Pedreira Denise Araújo Lapa, Quintero Ruben A, Acácio Gregório Lorenzo, Caldini Elia Tamaso Espin Garcia, Saldiva Paulo Hilário Nascimento
Maternal-fetal specialist, Pathology Department, Faculty of Medicine, University of São Paulo (USP), São Paulo, Brazil.
J Matern Fetal Neonatal Med. 2011 Oct;24(10):1243-8. doi: 10.3109/14767058.2011.564486. Epub 2011 Aug 17.
To assess the ability of a three-layer graft in the closuse of large fetal skin defects.
Ovine fetuses underwent a large (4 × 3 cm) full-thickness skin defect over the lumbar region at 105 days' gestation (term = 140 days). A bilaminar artificial skin was placed over a cellulose interface to cover the defect (3-layer graft). The skin was partially reapproximated with a continuous nylon suture. Pregnancy was allowed to continue and the surgical site was submitted to histopathological analysis at different post-operative intervals.
Seven fetuses underwent surgery. One maternal/fetal death occurred, and the remaining 6 fetuses were analyzed. Artificial skin adherence to the wound edges was observed in cases that remained in utero for at least 15 days. Neoskin was present beneath the silicone layer of the bilaminar artificial skin.
Our study shows that neoskin can develop in the fetus using a 3-layer graft, including epidermal growth beneath the silicone layer of the bilaminar skin graft. These findings suggest that the fetus is able to reepithelialise even large skin defects. Further experience is necessary to assess the quality of this repair.
评估三层移植物闭合大型胎儿皮肤缺损的能力。
在妊娠105天（足月为140天）时，对绵羊胎儿的腰部进行一个大的（4×3厘米）全层皮肤缺损手术。将双层人工皮肤置于纤维素界面上以覆盖缺损（三层移植物）。用连续尼龙缝线将皮肤部分重新对合。让妊娠继续进行，并在不同的术后时间间隔对手术部位进行组织病理学分析。
七只胎儿接受了手术。发生了一例母胎死亡，对其余6只胎儿进行了分析。在至少在子宫内留存15天的病例中观察到人工皮肤与伤口边缘粘连。双层人工皮肤的硅酮层下方出现了新皮肤。
我们的研究表明，使用三层移植物，胎儿能够形成新皮肤，包括在双层皮肤移植物的硅酮层下方出现表皮生长。这些发现表明，胎儿即使对于大型皮肤缺损也能够重新上皮化。需要进一步的经验来评估这种修复的质量。
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