Yara Tedavsinde Otolog Yağ Doku Grefti (AMHAT)
Özet
Kronik yaralar; dolaşım bozukluğu, nöropati ve enfeksiyon zemininde gelişerek yüksek mortalite ve ampütasyon riskine yol açmaktadır. Geleneksel tedavilerin ve mevcut doku eşdeğerlerinin zayıf vaskülarizasyon ve fibröz kapsül oluşumu gibi sınırlılıkları nedeniyle, neovaskülarizasyonu destekleyen etkili otolog hücre tedavilerine ihtiyaç duyulmaktadır. Kolay erişilebilir bir kaynak olan adipoz (yağ) dokusu, içerdiği stromal vasküler fraksiyon (SVF) ve adipoz kaynaklı kök hücreler (ADSC) sayesinde anjiyojenik, immünomodülatör ve epitelizasyonu uyarıcı güçlü parakrin etkilere sahiptir. Kronik yaraların büyük bir kısmı inflamasyon fazında durakladığından, ADSC uygulaması aşırı inflamasyonu engelleyerek yaranın proliferasyon ve yeniden şekillenme (remodeling) fazlarına geçmesini sağlar. Bu doğrultuda geliştirilen AMHAT (otolog minimal manipüle edilmiş homolog yağ dokusu) yöntemi, liposuction ile elde edilen yağ dokusunun nano filtrelerden ve sedimentasyondan geçirilmesini içerir. Elde edilen nanoyağ, fibrin ile karıştırılarak Dr Invivo™ adlı 3 boyutlu biyoyazıcı yardımıyla yaranın boyutuna, şekline ve derinliğine uygun olarak basılmakta ve üzerine trombin uygulanarak yara yerine yapıştırılmaktadır. 7-10 gün içerisinde tamamen absorbe olan bu otolog greft, yapısındaki multipotent hücreler vasıtasıyla anjiyogenezi ve epitelizasyonu uyararak kronik yara iyileşmesini hızlandıran yenilikçi bir yöntem olarak literatürde yer almaktadır.
Chronic wounds develop on the basis of circulatory disorders, neuropathy, and infection, leading to high mortality and amputation risks. Due to the limitations of conventional treatments and current tissue equivalents, such as poor vascularization and fibrous capsule formation, there is a need for effective autologous cell therapies that support neovascularization. Adipose (fat) tissue, which is an easily accessible source, possesses potent angiogenic, immunomodulatory, and epithelialization-stimulating paracrine effects thanks to the stromal vascular fraction (SVF) and adipose-derived stem cells (ADSCs) it contains. Since the majority of chronic wounds are stalled in the inflammation phase, the application of ADSCs prevents excessive inflammation, allowing the wound to progress into the proliferation and remodeling phases. The AMHAT (autologous minimally manipulated homologous adipose tissue) method, developed in this direction, involves passing fat tissue obtained via liposuction through nanofilters and utilizing the sedimentation method. The resulting nanofat is mixed with fibrin and printed using a 3D bioprinter called Dr Invivo™ in accordance with the size, shape, and depth of the wound, and is adhered to the wound site by applying thrombin on top. This autologous graft, which is completely absorbed within 7-10 days, stimulates angiogenesis and epithelialization through the multipotent cells within it, taking its place in the literature as an innovative method that accelerates chronic wound healing.
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