Dolderer J H, Medved F, Haas R M, Siegel-Axel D I, Schiller S M, Schaller H-E
Hochschulzentrum für Plastische, Hand- und Wiederherstellungschirurgie, -Universitätsklinikum Regensburg, Regensburg.
Handchir Mikrochir Plast Chir. 2013 Apr;45(2):99-107. doi: 10.1055/s-0032-1329944. Epub 2013 Jan 22.
The current standard for the reconstruction of large soft tissue defects with exposed bone, nerves or blood vessels, for example after extensive tumor resections, complex injuries, severe burns or infections, is the local or free microsurgical tissue transfer. Despite the development of new surgical techniques and many synthetic materials, there are still a large number of limitations and complications at the donor and recipient site. Thus, in a subset of patients either complete treatment is not possible or poses problems. Therefore, there is a great need for the development of new methods and materials allowing for a permanent replacement with body own soft tissue. A promising therapeutic approach is the soft tissue replacement with autologous adipose tissue. Innovative research on the reconstruction of soft tissue by adipose tissue, and clinical and experimental studies on the long-term survival and transplantation of autologous adipose tissue showed that the free fat tissue graft without direct vascular connection come along with disappointing results. Often a loss of volume or a complete resorption of the graft because of insufficient tissue quality by lack of cell differentiation was observed. This fact points to the special role of the maintenance and development of the graft's blood supply (angiogenesis and vascularization) crucial for maintaining a constant volume of the tissue. The rapidly growing interdisciplinary field of tissue engineering offers alternative solutions to the existing treatment options with the aim to produce autologous adipose tissue, stable in volume in vitro as well as in vivo, which can be transplanted as a permanent tissue replacement to corresponding parts of the body. Numerous studies have demonstrated the important and most critical factor of vascularisation for quality, volume and long-term survival of transplanted newly generated adipose tissue constructs. Although our understanding of the regulatory mechanisms of adipogenesis is still limited, there are clear indications that the complex sequences of cell interactions in the differentiation and proliferation of adipocytes is directly related to angiogenesis.
目前，对于大面积软组织缺损伴骨、神经或血管外露的重建，例如在广泛肿瘤切除、复杂损伤、严重烧伤或感染后，标准方法是局部或游离显微外科组织移植。尽管新的外科技术和许多合成材料不断发展，但供体和受体部位仍存在大量局限性和并发症。因此，在一部分患者中，要么无法进行彻底治疗，要么会出现问题。所以，迫切需要开发新的方法和材料，以便用自体软组织进行永久性替代。一种有前景的治疗方法是用自体脂肪组织替代软组织。关于脂肪组织重建软组织的创新性研究，以及自体脂肪组织长期存活和移植的临床与实验研究表明，无直接血管连接的游离脂肪组织移植效果令人失望。由于缺乏细胞分化导致组织质量不足，常常会观察到移植组织体积减小或完全吸收。这一事实表明，移植组织血供的维持和发展（血管生成和血管化）对于维持组织恒定体积起着特殊作用。迅速发展的跨学科组织工程领域为现有治疗方案提供了替代解决方案，旨在生产出在体外和体内体积稳定的自体脂肪组织，可作为永久性组织替代物移植到身体相应部位。大量研究表明，血管化是移植新生成脂肪组织构建体质量、体积和长期存活的重要且最关键因素。尽管我们对脂肪生成调节机制的理解仍然有限，但有明确迹象表明，脂肪细胞分化和增殖过程中复杂的细胞相互作用序列与血管生成直接相关。
