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Żywe substytuty skóry – zastosowanie w leczeniu trudno gojących się ran

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Żywe substytuty skóry to tworzone metodami inżynierii tkankowej produkty łączące polimery z żywymi komórkami. Wykorzystuje się je m.in. w leczeniu ran oparzeniowych, rozległych odleżyn oraz trudno gojących się ran goleni. W jaki sposób pozyskuje się ŻSS i jakie powinny mieć cechy, by leczenie z ich wykorzystaniem było efektywne?

Budowa żywego substytutu skóry

Żywy substytut skóry to połączenie polimeru z żywymi komórkami, z którego powstaje funkcjonalny ekwiwalent tkanki. Do trójwymiarowej macierzy kolagenowej z glikozaminoglikanami wysiewane są skórne fibroblasty, w wyniku czego powstaje substytut skóry właściwej. Następnie na górnej powierzchni struktury uwarstwiane są autogenne hodowane keratynocyty, co pozwala uzyskać ekwiwalent naskórka.

Żywe substytuty skóry są produkowane in vitro, a następnie w gotowej postaci przenoszone na łożysko rany.

Cechy żywego substytutu skóry

Skóra wyhodowana z wykorzystaniem inżynierii tkankowej powinna posiadać określone cechy, aby mogła uzyskać wysoką efektywność terapeutyczną. Są to cechy takie jak: dostosowana do rodzaju rany objętość wody w składzie i utrzymywanie wilgotności (przy kontrolowanym parowaniu), nieprzepuszczalność dla drobnoustrojów, sterylność, przyczepność do łożyska rany, kontrolowana biodegradacja, nietoksyczność, brak działania prozapalnego, stymulacja angiogenezy, wytrzymałość mechaniczna i elastyczność. Ponadto sztuczna skóra nie powinna powodować przykurczania i bliznowacenia tkanek ani stwarzać dolegliwości bólowych.

Wady żywych substytutów skóry

Dzięki zastosowaniu żywych substytutów skóry możliwe jest przyspieszenie gojenia rany lub uzyskanie pełnego wygojenia. Dostępne na rynku żywe substytuty skóry wciąż nie posiadają jednak istotnych właściwości skóry, takich jak odczuwanie bodźców, termoregulacja, wydzielanie potu i łoju, ochrona przed promieniowaniem ultrafioletowym. ŻSS nie zawierają melanocytów oraz komórek Langerhansa, które są kluczowe dla prawidłowego funkcjonowania systemu immunologicznego skóry.

Zastosowania kliniczne żywych substytutów skóry

Materiały zastępcze skóry znajdują zastosowanie w leczeniu rozległych uszkodzeń skóry, w przypadku których możliwości pobrania autologicznego przeszczepu są ograniczone.

W literaturze naukowej wskazuje się na możliwość zastosowania żywych substytutów skóry w leczeniu oparzeń (zarówno niepełnej, jak i pełnej grubości), owrzodzeń cukrzycowych oraz owrzodzeń na podłożu niewydolności żylnej. Co istotne, w wielu przypadkach ŻSS stosowane są nie jako zamiennik, ale uzupełnienie autologicznego przeszczepu. Badania wskazują, że umożliwia to osiągnięcie lepszych efektów terapeutycznych (szybsze gojenie, mniejsza skłonność do bliznowacenia tkanek, większa elastyczność skóry).

Niektóre z materiałów zastępczych skóry dostępnych na rynku są również stosowane jako biologicznie aktywne opatrunki, a nie trwałe przeszczepy. Dzięki wykorzystaniu tych preparatów możliwe jest uzyskanie szybszego gojenia i zmniejszenie dolegliwości bólowych. Ograniczona zostaje również konieczność wykonania wtórnego przeszczepu.

Źródła:

J. Gosk, „Materiały zastępcze skóry – teraźniejszość i przyszłość”, „Polymers in Medicine” 2012, 42, 2, 109-114.

K. Cieślik, W. Witkowski i in., „Biotechnologiczne opatrunki i żywe substytuty skóry – przegląd i współczesne możliwości zastosowania”, „Leczenie Ran” 2005, 2(3): 71-83.

Przeczytaj także: Zdalna diagnostyka owrzodzeń żylnych – jak ją przeprowadzić?

Przeczytaj bezpłatnie pokrewny artykuł w czasopiśmie „Chirurgia Plastyczna i Oparzenia”:

Zastosowanie autologicznych mikroprzeszczepów tkankowych w leczeniu trudno gojących się ran. Opis przypadków

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