Kim Min Ji, Lee Woo Beom, Park Bo Young
Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea.
Department of Plastic and Reconstructive Surgery, School of Medicine, Ewha Womans University, Seoul, South Korea.
J Surg Res. 2022 Apr;272:153-165. doi: 10.1016/j.jss.2021.11.009. Epub 2021 Dec 30.
The use of acellular dermal matrix on chronic diabetic wounds in clinical practice is hindered by its high cost and difficulty in application. We aimed to acquire experimental evidence on the effect of morphologically transformed acellular dermal matrix on chronic diabetic wounds and investigate how this transformation affects the wound healing mechanism.
We developed a new chronic wound model that resembles a diabetic chronic wound as it involves an open wound with partial calvarial bone exposure in diabetic rats. According to treatment materials, rats were assigned into the CONTROL, ADM, and PASTE groups. The wound healing period was subdivided into T1 and T2 (postoperative days 14 and 30, respectively). Three-staged analyses were performed using 3D camera, histological analysis, and real-time quantitative polymerase chain reaction.
The morphologically transformed acellular dermal matrix showed a compatible treatment rate in the total wound and more rapidly reduced the initial bone exposure area. In the PASTE group, collagen scaffold appeared at a later period and expression levels of epidermal growth factor and epidermal growth factor receptor increased.
The transformation of acellular dermal matrix into the pulverized form is thought to contribute to its non-inferior therapeutic effect compared with normal acellular dermal matrix. With respect to the mechanism, the pulverized form reduced the bone exposure area in the early stage and provided a collagen scaffold at a later period. An increase in epithelial growth factors through mechanochemical transformations along with increased contact area contribute to the enhanced healing capacity of the morphologically transformed acellular dermal matrix.
脱细胞真皮基质在临床实践中用于慢性糖尿病伤口时，因其成本高和应用困难而受到阻碍。我们旨在获取关于形态转化的脱细胞真皮基质对慢性糖尿病伤口影响的实验证据，并研究这种转化如何影响伤口愈合机制。
我们建立了一种新的慢性伤口模型，该模型类似于糖尿病慢性伤口，因为它涉及糖尿病大鼠的开放性伤口且部分颅骨暴露。根据治疗材料，将大鼠分为对照组、脱细胞真皮基质组和糊剂组。伤口愈合期分为T1和T2（分别为术后第14天和第30天）。使用3D相机、组织学分析和实时定量聚合酶链反应进行三阶段分析。
形态转化的脱细胞真皮基质在总伤口中显示出相当的治愈率，并更快地减少了初始骨暴露面积。在糊剂组中，胶原支架出现较晚，表皮生长因子和表皮生长因子受体的表达水平增加。
脱细胞真皮基质转化为粉碎形式被认为与其与正常脱细胞真皮基质相比的非劣效治疗效果有关。就机制而言，粉碎形式在早期减少了骨暴露面积，并在后期提供了胶原支架。通过机械化学转化增加上皮生长因子以及增加接触面积有助于提高形态转化的脱细胞真皮基质的愈合能力。
