Autologe Hautzelltransplantation und Medical Needling zur Repigmentierung von depigmentierten Verbrennungsnarben an UV-exponierter und -geschützter Haut

Zusammenfassung

Hintergrund: Verbrennungsnarben sind ein ernstzunehmendes physisches und psychisches Problem für die betroffenen Personen. Experimentelle Forschung sowie klinische Studien haben erwiesen, dass Medical Needling signifikant die Qualität von Verbrennungsnarben, in Hinsicht auf Hautelastizität und -feuchtigkeit, Rötung und transepidermalen Wasserverlust, verbessert. Dies mit vergleichsweise geringen Risiken und Stress für den Patienten. Trotz dessen zeigte Needling keinen Einfluss auf die Repigmentierung von großen hypopigmentierten Narben.

Ziel: Das Ziel dieser Studie war es, Medical Needling (Verbesserung der Narbenqualität) und die nicht-kultivierte autologe Hautzelltransplantation (NKAHZT) „ReNovaCell“ (Repigmentierung) in einer Kombination zu testen. Es wurden 20 Patienten, im Durchschnittsalter von 33 Jahren (6–60 Jahre), mit Verbrennungen 2. und 3. Grades behandelt. Die durchschnittlich behandelte Hautoberfläche betrug 94 cm² (15–250 cm²), meist im Gesicht, auf der Brust oder an den Armen.

Methoden: Medical Needling wird mit einer Rolle durchgeführt, welche mit zahlreichen 3 mm langen Nadeln bestückt ist. Diese wird vertikal, horizontal und diagonal über die behandelten Narben gerollt, wodurch unzählige kleine Stichkanäle verursacht werden. Danach wird die NKAHZT-Suspension auf die behandelten Areale appliziert. Die Patienten wurden bis zu 15 Monate postoperativ anhand von objektivierbaren Messmethoden untersucht. Die Narben der Patienten wurden in die Gruppen „UV-exponiert“ und „-geschützt“ unterteilt, um herauszufinden, ob die Repigmentierung eher durch die UV-bedingte Aktivierung noch in der Haut vorhandener Melanozyten, oder durch die neu transplantierten Melanozyten geschieht.

Ergebnisse: Die objektiven Messdaten zeigen eine Zunahme der Pigmentierung sowohl in den UV-exponierten, als auch in den -geschützten Hautarealen. Ein Jahr postoperativ ist die Steigerung des Melaninwertes in den sonnengeschützten Arealen statistisch signifikant.

Schlussfolgerung: Die Kombination von Medical Needling und NKAHZT ist ein vielversprechender Therapieansatz, um depigmentierte Verbrennungsnarben sogar an sonnengeschützten Arealen zu repigmentieren.

Abstract

Background: Burn scars remain a serious physical and psychological problem for the affected people. Both clinical studies and basic scientific research have shown that medical needling can significantly increase the quality of burn scars with comparatively low risk and stress for the patient related to skin elasticity, moisture, erythema and transepidermal water loss. However, medical needling does not influence repigmentation of large hypopigmented scars.

Objective: The goal is to evaluate whether both established methods – needling (improvement of scar quality) and non-cultured autologous skin cell suspension (NCASCS) “ReNovaCell” (repigmentation) – can be combined. So far, 20 patients with mean age of 33 years (6–60 years) with deep second and third degree burn scars have been treated. The average treated tissue surface was 94 cm² (15–250 cm²) and was focused on areas like face, neck, chest and arm.

Methods: Medical needling is performed using a roller covered with 3 mm long needles. The roller is vertically, horizontally and diagonally rolled over the scar, inducing microtrauma. Then, NCASCS is applied, according to the known protocol. The patients have been followed up for 15 months postoperatively. The scars were subdivided into “UV-exposed” and “UV-protected” to discover whether the improved repigmentation is due to transfer of melanocytes or to reactivation of existing melanocytes after exposure to UV or the sun.

