Retalho ósseo neo-fabricado de gálea e periósteo preenchido com células-tronco mesenquimais, plasma rico em plaquetas, pó de osso e ácido hialurônico: estudo em coelho
Arquivos
Data
2017-01-31
Autores
Brock, Ryane Schmidt [UNESP]
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ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
As deformidades craniofaciais decorrentes de traumas, ressecções de tumores ou malformações congênitas são freqüentes na prática médica e o tratamento destas necessitam de cirurgia reparadora, com técnicas especializadas e profissionais qualificados para corrigir os defeitos e proporcionar melhor qualidade de vida, aprimorar a fala, respiração, mastigação e deglutição. Há diversas técnicas descritas para corrigir os defeitos ósseos, cada uma com vantagens e desvantages, escolhidas de acordo com o tipo de deformidade. Este estudo avaliou a formação óssea em um retalho tubular vascularizado, gáleo-periostal, enriquecido com o uso de pó de osso, plasma rico em plaquetas, células-tronco mesenquimais e ácido hialurônico, em coelhos, que tenha capacidade de substituir o enxerto ósseo nas reconstruções, principalmente nos defeitos faciais. No estudo, utilizou-se 98 coelhos divididos em doze grupos, submetidos à cirurgia para confecção do retalho em calota craniana. Foram realizados retalhos tubulares com o periósteo voltado para dentro e preenchidos com pó de osso, plasma rico em plaquetas (PRP), células-tronco mesenquimais (CTM) e ácido hialurônico. O Grupo 1 não foi manipulado. No Grupo 2 foi realizado o retalho tubular e mantido vazio. O Grupo 3 teve o retalho preenchido com pó de osso, no Grupo 4 o retalho foi mantido vazio. O Grupo 5 teve o retalho preenchido com PRP. No Grupo 6 o retalho foi preenchido com PRP e pó de osso. O Grupo 7 foi preenchido com CTM. O Grupo 8 teve o retalho preenchido com CTM e pó de osso. O Grupo 9 teve o retalho preenchido com CTM e PRP. No Grupo 10, o retalho tubular foi preenchido com PRP, CTM e pó de osso. O Grupo 11 foi mantido vazio e o Grupo 12 foi preenchido com ácido hialurônico. Os resultados foram avaliados através de métodos de imagem e avaliação histológica. Os resultados demonstraram que, no modelo experimental utilizado, os grupos com apenas periósteo, isto é, retalho tubular vazio, apresentaram formação óssea pequena e irregular. No grupo com PRP também houve a formação óssea irregular e imatura. Quando o PRP foi associado ao pó de osso houve uma formação mais regular e organizada. O grupo com célula-tronco mesenquimal também apresentou formação óssea, com características teciduais organizadas, próprias do tecido ósseo maduro. Quando associada ao pó de osso e ao PRP, as características histológicas apresentaram-se com tecido organizado, regular, maduro com células bem formadas e organizadas. O uso de materiais com fatores de crescimento celular ósseo melhoram a qualidade e organização do tecido neoformado. Quanto maior o número de fatores de enriquecimento usados, melhores foram os resultados quanto a qualidade tecidual neoformada.
