Fimiani Michele, Pianigiani Elisa, Di Simplicio Francesca Cherubini, Sbano Paolo, Cuccia Aldo, Pompella Gerarda, De Aloe Giovambattista, Petraglia Felice
Department of Dermatologic Sciences, University of Siena, Policlinico Le Scotte, 53100 Siena, Italy.
Clin Dermatol. 2005 Jul-Aug;23(4):396-402. doi: 10.1016/j.clindermatol.2004.07.025.
The main use of homologous skin grafts or grafts of related bioproducts is in the treatment of severe burns. However, various new clinical and experimental sectors, in which this type of skin substitute can be useful, have recently emerged. The main new clinical indications for skin allografts include: skin loss, surgical wounds and bullous diseases. In these fields donor skin can be used for different purposes: as a physiological biological dressing to control pain and protect deep structures such as tendons, bones, cartilage and nerves, and to promote reepithelization with a significant reduction in healing time, and as skin substitute with dermal tissue to guide repair and make it as physiological as possible. In particular, skin bank bioproducts are currently used in the treatment of several conditions such venous and arterial leg ulcers, pressure ulcers, diabetic foot ulcers, pyoderma gangrenosum, post traumatic lesions, Mohs surgery, reconstructive surgery, wound cover in critical areas, aesthetic surgery, congenital epidermolysis bullosa and Lyell's syndrome. Skin bank bioproducts have also been used for experimental indications, to study in vitro toxicology and in vitro skin biology. Recently the demonstration that de-epidermized dermis (DED) has all the characteristics of an excellent dermal substitute into which various types of cells can be introduced and made to develop, opens exciting new possibilities of research in the field of wound healing and tissue engineering. Our preliminary observations seems to indicate that CD 34+ stem cells from umbilical cord blood can survive in DED and in a few weeks populate collagen bundles. The observation of tubular structures without lumina close to collagen bundles as well as clusters of epithelioid or fibroblast-shaped cells may represent aspects of differentiation of CD 34+ stem cells. More detailed and sophisticated studies are clearly needed to answer all the questions that these initial observations pose. Anyway the 3-dimensional model proposed seems to be suitable for the study of the behaviour of peripheral CD 34+ and perhaps also other types of stem cells in 3-dimensional dermal matrix.
同种异体皮肤移植或相关生物制品移植的主要用途是治疗严重烧伤。然而，最近出现了各种新的临床和实验领域，这种类型的皮肤替代物在这些领域可能会有用。皮肤同种异体移植的主要新临床适应症包括：皮肤缺损、手术伤口和大疱性疾病。在这些领域，供体皮肤可用于不同目的：作为生理性生物敷料，以控制疼痛并保护肌腱、骨骼、软骨和神经等深部结构，并促进上皮再形成，显著缩短愈合时间；作为带有真皮组织的皮肤替代物，以引导修复并使其尽可能生理化。特别是，皮肤库生物制品目前用于治疗多种病症，如腿部静脉和动脉溃疡、压疮、糖尿病足溃疡、坏疽性脓皮病、创伤后病变、莫氏手术、重建手术、关键区域的伤口覆盖、美容手术、先天性大疱性表皮松解症和莱尔综合征。皮肤库生物制品也已用于实验适应症，以研究体外毒理学和体外皮肤生物学。最近有证据表明，去表皮真皮（DED）具有优秀真皮替代物的所有特征，可以引入各种类型的细胞并使其生长，这为伤口愈合和组织工程领域开辟了令人兴奋的新研究可能性。我们的初步观察似乎表明，脐带血中的CD 34+干细胞可以在DED中存活，并在几周内填充胶原束。观察到靠近胶原束的无管腔管状结构以及上皮样或成纤维细胞样细胞簇可能代表了CD 34+干细胞的分化方面。显然需要更详细和复杂的研究来回答这些初步观察提出的所有问题。无论如何，提出的三维模型似乎适合研究外周CD 34+以及其他类型干细胞在三维真皮基质中的行为。