Results: The objective measures show improved pigmentation in both UV-exposed and UV-protected groups. Melanin increases 1 year after NCASCS treatment in the UV-protected group are statistically significant.

Conclusion: Medical needling in combination with NCASCS shows promise for repigmentation of burn scars, even in sun protected scars.

Schlüsselwörter

Medical Needling - nicht-kultivierte autologe Hautzelltransplantation - Repigmentierung - Hypopigmentierung - Brandnarben

Key words

medical needling - non-cultured autologous skin cell transplantation - repigmentation - hypopigmentation - burn scars

^* geteilte Erstautorenschaft: Dr. Kay-Hendrik Busch, Richard Bender

• Literatur

• 1 Chadwick S, Heath R, Shah M. Abnormal pigmentation within cutaneous scars: A complication of wound healing. Indian J Plast Surg 2012; 45: 403-411
• 2 Imokawa G. Autocrine and paracrine regulation of melanocytes in human skin and in pigmentary disorders. Pigment Cell Res. 2004; 17: 96-110
• 3 Imokawa G, Yada Y, Morisaki N et al. Biological characterization of human fibroblast-derived mitogenic factors for human melanocytes. Biochem J 1998; 330 (Pt 3): 1235-1239
• 4 Açikel C, Ulkür E, Güler MM. Treatment of burn scar depigmentation by carbon dioxide laser-assisted dermabrasion and thin skin grafting. Plast Reconstr Surg. 2000; 105: 1973-1978
• 5 Davoodi P, Fernandez JM O SJ Postburn sequelae in the pediatric patient: clinical presentations and treatment options. J Craniofac Surg 2008; 19: 1047-1052
• 6 Rumsey N, Clarke A, White P. Exploring the psychosocial concerns of outpatients with disfiguring conditions. J Wound Care 2003; 12: 247-252
• 7 Pallua N, Künsebeck HW, Noah EM. Psychosocial adjustments 5 years after burn injury. Burns 2003; 29: 143-152
• 8 Henderson MD, Huggins RH, Mulekar SV et al. Autologous noncultured melanocyte-keratinocyte transplantation procedure in an African American man with postburn leukoderma. Arch Dermatol 2011; 147: 1025-1028
• 9 Mulekar SV, Issa AA, Eisa AA. Treatment of post-burn leucoderma with non-cultured melanocyte-keratinocyte transplantation (MKTP). Burns 2011; 37: 448-452
• 10 Back C, Dearman B, Li A et al. Noncultured keratinocyte/melanocyte cosuspension: effect on reepithelialization and repigmentation – a randomized, placebo-controlled study. J Burn Care Res 2009; 30: 408-416
• 11 Cervelli V, de Angelis B, Balzani A et al. Treatment of stable vitiligo by ReCell system. Acta Dermatovenerol Croat 2009; 17: 273-278
• 12 Mulekar SV. Long-term follow-up study of 142 patients with vitiligo vulgaris treated by autologous, non-cultured melanocyte-keratinocyte cell transplantation. Int J Dermatol 2005; 44: 841-845
• 13 Rawlins JM, Lam WL, Karoo RO et al. Quantifying collagen type in mature burn scars: a novel approach using histology and digital image analysis. J Burn Care Res 2006; 27: 60-65
• 14 Roy D. Ablative facial resurfacing. Dermatol Clin 2005; 23: 549-559 viii
• 15 Thomas JR, Somenek M. Scar revision review. Arch Facial Plast Surg 2012; 14: 162-174
• 16 Aust MC, Fernandes Des, Kolokythas P et al. Percutaneous collagen induction therapy: an alternative treatment for scars, wrinkles, and skin laxity. Plast Reconstr Surg 2008; 121: 1421-1429
