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Handchir Mikrochir Plast Chir 2020; 52(06): 533-544
DOI: 10.1055/a-1200-1189
Originalarbeit

Eignung biologischer azellulärer dermaler Matrices als Hautersatz

Suitability of biological acellular dermal matrices as a skin replacement
Marcin Specht
1   Klinikum Bremen-Mitte gGmbH Plastisc, Reconstructive and Aesthetic Surgery
,
Sorge Kelm
2   University of Bremen CBIB, Faculty of Biology and Biochemistry
,
Ursula Mirastschijski
2   University of Bremen CBIB, Faculty of Biology and Biochemistry
3   Mira-Beau gender esthetics, Berlin
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Zusammenfassung

Einleitung Bei Gewebedefekten können epidermale und dermale Anteile der Haut verloren gehen. Häufig ist eine reduzierte Gewebeelastizität, ggf. mit Narbenkontrakturen, die die Gelenkbeweglichkeit einschränken können, die Folge. Artifizielle Kollagenmatrices und humane azelluläre dermale Matrices (ADM) stellen ein neues Verfahren der kutanen Rekonstruktion vor allem in der Verbrennungsmedizin dar.

Zielsetzung Ziel dieser Studie war es, die Eignung von ADM als dermalen Ersatz zu untersuchen. Hierbei wurden die zelluläre Migration und Differenzierung sowie die inflammatorische Reaktion auf verschiedene Matrices in einem etablierten Hautorgankulturmodell ex vivo untersucht.

Material und Methoden Reste von vitalen, operativ entnommenen Spalthauttransplantaten wurden auf humane ADM (Epiflex), deepidermalisierte humane Dermis (DED) oder artifizielle Kollagen-Elastin Matrix (KEM, Matriderm) transferiert und das epitheliale Resurfacing in einem standardisierten Wundmodell an der Luft-Feuchtigkeitsgrenze untersucht. Um den Einfluss unterschiedlicher dermaler Anteile auf das epitheliale Verhalten zu untersuchen, wurde zudem die Migration auf ADM aus papillären mit retikulären Dermisanteilen verglichen. Die Reepithelialisierung und zelluläre inflammatorische Reaktion wurden histologisch, immunhistochemisch und biochemisch analysiert.

Ergebnisse und Schlussfolgerung Die größte epitheliale Ausbreitung und Differenzierung fand auf DED (2,54 mm ± 0,43 mm, Mittelwert ± SEM) im Vergleich zu ADM (1,32 mm ± 0,44 mm, p < 0,09) oder KEM (0,77 mm ± 0,11 mm, p < 0,02) statt, was unter anderem auf promigratorische Basalmembranreste auf DED zurückzuführen ist. Die keratinozytäre Migration war deutlich größer auf papillärer ADM im Vergleich zu retikulärer ADM. Im Gegensatz zu den biologischen Matrices fand sich in der grobporigen KEM nur eine horizontale Durchwanderung des Gewebes. Die Expression proinflammatorischer Mediatoren unterschied sich je nach Hautdonor und Matrix.

Zusammenfassend ist festzustellen, dass die Struktur und Herkunft der dermalen Matrix von großer Bedeutung für die Reepithelialiserung und inflammatorische zelluläre Reaktion sind.

Abstract

Introduction Tissue defects are associated with loss of epidermal and dermal components of the skin. For full-thickness tissue defects, dermal equivalents are useful to enable rapid wound closure. Split-thickness skin grafts are associated with loss of tissue elasticity resulting in scar contractures that can impair joint mobility. Synthetic collagen matrices and allogeneic acellular dermal matrices (ADM) are commercially available and could serve as skin tissue replacement. The aim of this study was to investigate whether ADM of different dermal layers or bioartificial matrices can serve as cutaneous replacement. For this purpose, cellular migration, differentiation and the inflammatory reaction were studied in an established ex vivo skin organ model.

Materials and Methods Human split-thickness skin grafts were transplanted onto ADM (Epiflex, DIZG, Berlin, Germany), de-epidermized dermis (DED) or an artificial collagen-elastin matrix (Matriderm, Dr. Suwelack, Billerbeck, Germany). Epithelial migration was studied using an established skin culture model at the air-liquid interface. In addition, the effect of tissue from different dermal compartments, e. g. papillar and reticular dermis, on epithelial migration was compared. Epithelial resurfacing and differentiation of matrices as well as the inflammatory reaction were studied using histological, immunohistochemical and biochemical analyses.

Results and Conclusion Significantly more epithelial outgrowth area was found on DED (2.54 mm ± 0.43 mm, mean ± SEM) compared to papillary ADM (1.32 mm ± 0.44 mm, p = 0.039), to reticular ADM (no horizontal growth, p < 0.0001) and collagen-elastin matrix (0.78 mm ± 0.11 mm, p = 0.0056) measured by fluorescence microscopy over 10 days presumably due to the presence of pro-migratory basement membrane residues on DED. Reepithelialization was significantly higher (p < 0.002) on papillary dermis compared to ADM of reticular origin. In contrast to the biological matrices, a complete horizontal penetration was found in the macroporous collagen-elastin matrix. Pro-inflammatory mediators varied depending on the human skin donor and matrix. In summary, the biochemical structure of the matrix’ surface and its origin influenced the epithelial behaviour with regard to migration, differentiation and inflammatory response.

Schlüsselwörter

Dermaler Hautersatz - Epiflex - Keratinozyten - biologische Matrices - azelluläre dermale Matrix

Key words

Dermal skin substitute - Epiflex - keratinocyte - biological matrices - acellular dermal matrix


Publication History

Received: 15 February 2020

Accepted: 12 May 2020

Article published online:
30 July 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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