Роль клітинних технологій в пластичному закритті дефектів шкіри та м’яких тканин

Abstract

В статті наведено ефективність застосування дермального (ДЕ) еквіваленту на основі фібринового гідрогелю та культивованих алогенних мультипотентних мезенхімальних стромальних клітин із жирової тканини (ММСК-ЖТ) на приживлення трансплантатів після проведення аутодермопластики. Встановлено повне приживлення трансплантатів у основній групі, де застосовували ДЕ, та значний відсоток незадовільних результатів у контрольній групі. Разом з тим, відмічено позитивну дію ДЕ на трансплантати контрольної групи, де спостерігався частковий лізис; В статье приведена оценка эффективности применения дермального эквивалента (ДЭ) на основе фибринового гидрогеля и культивированных аллогенных мультипотентных стромальных клеток из жировой ткани (ММСК-ЖТ) на приживление трансплантатов после аутодермопластики. Выявлено полное приживление трансплантатов в основной группе, где применяли ДЭ, и значительный процент неудовлетворительных результатов в контрольной группе. Кроме того, имеет место положительное действие ДЭ на трансплантаты контрольной группы, где имел место частичный их лизи; Surgical treatment of necrotic wound defects remains one of the urgent problems of modern surgery, the resolution of which comprises skin defects closure and, in some cases, the maintaining of the lower limb support function. Amputation at foot and necrectomy diabetic foot syndrome, opening abscesses and boils in treatment of purulent-necrotic complications of erysipelas and necrotic fasciitis can lead to the formation of extensive wound defects that need further plastic closure. Despite the presence of a large number of techniques in the treatment of chronic wounds, the results are not reassuring. The search for new drugs of both conventional and biomedical ones is still continuing. There are a number of requirements for modern dressings. The bandage should not be only antiseptic, but also actively promote wound reparative processes, with considering metabolism, angio- and neuropathy that occur in chronic wounds. Recently, for the wound treatment, along with the skin substitutes’ approach (collagen plastics, xenogeneic skin substitutes, biopolymer coating), cell therapy methods are widely used. It is known about regenerative medicine approach with promising results and clinical outcomes in combat casualty when using of cultured multipotent mesenchymal stem/stromal cells. It was also reported the exosomes derived from human MSCs aid the repair of skin burn injuries through paracrine actions. The aim of our study was to explore the mechanisms and assess the effectiveness of dermal equivalent (DE) application, consisting of a fibrin hydrogel and cultured allogeneic adipose-derived multipotent mesenchymal stromal cells from adipose tissue (MSCs/ADSCs) on wound healing processes in patients with chronic traumatic defects. Visual assessment of regenerative processes in the area of the wound (the presence of granulation, epithelization, amount of wound content, state of surrounding tissue) was carried out by means of scoring test at early stage, the dressings changes (every 3 days) and at the end of treatment. DE applications on wound surface after cleaning the wound, can deliver the cells to the forming granulation tissue, significantly reducing unwanted loss of therapeutic effect associated with possible rapid collapse and cell death. It can significantly improve the results of chronic wounds’ treatment, initiate repair processes in granulation tissue, stimulate angiogenesis, reduce the wound inflammation, and to prepare a wound to plastic closure. However, these cells can be applied over wound surface at any desired time, depending on the processes that occur in the wound. DE effects achieved by improving the vascularization of granulation tissue, stimulation of skin residual epithelial islets, reduce signs of inflammation, immune-regulating and anti-fibrotic activities. The use of DE in patients with chronic traumatic defects allowed accelerating the regenerative processes triggering in wounds and in less time to prepare a wound for further treatment dermoplasty stage. When using this dermal equivalent marked decrease patient pain to slightly during the first three days of treatment.