Klein Silvan, Aung Thiha, Haas Robert Michael, Medved Fabian, Schiller Stefan M, Felthaus Oliver, Dolderer Jürgen H
Universitätsklinikum Regensburg, Zentrum für Plastische, Hand- und Wiederherstellungschirurgie.
BG-Unfallklinik, Eberhard Karls Universität Tübingen, Klinik für Hand, Plastische, Rekonstruktive und Verbrennungschirurgie.
Handchir Mikrochir Plast Chir. 2018 Apr;50(2):83-92. doi: 10.1055/s-0043-115117. Epub 2018 Apr 19.
Soft tissue defects resulting from injuries, tumor resection, congenital anomalies or chronic wounds pose a great challenge to reconstructive surgery. The current gold standard in therapy of such defects is the tissue transplantation in terms of free or local flaps. Unfortunately, donor site morbidity remains a considerable risk of flap surgery. Therefore, tissue engineering of autologous vascularized long term stable adipose tissue constructs could enrich the therapeutic possibilities of soft tissue defects. De novo adipose tissue growing requires fundamental knowledge about this kind of tissue and its synthesis, closely linked to angiogenesis. Bioresorbable biomaterials (scaffolds) are of crucial importance for adipose tissue engineering. Simulation or replacement of extracellular matrix for tissue growth by scaffold application requires a profound understanding of cell-matrix interactions. A proper biomaterial should be capable of supporting cell adherence, proliferation and differentiation. Important features are biocompatibility and resorption without toxic metabolites. In this review, various scaffold materials are discussed and novel achievements are presented. Persisting problems of de novo adipose tissue formation are high resorption rates and small tissue volumes of adipose constructs. Adipose tissue formation in a tissue engineering chamber is an additional possibility for in vivo tissue engineering. Recent studies proof that long term stable de novo adipose tissue formation of clinically relevant tissue volumes is possible. This method, in our opinion, has the potential to improve therapeutic strategies of soft tissue defects significantly.
由损伤、肿瘤切除、先天性异常或慢性伤口导致的软组织缺损给重建手术带来了巨大挑战。目前治疗此类缺损的金标准是采用游离或局部皮瓣进行组织移植。不幸的是，供区并发症仍然是皮瓣手术的一个重大风险。因此，构建自体血管化的长期稳定脂肪组织工程可能会丰富软组织缺损的治疗手段。从头生成脂肪组织需要对这种组织及其合成有基本的了解，这与血管生成密切相关。可生物降解的生物材料（支架）对脂肪组织工程至关重要。通过应用支架模拟或替代组织生长的细胞外基质需要对细胞-基质相互作用有深入的理解。合适的生物材料应能够支持细胞黏附、增殖和分化。重要特性包括生物相容性和无毒性代谢产物的吸收性。在本综述中，讨论了各种支架材料并介绍了新的成果。从头生成脂肪组织持续存在的问题是脂肪构建体的高吸收率和小组织体积。在组织工程腔室内形成脂肪组织是体内组织工程的另一种可能性。最近的研究证明，有可能形成具有临床相关组织体积的长期稳定的从头生成脂肪组织。我们认为，这种方法有可能显著改善软组织缺损的治疗策略。
