Skin regenerated from cultured epithelial autografts on full-thickness burn wounds from 6 days to 5 years after grafting. A light, electron microscopic and immunohistochemical study.
Skin regenerated from cultured epithelial autografts on full-thickness burn wounds from 6 days to 5 years after grafting. A light, electron microscopic and immunohistochemical study.
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发表时间：
1989
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通讯作者：
C. Compton;J. M. Gill;D. Bradford;S. Regauer;G. Gallico;Nicholas E. O'Connor
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作者：
C. Compton;J. M. Gill;D. Bradford;S. Regauer;G. Gallico;Nicholas E. O'Connor
应用培养的自体角质形成细胞移植治疗儿童全层烧伤创面21例，术后6天~5年观察皮肤再生情况。研究结果与年龄和部位匹配的正常皮肤的对照组以及移植后年龄相当的网状中厚皮肤移植的上皮伤口愈合和重新上皮化的间隙的对照组进行了比较。移植后6天，轻度肥大、扁平的表皮全部正常层再生，开始新生真皮-表皮交界处的形成过程。半桥粒、基板和锚定纤维沿着移植物附着面以点状方式结合在一起。在3-4周内，真皮-表皮连接完成，但锚定纤维的完全成熟需要一年多的时间。这一过程与网状移植物间隙中观察到的过程类似。移植后6周至1年，网脊再生。周围结缔组织最初愈合形成正常瘢痕，但在4至5年内显著重塑，再生弹性蛋白，类似于真正的真皮。网状移植物间质对照组在移植后5年内未见网脊再生、上皮下结缔组织重塑或弹性蛋白产生。移植的朗格汉斯细胞在1周内重新填充，2~6个月内达到正常群体密度。1年后，朗格汉斯细胞密度较正常皮肤增加，但低于年龄匹配的网状移植物对照组。黑素细胞在移植时存在于培养物中，但直到移植后一年或更长时间，腹股沟或腋窝来源的移植物中才能看到功能性表皮黑素单位，或者在鞋底来源的表皮中才能看到功能的表皮黑素单位。移植后数年仍保持正常的组织学特征。包括角化不全、角化不良和上皮内摩擦水泡形成在内的一过性病理改变很少见。未见异型或癌前病变。
Regeneration of skin from cultured keratinocyte autografts used in the treatment of full-thickness burn wounds was studied in 21 pediatric patients from 6 days to 5 years after grafting. Findings were compared both to controls of age- and site-matched normal skin and to controls for epithelial wound-healing, re-epithelialized interstices of meshed split-thickness skin grafts of comparable postgrafting age. Six days after transplantation, a mildly hypertrophic, flat epidermis with all normal strata had regenerated, and the process of de novo dermal-epidermal junction formation had begun. Hemidesmosomes, basal lamina, and anchoring fibrils reformed conjointly in punctate fashion along the attachment face of the grafts. Within 3 to 4 weeks, the dermal-epidermal junction was complete, but full maturation of anchoring fibrils required more than a year. The process was comparable to that observed in meshed graft interstices. Rete ridges regenerated from 6 weeks to 1 year after grafting. The subjacent connective tissue initially healed to form normal scar, but it remodeled dramatically, regenerated elastin, and resembled a true dermis within 4 to 5 years. Meshed-graft interstice controls showed no rete ridge regeneration, subepithelial connective tissue remodeling, or elastin production up to 5 years after grafting. Langerhans cells repopulated grafts within 1 week, and normal population densities were reached within 2 to 6 months. After 1 year, Langerhans cell densities were increased compared with normal skin but were lower than those in age-matched meshed graft controls. Melanocytes were present in cultures at the time of transplantation, but functional epidermal melanin units were not seen in groin- or axilla-derived grafts for 6 to 8 weeks or in sole-derived epidermis until a year or more after transplantation. Normal histologic features were maintained for years after grafting. Transitory pathologic changes including parakeratosis, dyskeratosis, and intraepithelial friction blister formation were infrequently observed. No dysplastic or premalignant changes were seen.