空调温度过低致皮瓣部分坏死。21例患者中共19例获得随访,随访时间3~18个月,平均(8.9±4.6)个月。获得随访患者中,患者的主观满意度:很满意16例(84.2%)、比较满意3例(15.8%),无不满意病例。皮瓣感觉恢复情况:S415例(78.9%),S3+3例(15.8%),S31例(5.3%)。患指活动功能:优16例(84.2%),良3例(15.8%)。结论指固有动脉背侧支血管链蒂逆行岛状皮瓣修复指端缺损外形功能满意,优势明显,术后积极处理和密切护理对于术后良好疗效亦至关重要。

脂肪组织及其衍生成分在创面修复和血管化中的作用

背景:软组织损伤修复过程中,局部的血管化对创面愈合和功能恢复至关重要。脂肪组织被认为是人体最大的干细胞来源库,目前已开发出多种不同的脂肪成分被用于研究和治疗,其促进血管再生和软组织修复的能力被广泛研究。目的:综述血管化在软组织损伤修复中的研究进展,总结脂肪组织及其衍生成分的制备方法及其在血管化和软组织损伤修复中的应用。证实脂肪组织及其衍生成分在血管和软组织工程中具有卓越的研究价值和临床应用前景。方法:利用PubMed、Web of Science和CNKI数据库检索2010年1月至2023年2月发表的相关文献,中文检索词为“软组织修复,伤口愈合,血管化,血管新生,脂肪组织,间质血管成分细胞,脂肪源微血管片段,纳米脂肪,脂肪干细胞基质胶”,英文检索词为“soft tissue repair,wound healing,vascularization,angiogenesis,adipose tissue,stromal vascular fraction,adipose tissue-derived microvascular fragment,nanofat,adipose extracellular matrix/stromal vascular fraction gel”,并纳入少量年份久远的经典文献。通过阅读标题和摘要进行初筛,排除与文章主题不相关的文献,最终纳入69篇文献进行综述分析。结果与结论:(1)创面愈合是一项重要的生理过程,主要发生在组织受到损伤时,如创伤、手术、烧伤、肿瘤、感染以及血管性疾病引起的组织损伤缺损等;(2)创伤部位足够的血管化对组织修复、局部稳态的重新构建和功能恢复至关重要;(3)脂肪组织被认为是人体最大的干细胞来源库,目前已有多种不同的脂肪成分被用于研究和治疗;(4)由于其本身具有的成分和制备优势,脂肪组织将在未来的组织工程研究和治疗中继续扮演重要角色。

督脉隔药灸联合水凝胶多功能复合敷料对压力性损伤大鼠Nrf2/HO-1/NQO1信号通路的影响

目的观察督脉隔药灸联合水凝胶多功能复合敷料对压力性损伤大鼠创面修复及核因子E2相关因子2(nuclear factor-erythroid 2 related factor 2,Nrf2)/血红素氧合酶1(heme oxygenase-1,HO-1)/NADPH醌氧化还原酶1(NADPH quinone oxidoreductase 1,NQO1)信号通路的影响。方法选取50只SPF级SD大鼠,随机分为假手术组、模型组、水凝胶敷料组、督脉隔药灸组、联合干预组,每组10只。除假手术组外,其余4组借助压力装置构建压力性损伤大鼠模型。分组干预并记录各组大鼠的压力性损伤修复情况及创面组织病理变化;借助ELISA检测各组大鼠的血清炎性因子肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素(interleukin,IL)-1β、IL-6以及氧化应激因子丙二醛(malondialdehyde,MDA)、超氧化物歧化酶(superoxide dismutase,SOD)、谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-Px)水平;Western blot与RT-PCR检测各组大鼠创面肉芽组织Nrf2、HO-1、NQO1、基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)蛋白及mRNA的表达水平。结果HE染色结果显示:假手术组皮肤结构未被破坏;模型组创面肉芽组织可见明显的细胞坏死、变性及炎性细胞浸润;干预各组可见创面修复,表现为散在炎性细胞浸润,“气球样”坏死变性明显减少。Masson染色结果显示:假手术组创面皮肤组织胶原纤维较为整齐;模型组创面肉芽组织可见大面积的胶原纤维沉积、紊乱;干预各组可见不同程度的创面修复。与假手术组对比,模型组大鼠血清TNF-α、IL-1β、IL-6、MDA水平和创面肉芽组织Nrf2、HO-1、NQO1、MMP-9蛋白及mRNA的表达水平均升高(P<0.05),而创面修复率、血清SOD、GSH-Px水平均下降(P<0.05);与模型组比较,水凝胶敷料组、督脉隔药灸组、联合干预组的血清TNF-α、IL-1β、IL-6、MDA水平均下降(P<0.05),而创面修复率、血清SOD、GSH-Px水平和创面肉芽组织Nrf2、HO-1、NQO1、MMP-9蛋白及m RNA的表达水平均升高(P<0.05),且联合干预组较其他干预组更优(P<0.05)。结论督脉隔药灸可有效促进压力性损伤的创面修复,与水凝胶多功能复合敷料联合使用效果更佳,其机制可能与督脉隔药灸抑制创面炎性反应及氧化应激,并激活Nrf2/HO-1/NQO1信号通路相关。