Craniofacial deformities caused by traumas, tumor ressections or congenital malformation are frequent in medical practice, and their treatment with reconstructive surgeries are common, especially in plastic surgery, which aim to provide the patients with better quality of life and functional improvement of speach, breathing, chewing and swallowing. Many different techniques are described to correct bone defects. They have advantages and disadvantages, chosen according to the type of deformity. This study evaluated a vascularized galeal and periosteum flap filled with bone fragments, platelet rich plasma, mesenchymal stem cells and hyaluronic acid, using rabbits, which could possibily substitute the bone graft in reconstructive surgery, especially for facial defects. It was an experimental study, with 98 rabbits divided into twelve groups, submitted to a surgical procedure to construct a calvaria flap. A tubular flap with the periosteum inside was constructed and filled with bone fragments, platelet rich plasma (PRP), mesenchymal stem cells (MSC) and hyaluronic acid. Group 1 was not manipulated. In Group 2, the tubular flap was maintained empty. Group 3 had the flap filled with bone fragments, in Grupo 4 the flap was maintained empty. Group 5 had the flap filled with PRP. In Group 6 the flap was filled with PRP and bone fragments. The Group 7 was filled with MSC. Group 8 had the flap filled with MSC and bone fragments. The Group 9 had the flap filled with MSC and PRP. In Group 10, the tubular flap was filled with PRP, MSC and bone fragments.The Group 11 was maintained empty and Group 12 was filled with hyaluronic acid. The results were evaluated using image methods and histological analysis. The results demonstrated that, in the experimental model used, the groups with only periosteum, this is the empty tubular flap, presented small and irregular bone formation. In the group with PRP, it also had irregular and imature bone formation. When the PRP was associated to bone fragments it had a more regular and organized formation. The group with mesenchymal stem cell also presented bone formation, with organized tissue characteristics, proper of mature osseous tissue. When associated to bone fragments and PRP, the histological characteristics presented organized, regular, mature tissue with organized and well formed cells. The use of materials with osseous cellular growth factors improves the quality and organization of the neoformed tissue. The more enrichment factor used, the better the neoformed tissue quality result was.
Craniofacial deformities caused by traumas, tumor ressections or congenital malformation are frequent in medical practice, and their treatment with reconstructive surgeries are common, especially in plastic surgery, which aim to provide the patients with better quality of life and functional improvement of speach, breathing, chewing and swallowing. Many different techniques are described to correct bone defects. They have advantages and disadvantages, chosen according to the type of deformity. This study evaluated a vascularized galeal and periosteum flap filled with bone fragments, platelet rich plasma, mesenchymal stem cells and hyaluronic acid, using rabbits, which could possibily substitute the bone graft in reconstructive surgery, especially for facial defects. It was an experimental study, with 98 rabbits divided into twelve groups, submitted to a surgical procedure to construct a calvaria flap. A tubular flap with the periosteum inside was constructed and filled with bone fragments, platelet rich plasma (PRP), mesenchymal stem cells (MSC) and hyaluronic acid. Group 1 was not manipulated. In Group 2, the tubular flap was maintained empty. Group 3 had the flap filled with bone fragments, in Grupo 4 the flap was maintained empty. Group 5 had the flap filled with PRP. In Group 6 the flap was filled with PRP and bone fragments. The Group 7 was filled with MSC. Group 8 had the flap filled with MSC and bone fragments. The Group 9 had the flap filled with MSC and PRP. In Group 10, the tubular flap was filled with PRP, MSC and bone fragments.The Group 11 was maintained empty and Group 12 was filled with hyaluronic acid. The results were evaluated using image methods and histological analysis. The results demonstrated that, in the experimental model used, the groups with only periosteum, this is the empty tubular flap, presented small and irregular bone formation. In the group with PRP, it also had irregular and imature bone formation. When the PRP was associated to bone fragments it had a more regular and organized formation. The group with mesenchymal stem cell also presented bone formation, with organized tissue characteristics, proper of mature osseous tissue. When associated to bone fragments and PRP, the histological characteristics presented organized, regular, mature tissue with organized and well formed cells. The use of materials with osseous cellular growth factors improves the quality and organization of the neoformed tissue. The more enrichment factor used, the better the neoformed tissue quality result was.
Descrição
Palavras-chave
Osso, Malformação crânio-facial, Calvária, Retalho, Reconstrução, Face, Enxerto ósseo, Enxerto de gordura, Plasma rico em plaquetas, Célula-tronco mesenquimal, Ácido hialurônico, Coelho, Embriogênese óssea, Bone, Calvaria, Craniofacial malformation, Flap, Reconstruction, Graft, Mesenchymal stem cell, Platelet rich plasma, Hyaluronic acid, Rabbit, Osseous embryogenesis