Tissue-Engineered Soft-Tissue Reconstruction Using Noninvasive Mechanical Preconditioning and a Shelf-Ready Allograft Adipose Matrix
Tissue-Engineered Soft-Tissue Reconstruction Using Noninvasive Mechanical Preconditioning and a Shelf-Ready Allograft Adipose Matrix
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DOI：
10.1097/prs.0000000000006085
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发表时间：
2019-10-01
影响因子：
3.6
通讯作者：
Orgill, Dennis P.
中科院分区：
文献类型：
--
作者：
Giatsidis, Giorgio;Succar, Julien;Orgill, Dennis P.
背景资料：脂肪组织缺损导致严重的功能（残疾）和形态（毁容）的发病率通常是在整形外科治疗脂肪移植，这可能是有限的吸收，坏死和囊肿形成。本研究旨在评估脂肪支架是否可以为原位自体脂肪移植提供环境，并研究是否可以通过预先增加接受支架的周围组织的血管分布（预处理）来增强支架内脂肪细胞的迁移和增殖（脂肪生成）。研究方法：使用已建立的皮下组织/支架移植啮齿动物模型，作者测试了人源性、货架可用、可注射、脱细胞同种异体脂肪基质与无创机械（抽吸诱导）皮肤预处理联合使用时重建软组织缺损的潜力。结果如下：与标准治疗（自体脂肪移植）相比，联合使用同种异体脂肪基质和非侵入性皮肤预处理显著改善了长期体积保留（在12周随访时高出50%至80%）和重建组织的组织学质量。同种异体脂肪基质的成分支持脂肪生成和血管生成。将同种异体脂肪基质与活体脂肪移植物结合可减轻不良结局（长期体积保留较低，囊肿样区域存在较高）。结论：这项研究表明，同种异体脂肪基质和非侵入性组织预处理的协同使用为改善脂肪移植提供了一种有效的解决方案。这些策略可以很容易地在临床试验中进行测试，并可以为重建手术中的新治疗模式奠定基础。
Background: Adipose tissue defects leading to severe functional (disability) and morphologic (disfigurement) morbidity are often treated in plastic surgery with fat grafting, which can be limited by resorption, necrosis, and cyst formation. This study aimed to assess whether adipose scaffolds could provide an environment for in situ autologous fat grafting, and to study whether adipose cell migration and proliferation (adipogenesis) within scaffolds could be enhanced by preliminarily increasing the vascularity (preconditioning) of the surrounding tissue receiving the scaffolds. Methods: Using an established rodent model of subcutaneous tissue/scaffold grafting, the authors tested the potential of a human-derived, shelf-ready, injectable, decellularized allograft adipose matrix to reconstruct soft-tissue defects when used in combination with noninvasive mechanical (suction-induced) skin preconditioning. Results: Combined use of the allograft adipose matrix and noninvasive skin preconditioning significantly improved long-term volume retention (50 to 80 percent higher at a 12-week follow-up) and histologic quality of reconstructed tissues compared with standard of care (autologous adipose grafts). The components of the allograft adipose matrix supported adipogenesis and angiogenesis. Combining the allograft adipose matrix with living adipose grafts mitigated negative outcomes (lower long-term volume retention, higher presence of cystic-like areas). Conclusions: This study suggests that the synergistic use of the allograft adipose matrix and noninvasive tissue preconditioning provides an effective solution for improving fat grafting. These strategies can easily be tested in clinical trials and could establish the basis for a novel therapeutic paradigm in reconstructive surgery.