Han Seung-Kyu, Choi Kyu-Jin, Kim Woo-Kyung
Department of Plastic and Reconstructive Surgery, College of Medicine and Medical Science Research Center, Korea University, Seoul, Korea.
Plast Reconstr Surg. 2004 Dec;114(7):1783-9. doi: 10.1097/01.prs.0000142415.57470.df.
Diabetic foot ulcers often pose a difficult problem for health care professionals because of the defects associated with fibroblast functioning. Although there has been much interest recently in the use of topical growth factors for the treatment of diabetic foot ulcers, the effects are generally not very dramatic. Cryopreserved fibroblast implants, which are able to adjust to a wound's environment and provide the desired growth factors and other substances that may be lacking in a chronic wound, represent an exciting development and a major advance. These products may well provide growth factors in the right concentration and in the right sequence, something that has proved difficult to achieve with the topical application of recombinant growth factors. However, cell activities are impaired by cryopreservation. The purpose of this study was to assess the effects of fresh human allogeneic fibroblast grafting for the treatment of diabetic foot ulcers. Eight patients with diabetic foot ulcers ranging from 6 to 17 weeks in duration were treated. The size of the wounds ranged from 2.0 to 6.0 cm2, with three patients exhibiting exposed bones. A history of diabetic foot ulcers was present in five patients. Human dermal fibroblasts from healthy teenagers were cultured in Dulbecco's modified Eagle medium/Ham's F-12 supplemented with 10% autologous serum. The cultured cells were applied over the wounds immediately after debridement; fibrin was used as a cell carrier. A dressing was then applied with Tegaderm and kept moist until healing was complete. The progress and time for complete wound closure and patient satisfaction were assessed, with follow-up time ranging from 6 to 18 months. Complete wound healing occurred in all patients. Eleven to 21 days were needed for complete reepithelization of the wound, and no clinical or laboratory abnormalities were noted. Patient satisfaction was also very positive. In this study, the use of fresh human fibroblast allografts was found to be a safe and effective treatment for diabetic foot ulcers.
由于与成纤维细胞功能相关的缺陷，糖尿病足溃疡常常给医护人员带来难题。尽管最近人们对使用局部生长因子治疗糖尿病足溃疡兴趣浓厚，但效果通常并不显著。能够适应伤口环境并提供慢性伤口中可能缺乏的所需生长因子和其他物质的冷冻保存成纤维细胞植入物，是一项令人兴奋的进展。这些产品很可能以合适的浓度和顺序提供生长因子，而这已证明通过局部应用重组生长因子难以实现。然而，冷冻保存会损害细胞活性。本研究的目的是评估新鲜人同种异体成纤维细胞移植治疗糖尿病足溃疡的效果。对8例糖尿病足溃疡病程为6至17周的患者进行了治疗。伤口面积为2.0至6.0平方厘米，3例患者有骨质外露。5例患者有糖尿病足溃疡病史。从健康青少年获取的人真皮成纤维细胞在添加10%自体血清的杜尔贝科改良伊格尔培养基/哈姆F-12培养基中培养。清创后立即将培养的细胞覆盖在伤口上；纤维蛋白用作细胞载体。然后用泰德 Derm 敷料包扎并保持湿润，直至完全愈合。评估了伤口完全闭合的进展和时间以及患者满意度，随访时间为6至18个月。所有患者伤口均完全愈合。伤口完全重新上皮化需要11至21天，未发现临床或实验室异常。患者满意度也非常高。在本研究中，发现使用新鲜人成纤维细胞同种异体移植是治疗糖尿病足溃疡的一种安全有效的方法。
