Liang Norah E, Griffin Michelle F, Berry Charlotte E, Parker Jennifer B, Downer Mauricio A, Wan Derrick C, Longaker Michael T
Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA.
Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA.
Tissue Eng Part B Rev. 2023 Dec;29(6):671-680. doi: 10.1089/ten.TEB.2023.0060. Epub 2023 Jun 7.
Surgical implants are increasingly used across multiple medical disciplines, with applications ranging from tissue reconstruction to improving compromised organ and limb function. Despite their significant potential for improving health and quality of life, biomaterial implant function is severely limited by the body's immune response to its presence: this is known as the foreign body response (FBR) and is characterized by chronic inflammation and fibrotic capsule formation. This response can result in life-threatening sequelae such as implant malfunction, superimposed infection, and associated vessel thrombosis, in addition to soft tissue disfigurement. Patients may require frequent medical visits, as well as repeated invasive procedures, increasing the burden on an already strained health care system. Currently, the FBR and the cells and molecular mechanisms that mediate it are poorly understood. With applications across a wide array of surgical specialties, acellular dermal matrix (ADM) has emerged as a potential solution to the fibrotic reaction seen with FBR. Although the mechanisms by which ADM decreases chronic fibrosis remain to be clearly characterized, animal studies across diverse surgical models point to its biomimetic properties that facilitate decreased periprosthetic inflammation and improved host cell incorporation. Impact Statement Foreign body response (FBR) is a significant limitation to the use of implantable biomaterials. Acellular dermal matrix (ADM) has been observed to decrease the fibrotic reaction seen with FBR, although its mechanistic details are poorly understood. This review is dedicated to summarizing the primary literature on the biology of FBR in the context of ADM use, using surgical models in breast reconstruction, abdominal and chest wall repair, and pelvic reconstruction. This article will provide readers with an overarching review of shared mechanisms for ADM across multiple surgical models and diverse anatomical applications.
外科植入物在多个医学学科中的使用越来越广泛，其应用范围涵盖从组织重建到改善受损器官和肢体功能。尽管它们在改善健康和生活质量方面具有巨大潜力，但生物材料植入物的功能受到身体对其存在的免疫反应的严重限制：这被称为异物反应（FBR），其特征是慢性炎症和纤维化包膜形成。这种反应除了会导致软组织畸形外，还可能导致危及生命的后遗症，如植入物故障、叠加感染和相关血管血栓形成。患者可能需要频繁就医以及反复进行侵入性手术，这增加了本已不堪重负的医疗保健系统的负担。目前，人们对FBR及其介导的细胞和分子机制了解甚少。随着在广泛的外科专业中的应用，脱细胞真皮基质（ADM）已成为解决FBR所见纤维化反应的潜在解决方案。尽管ADM减少慢性纤维化的机制仍有待明确，但各种外科模型的动物研究表明其具有仿生特性，有助于减少假体周围炎症并改善宿主细胞整合。影响声明异物反应（FBR）是可植入生物材料使用的一个重大限制。已观察到脱细胞真皮基质（ADM）可减少FBR所见的纤维化反应，尽管其机制细节尚不清楚。本综述致力于在ADM使用的背景下，总结关于FBR生物学的主要文献，采用乳房重建、腹壁和胸壁修复以及盆腔重建中的外科模型。本文将为读者提供对ADM在多个外科模型和不同解剖应用中的共同机制的总体综述。
