显微外科与血管化组织工程组织的构建

血运重建是组织再生的基础，要获得组织工程化组织必须保证植入体内的种子细胞尤其是材料内部的种子细胞能够获得及时充分的营养。因此血供的重建就成为组织工程由基础向临床应用的关键性环节。血液供应的重建方法主要有：利用血管内皮细胞生长因子促进血管生长，采用血管内皮细胞与成骨细胞联合移植的方法，或应用显微外科技术。利用显微外科技术，可通过带蒂筋膜瓣包裹、带血供肌瓣包裹或血管束植入的方法，在构建组织工程化组织的同时建立其血液供应。组织工程化组织在临床应用时，如果修复邻近的缺损，只需在原位进行血管化；但在缺损局部软组织条件差、常常无法找到可供利用的筋膜瓣、肌瓣或血管束的情况下，可异位构建血管化的组织工程组织，二期采用显微外科方法通过带血管的组织移植修复缺损。

Application of microsurgery in fabrication of vascularized engineered tissue

Vascularization is the basis of tissue regeneration. To get engineered tissue, it is necessary that timely and enough nutrition be available to the seed cells, especially those within the biomaterials. Therefore reconstruction of blood supply is the key step leading from basic research to clinical application. Thee major methods have been used to reconstruct blood supply: promotion of vessel growth by means of VEGF, combined grafting of vascular endothelial cells and osteoblasts and microsurgical techniques. The microsurgical techniques, such as wrapping around with pedicled fascia flap, wrapping around with vascularized muscle flap and blood vessel implanting, can help reconstruct blood supply when engineered tissue is fabricated. When engineered tissue is used in clinic to repair defects in vicinity, vascularization can be done in the defect area. But when no fascia flap, muscle flap or vessel can be used in the defect area, the local defects can be repaired through reconstruction of vascularized engineered tissue in other areas and through second stage transplantation with microsurgical techniques.