Tissue-engineered skin. Current status in wound healing.
Tissue-engineered skin. Current status in wound healing.
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DOI：
10.2165/00128071-200102050-00005
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发表时间：
2001-01-01
影响因子：
7.3
通讯作者：
Eaglstein, W H
中科院分区：
文献类型：
--
作者：
Bello, Y M;Falabella, A F;Eaglstein, W H
组织工程皮肤是伤口愈合领域的一个重大进展，由于与自体移植物的使用相关的限制而开发。这些局限性包括供体部位的产生，其具有发展疼痛、瘢痕、感染和/或缓慢愈合的风险。一些产品已经上市，还有许多产品正在开发中。培养的表皮自体移植物可以提供永久性的大面积皮肤活检覆盖。然而，嫁接培养需要3周。培养的同种异体表皮移植物可立即获得，无需活检。它们可以被冷冻保存和储存，但目前还没有商业化。具有完整基底膜复合物的无生命同种异体脱细胞真皮基质（Alloderm）具有免疫惰性。它为移植准备伤口床，允许改进培养的同种异体移植物“吸收”，并提供完整的基底膜。胶原蛋白和软骨素-6-硫酸盐的无生命细胞外基质与硅胶背衬（Integra）用于生成新真皮。已经研究了用自体成纤维细胞和角质形成细胞接种的胶原蛋白和糖胺聚糖真皮基质，但尚未商购。它需要3到4周的时间来培养。Dermagraft由生长在可降解支架上的活的同种异体真皮成纤维细胞组成。它有很好的抗撕裂性。由同种异体人真皮成纤维细胞（TransCyte）产生的细胞外基质用作新真皮产生的基质。Apliferma是一种含有角质形成细胞、成纤维细胞和牛I型胶原蛋白的活的同种异体双层结构。它可以在门诊使用，避免了对供体部位伤口的需要。另一种活的皮肤等效物，复合培养皮肤（OrCel），由同种异体成纤维细胞和角质形成细胞组成，所述同种异体成纤维细胞和角质形成细胞接种在牛胶原蛋白的双层基质的相对侧上。该产品的临床数据有限，但大型临床试验正在进行中。猪源敷料材料的2种类型的数据也有限：猪小肠粘膜下层脱细胞胶原基质（Oasis）和脱细胞异种胶原基质（E-Z-Derm）。这两种产品都有很长的保质期。其他新的皮肤替代品正在研究中。使用组织工程皮肤的潜在风险和益处需要在临床试验中进一步评估，但很明显，它们为伤口治疗提供了一种新的选择。
Tissue-engineered skin is a significant advance in the field of wound healing and was developed due to limitations associated with the use of autografts. These limitations include the creation of a donor site which is at risk of developing pain, scarring, infection and/or slow healing. A number of products are commercially available and many others are in development. Cultured epidermal autografts can provide permanent coverage of large area from a skin biopsy. However, 3 weeks are needed for graft cultivation. Cultured epidermal allografts are available immediately and no biopsy is necessary. They can be cryopreserved and banked, but are not currently commercially available. A nonliving allogeneic acellular dermal matrix with intact basement membrane complex (Alloderm) is immunologically inert. It prepares the wound bed for grafting allowing improved cultured allograft 'take' and provides an intact basement membrane. A nonliving extracellular matrix of collagen and chondroitin-6-sulfate with silicone backing (Integra) serves to generate neodermis. A collagen and glycosaminoglycan dermal matrix inoculated with autologous fibroblasts and keratinocytes has been investigated but is not commercially available. It requires 3 to 4 weeks for cultivation. Dermagraft consists of living allogeneic dermal fibroblasts grown on degradable scaffold. It has good resistance to tearing. An extracellular matrix generated by allogeneic human dermal fibroblasts (TransCyte) serves as a matrix for neodermis generation. Apligraf is a living allogeneic bilayered construct containing keratinocytes, fibroblasts and bovine type I collagen. It can be used on an outpatient basis and avoids the need for a donor site wound. Another living skin equivalent, composite cultured skin (OrCel), consists of allogeneic fibroblasts and keratinocytes seeded on opposite sides of bilayered matrix of bovine collagen. There are limited clinical data available for this product, but large clinical trials are ongoing. Limited data are also available for 2 types of dressing material derived from pigs: porcine small intestinal submucosa acellular collagen matrix (Oasis) and an acellular xenogeneic collagen matrix (E-Z-Derm). Both products have a long shelf life. Other novel skin substitutes are being investigated. The potential risks and benefits of using tissue-engineered skin need to be further evaluated in clinical trials but it is obvious that they offer a new option for the treatment of wounds.