Fötal Yara İyileşmesi

Year 2008, Volume: 61 Issue: 3, 171 - 179, 01.03.2008

Hakan Gence

https://doi.org/10.1501/Tipfak_0000000667

Abstract

Keywords

-

Fötal Yara İyileşmesi

Abstract

Yara iyileşmesinin temel süreçlerinden biri olan skar oluşumu, fonksiyonel, kozmetik ve gelişimsel açıdan, özellikle çocuklarda olumsuz etkileri olan önemli bir tıbbi problemdir. Hayvan modellerinde, fötal deride yara iyileşmesinin makroskopik olarak minimal veya tamamen skarsız meydana geldiğinin tespit edilmesi, cerrahları fötal yara iyileşmesinin biyolojisine ve erişkinlerdeki yara iyileşmesinin manipülasyonuna yönlendirmiştir. Erişkinde eksizyonel yara iyileşmesi, akut inflamasyon, fibroblast proliferasyonu, anjiogenezis, kollajen ve matriks sentezi, kontraksiyon ve fibrozisden oluşmaktadır. Sonuçta olgun skar dokusu içeren kapanmış bir yara elde edilir. Fötusta ise eksizyonel yara iyileşmesi, inflamasyon, granülasyon dokusu, yara kontraksiyonu ve kollajen depolanması olmadan gerçekleşmektedir. Erişkin ve fötal doku yara iyileşmesi arasındaki bu farklılıklar, fötusun yara iyileşmesinde gösterdiği özelliklerin erişkine uyarlanması açısından önemlidir. Fötal yara iyileşmesi biyolojisinin daha açık ve net bir şekilde ortaya konması, ileride yetişkinlerde cerrahi müdahale veya travmaya bağlı skar formasyonunu önlemekte büyük bir imkan yaratacaktır.

