TGF-β의 길항제인 Decorin이 백서 태자의 반흔 형성에 미치는 영향

신극선,유원민,곽혁준 大韓成形外科學會 1998 Archives of Plastic Surgery Vol.25 No.8

Adult wounds heal with scar-tissue formation, whereas fetal wounds heal without scarring and with a lesser inflammatory and cytokine response. The unique fetal wound repair process is not dependent on the sterile, aqueous intrauterine environment. The differences between fetal and adult wound healing appear to reflect processes intrinsic to fetal tissue, such as the unique fetal fibroblast, a more rapid and ordered deposition and turnover of tissue components, and, particularly, a markedly reduced inflammatory infiltrate and cytokine profile. Among these cytokines, the transforming growth factor-β(TGF-β) is a growth factor which plays an important role in the regulation of cell growth and differentiation. The fibrosis characteristic of adult wound repair may be associated with TGF-βexcess. Recent experimental studies have focused on the specific anti-TGF-β strategies for scarless wound healing. Decorin, a proteoglycan, is known to regulate TGF-β. This factor antagonizes the action of TGF-βin tissues. However, little is known about the functions of this factor in vivo. The objects of the present study were to analyze the effects of TGF-β, an important regulatory molecule in adult healing events, and the effects of decorin, known inhibitor against TGF-β, on the fetal tissue response following wounding. Fetal cellular and extracellular matrix response to injury were evaluated by treating the wound with TGF-β and decorin in fetal rat at 14 days gestation (term = 21 days). Histologic response and histomorphometric analysis two to eight weeks later were compared between TGF-βonly treated wound and TGF-βwith decorin treated wound. The histologic finding of the TGF-β treated wound was characterized by an early acute inflammatory response : by week 6 fibroblasts and collagen were predominant. In contrast, TGF-β with decorin treated wound had no remarkable histologic evidence of acute inflammation or fibroblast penetration and few collagen was deposited. These observations demonstrate that the fetal response becomes adultlike with fibroblast proliferation and collagen accumulation when TGF-βis added, thus documenting the responsiveness of the fetal system to adult repair signals. Such responsiveness thus suggests a critical difference in the fetal wound environment. Fetal repair may proceed in the absence of trophic factors like TGF-β, thus accounting for optimal "healing" in the absence of excessive fibrosis. And these observations also confirmed the inhibitory action of decorin against TGF-β in rat fetus model. We can suggest that the decorin minimize the inflammatory response and subsequent cellular proliferation in wound healing process, thus eventually prevent collagen deposition and scar tissue formation.

가토에서 압좌된 자가 연골 이식후 용적변화에 관한 실험적 연구

김승홍,민대홍,백무현,김미경,곽혁준 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.5

Over the last two decades, the use of autogenous cartilage has gained increasing popularity in facial aesthetic and reconstructive surgery. In fact, the cartilage graft has added another dimension to thinoplasty, particularly in nasal tip surgery. Cartilage removed during primary septorhinoplasty remains the main source for grafts used in immediate reconstructive efforts. Surgeons had to resort to alternative sources, such as the conchal cartilage, when performing a revision rhinoplasty that required a cartilage grafts. Because, the harsh appearance of cartilage grafts in some sites requires crushing the cartilage to achieve a softer contour. This, however, could be a factor in graft failure and in reducing the success incidence. The goal of this study was to compare the volume retention and the chondrocyte survival of crushed and noncrushed cartilage grafts to observe the fate of fresh crushed cartilage, assessing the graft bulk retention and chondrocyte viability. So, this study was conducted to investigate volume retention and chondrocyte survival in autogenous fresh noncrushed, fresh crushed cartilage grafts in adult rabbits. Authors harvested cartilage from 48 adult NewZealand White rabbits ear, and divided into two groups; the first group was noncrused autogenous cartilage grafts as control group and the second group was crushed cartilage grafts as experimental group. We transplanted both groups of cartilage with unstripped intact perichondrium of dorsal side of ear. We examed the specimens of both groups after 1 month, 3months and 5 months. During the observation periods for 3 interval time, we took the cartilage from the back area and examed the gross appearance, the volume retention and finally confirmed the viability of chondrocyte with histologic study. The results were as follows: 1. In control & experimental groups, autogenous cartilage grafts were all survived. 2. For 5 months, all specimens of control group showed viable chondrocytes and maintenance of volume. 3. After 1 month, volume retention of each groups(0.4965ml vs 0.657ml) reveals statistically significant difference(p<0.05, paired t-test) when comparing the volume of crushed cartilage grafts with noncrushed cargilage grafts. 4. In histologic study, we observed that crushed cartilages(1month after transplantation) showed more fibrous tissue invasion with some inflammatory cell infiltration but smaller number of viable chondrocytes. Viable chondrocytes were found around perichondrial tissue postoperative 3 months and 5 months specimens, and crushed cartilage grafts showed no significant difference in volume retention and histologic findings compared with postoperative 1 month specimens. With above results, authors conclude that the crushed cartilage grafts were less viable and significant volume absorption occurred within 1 month. but thereafter maintained the volume with fibrous tissues.

외측 상박부 유리 근막 피판을 이용한 사지 연부 조직 결손부의 피복

김승홍,박정준,곽혁준,최병욱,민대홍 大韓成形外科學會 1996 Archives of Plastic Surgery Vol.23 No.4

Traumatic injury to the hand or foot often leads to extensive skin and soft tissue loss, exposing the blood vessels, nerves, tendons or bones. Therapeutic options for salvaging these soft tissue defects include local, regional or distant flaps and free flap transplantation. Over the last two decades, the use of free tissue transfer has gained increasing popularity in reconstruction of soft tissues defect. Reconstruction of soft tissue defects with exposure of bone, tendon or other vital structures on the hands and feet can be a challenging problem, especially open wounds on dorsum of the foot and hand. The main purposes of resurfacing of the soft tissue defects are early coverage and mobilization of the defects to cover the exposed vital structures and to prevent further deformity. In hand and foot dorsum resurfacing, the fascia is the most ideal donor flaps in terms of thin, pliable and well vascularized sheets of tissue. It leaves an inconspicuous donor site morbidity. In addition, microvascular transfer is facilitated the axial pattern flap with consist, reliable vascular pedicles. The flap is useful in covering exposed bone and tendon without unwanted bulk, in providing an ultrathin flap coverage in soft tissue defects, and it provides a good intrinsic blood supply to improve local conditions for healing and to decrease bacterial contamination of the wound. It can also establish a fine tendon-gliding mechanism. We have experienced 8 cases of resurfacing of full thickness skin and soft tissue loss in the hand and foot dorsum defects with lateral arm fascia free flap. We achieved successfully soft tissue coverage with minimal complications. The largest size of the flap had 13.5×9cm in dimesion. We could gain satisfactory results of soft tissue coverage with ultrathin arterialized pedicale flap and now we report our clinical experience of lateral arm fascia free flap.