Baus A, Chatard M, Bich C S, Trouillas M, Cirodde A, Bey E, Duhamel P
Plastic and reconstructive surgery department, Percy Military hospital, Clamart, France; Faculty of medicine Pierre et Marie Curie, Sorbonne university, Paris VI, France.
Plastic and reconstructive surgery department, Percy Military hospital, Clamart, France; Faculty of medicine of Nancy, university of Lorraine, Nancy, France.
Ann Chir Plast Esthet. 2021 Feb;66(1):10-18. doi: 10.1016/j.anplas.2020.11.002. Epub 2020 Dec 27.
Cultured Epithelial Autografts (CEAs), developed at the end of the 1970s from in vitro culture amplification of keratinocytes, have led to a therapeutic revolution in the treatment of major burns. The areas of improvement of the cultures initially involved the manufacturing processes (culture media, support matrices, etc.) and then clinical applications (use of a largely expanded allogeneic or autologous dermal bed). These advances have enabled burn centers (BC) using CEAs to obtain very satisfactory percentages of graft integration and survival of major burns patients. However, since CEAs are not without major drawbacks (fragility, high rate of infection, high cost, unstable scars), these pitfalls have restricted their use worldwide. As of 2014, CEAs produced by Genyzme Tissue Repair are no longer available in Europe, which has considerably reduced an indispensable therapeutic arsenal for severe and extensive burns. To overcome these therapeutic limitations, current research is focusing on techniques combining surgery, tissue engineering and cell therapy. The advent of regenerative medicine, based on the use of stem cells, in particular mesenchymal stem cells (MSC), can contribute to an improvement in the management of these massively burned patients (optimization of the environmental medium, attenuation of the systemic inflammatory response and the immunosuppressive effects of the burn, acceleration of tissue regeneration, etc.). Cell therapy, therefore, offers alternatives to CEAs, which must imperatively retain their place in the therapeutic arsenal, namely an effective emergency coverage technique that can be improved.
培养上皮自体移植片（CEAs）于20世纪70年代末由角质形成细胞的体外培养扩增发展而来，引发了大面积烧伤治疗的一场治疗革命。最初，培养的改进领域涉及制造工艺（培养基、支撑基质等），随后是临床应用（使用大量扩增的异体或自体真皮床）。这些进展使使用CEAs的烧伤中心（BC）在大面积烧伤患者的移植片整合和存活方面获得了非常令人满意的百分比。然而，由于CEAs并非没有重大缺点（脆弱性、高感染率、高成本、不稳定瘢痕），这些缺陷限制了它们在全球范围内的使用。截至2014年，Genyzme组织修复公司生产的CEAs在欧洲已不再可用，这大大减少了严重和大面积烧伤不可或缺的治疗手段。为了克服这些治疗局限性，目前的研究集中在结合手术、组织工程和细胞治疗的技术上。基于干细胞尤其是间充质干细胞（MSC）使用的再生医学的出现，有助于改善这些大面积烧伤患者的治疗管理（优化环境介质、减轻全身炎症反应和烧伤的免疫抑制作用、加速组织再生等）。因此，细胞治疗为CEAs提供了替代方案，而CEAs必须在治疗手段中保留其地位，即一种可改进的有效的紧急覆盖技术。