Keywords

Fötal yara iyileşmesi, skarsız iyileşme, fötal cerrahi

References

• Ferguson MWJ, Whitby DJ, Shah M, et al: Scar formation: The spectral nature of fe- tal and adult wound repair, Plast Recon- str Surg 1996; 97: 854-860.
• Lorenz HP, Longaker MT, Perkacha LA, et al: Scarless wound repair: a human fetal skin model. Development 1992; 114: 253-259.
• Adzick NS, Harrison MR: Fetal surgical therapy, Lancet 1994; 343: 897-902.
• Mast BA: The skin. In Cohen IK, Diegel- mann RF, Lindblad WL, editors: Wound healing: biochemical and clinical aspects, Philadelphia: WB Saunders; 1993.
• Mast BA, Cohen IK: Pediatric and fetal wound healing. In Benz M, editor: Pedi- atric plastic surgery, New York: Appleton- Lange; 1998.
• Andersen L, Attstrom R, Feferskov O: Ef- fect of experimental neutropenia on oral wound healing in guinea pigs, Scand J Dent Res 1978; 86: 237-247.
• Simpson DM, Ross R: The neutrophilic leukocyte in wound repair: a study with antineutrophilic serum, J Clin Invest 1972; 51: 2009-2023.
• Mast BA, Schultz GS: Interaction of cy- tokines, proteases and growth factors in acute and chronic wounds, Wound Rep Reg 1996; 4: 411-420.
• Diegelmann RF, Rothkipf LC, Cohen IK: Measurement of collagen biosynthesis during wound healing, J Surg Res 1975; 19: 239-243.
• Sandberg N, Zederfeldt B: The tensile strenght of healing wounds and collagen formation in rats and rabbits, Acta Chir Scand 1964; 127: 445-446.
• Levenson SM, Geever EF, Crowley LV, et al: The healing of rat skin wounds, Ann Surg 1965; 161: 293-308.
• Gabbiani G, Hirschel BJ, Ryan B, et al: Granulation tissue as a contractile organ, J Exp Med 1972; 135: 719-734.
• Longaker MT, Adzick NS: The biology of fetal wound healing: a review, Plast Re- constr Surg 1991; 87: 788-798.
• Adzick NS, Longaker MT: Animal models for the study of fetal tissue repair, J Surg Res 1991; 51: 216-222.
• Longaker MT, Adzick NS, Hall JL, et al: Studies in fetal wound healing. VII. Fetal wound healing may be modulated by ele- vated hyaluronic acid stimulating activity in amniotic fluid, J Pediatr Surg 1990; 25: 430-433.
• Adzick NS, Lorenz HP: Cells, matrix, growth factors, and the surgeon: the bi- ology of scarless fetal wound repair, Ann Surg 1994; 220: 10-18.
• Estes JM, Spencer EM, Longaker MT, et al: Insulin-like growth factor-II in ovine wound fluid: evidence for developmental regulation, Surg Forum 1991; 42: 659- 661.
• Longaker MT, Chiu ES, Harrison MR, et al: Studies in fetal wound healing. IV. Hyaluronic acid stimulating activity dis- tinguishes fetal from adult wound fluid, Ann Surg 1989; 210: 667-672.
• Armstrong JR, Ferguson MWJ: Ontogeny of the skin and transition from scar-free to scarring phenotype during wound healing in the pouch young of a marsu- pial, Monodelphis domestice, Dev Biol 1995; 169: 242-260.
• Longaker MT, Whitby DJ, Adzick NS, et al: Adult skin wounds in the fetal environ- ment heal with scar formation, Ann Surg 1994; 219: 65-72.
• Ihara I, Motobayashi Y: Wound closure in fetal rat skin, Development 1991; 114: 573-582.
• Lorenz HP, Whitby DJ, Longaker MT, et al: Fetal wound healing: the ontogeny of scar formation in the non-human pri- mate, Ann Surg 1993; 217: 391-396.
• Longaker MT, Golbus MS, Filly RA, et al: Maternal outcome after open fetal sur- gery: a review of the first 17 human cases, JAMA 1991; 265: 737-741.
• Meuli M, Lorenz HP, Hedrick MM, et al: Scar formation in the fetal alimentary tract, J Pediatr Surg 1995; 30: 392-395.
• Longaker MT, Moelleken BRW, Cheng 34. Houghton PE, Keefer KA, Krummel TM: JC, et al: Fetal fracture healing in a lamb model, Plast Reconstr Surg 1992; 90: 161- 171.
• Estes JM, Vandeberg JS, Adzick NS, et al: Phenotypic and functional features of myofibroblast in sheep fetal wounds, Dif- ferantiation 1994; 56: 173-181.
• Longaker MT, Whitby DJ, Adzick NS, et al: Studies in fetal wound healing.VI. Second and early third trimester fetal wounds demonstrate rapid collagen deposition without scar formation, J Pediatr Surg 1990; 25: 63-69.
• Merkel JR, DiPaolo BR, Hallock GG, et al: Type I and Type III collagen content of healing wounds in fetal and adult rats, Proc Soc Exp Biol Med 1988; 187: 493- 497.
• DePalma RL, Krummel TM, Durham LA, et al: Characterization and quantitation of wound matrix in the fetal rabbit Matrix 1989; 9: 224-231.
• Olutoye OO, Cohen IK: Fetal wound heal- ing: an overview, Wound Rep Reg 1996; 4: 66-74.
• DeLozier J, Nanney LB, Hago K, et al: Epidermal growth factor enhances fetal reepitelization, Surg Forum 1987; 38: 623-626.
• Shah M, Foreman DM, Ferguson MWJ: Neutralization of TGF-beta 1 and TGF- beta 2 or exogeneous addition of TGF- beta 3 to cutaneous rat wounds reduces scarring, J Cell Sci 1995; 108: 985-1002.
• Longaker MT, Bouhana KS, Harrison MR, et al: Wound healing in the fetus: possi- ble role for macrophages and TGF-beta isoforms, Wound Rep Reg 1994; 2: 104- 112. Scar formation in wounded fetal mouse limbs is reduced by platelet derived growth factor neutralizing antibody, Wound Rep Reg 1994; 2: 80.