• 17 Aust MC, Knobloch K, Reimers K et al. Percutaneous collagen induction therapy: an alternative treatment for burn scars. Burns 2010; 36: 836-843
• 18 Aust MC, Reimers K, Kaplan HM et al. Percutaneous collagen induction-regeneration in place of cicatrisation?. J Plast Reconstr Aesthet Surg 2011; 64: 97-107
• 19 Aust MC, Reimers K, Repenning C et al. Percutaneous collagen induction: minimally invasive skin rejuvenation without risk of hyperpigmentation-fact or fiction?. Plast Reconstr Surg 2008; 122: 1553-1563
• 20 Busch KH, Bender R, Walezko N et al. Combination of medical needling and non-cultured autologous skin cell transplantation (ReNovaCell) for repigmentation of hypopigmented burn scars. Burns 2016
• 21 Mulekar SV, Isedeh P. Surgical interventions for vitiligo: an evidence-based review. Br J Dermatol 2013; 169 (Suppl. 03) 57-66
• 22 Bisen N, Bhat RM, Lahiri K et al. Target-like Pigmentation After Minipunch Grafting in Stable Vitiligo. Indian J Dermatol 2014; 59: 355-356
• 23 Camirand A, Doucet J. Needle dermabrasion. Aesthetic Plast Surg 1997; 21: 48-51
• 24 Fernandes D. Percutaneous collagen induction: an alternative to laser resurfacing. Aesthet Surg J 2002; 22: 307-309
• 25 Orentreich DS, Orentreich N. Subcutaneous incisionless (subcision) surgery for the correction of depressed scars and wrinkles. Dermatol Surg 1995; 21: 543-549
• 26 Aust MC, Reimers K, Gohritz A et al. Percutaneous collagen induction. Scarless skin rejuvenation: fact or fiction? Clin Exp Dermatol 2010; 35: 437-439
• 27 Fernandes D. Minimally invasive percutaneous collagen induction. Oral Maxillofac Surg Clin North Am 2005; 17: 51-63 vi
• 28 Ferguson MWJ, O’Kane S. Scar-free healing: from embryonic mechanisms to adult therapeutic intervention. Philos. Trans R Soc Lond, B Biol Sci 2004; 359: 839-850
• 29 Bandyopadhyay B, Fan J, Guan S et al. A „traffic control“ role for TGFbeta3: orchestrating dermal and epidermal cell motility during wound healing. J Cell Biol 2006; 172: 1093-1105
• 30 Mulekar SV, Ghwish B, Al Issa A et al. Treatment of vitiligo lesions by ReCell vs. conventional melanocyte-keratinocyte transplantation: a pilot study. Br J Dermatol 2008; 158: 45-49
• 31 Gravante G, Di Fede MC, Araco A et al. A randomized trial comparing ReCell system of epidermal cells delivery versus classic skin grafts for the treatment of deep partial thickness burns. Burns 2007; 33: 966-972
• 32 Wood FM, Giles N, Stevenson A et al. Characterisation of the cell suspension harvested from the dermal epidermal junction using a ReCell^® kit. Burns 2012; 38: 44-51
• 33 Stavrou D, Haik J, Weissman O et al. Patient and observer scar assessment scale: how good is it?. J Wound Care 2009; 18: 171-176
• 34 Vercelli S, Ferriero G, Sartorio F et al. How to assess postsurgical scars: a review of outcome measures. Disabil Rehabil 2009; 31: 2055-2063
• 35 Tyack Z, Wasiak J, Spinks A et al. A guide to choosing a burn scar rating scale for clinical or research use. Burns 2013; 39: 1341-1350
• 36 Travis TE, Ghassemi P, Ramella-Roman JC et al. A Multimodal Assessment of Melanin and Melanocyte Activity in Abnormally Pigmented Hypertrophic Scar. J Burn Care Res. 2014
• 37 Baxter LL, Pavan WJ. The etiology and molecular genetics of human pigmentation disorders. Wiley Interdiscip Rev Dev Biol 2013; 2: 379-392