Dinar Rahmania, NIM011082402 (2016) Peran Sel Punca Mesenkimal Jaringan Lemak dalam Mengembalikan Struktur pada Luka Donor Full-Thickness (Preliminary Study ). Thesis thesis, UNIVERSITAS AIRLANGGA.

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Abstract

Introduction Full-thickness skin graft is an option if we want a better aesthetic result. However, full-thickness donor scars often cause problems at the time of closure and wound healing. Being in the inguinal area which is an area of motion, the tension while closing the wound may cause necrotic or dehiscence wound edges. The final result of the full-thickness wound is a scar, and even become a hypertrophic scar. 70% of followed up patients who had a full-thickness donor in the region of the inguinal show Hypertrophic scar in the donor area at outpatient installation Dr. Soetomo Hospital. Stem cells are the innovations developed in solving the wound problems, because they can migrate to the wound site, becoming part of the micro-environment, increase growth factors, reduce inflammation, accelerate wound healing and inhibit hypertrophic scar. Mesenchymal stem cells accelerate wound closure and epithelialization process, improve the quality of the tissue tension, help chronic wound healing and minimize scarring. Therefore, the mesenchymal stem cells are expected to become the fundamental of the development method of returning donor skin structure on the full-thickness wounds. Methods This preliminary study, using patients underwent surgical removal of Full Thickness Graft donor in groin in Dr.Soetomo Hospital, Surabaya. The sample was random-matching prior grouped in clusters without the provision of mesenchymal stem cells or groups Non-Mesechymal Stem Cells (Non-MSCs) and a group given mesenchymal stem cells or groups Mesechymal Stem Cells (MSCs). The sample size for each group is 5. MSCs group had previously undergone surgical removal of abdominal fat blocks of 2x2 cm size which will be processed into mesenchymal stem cells in the laboratory Dr.Soetomo Hospital Tissue Bank for 14 days. MSCs group had previously undergone surgical removal of abdominal fat blocks of 2x2 cm size which will be processed into mesenchymal stem cells in the laboratory Dr.Soetomo Hospital Tissue Bank for 14 days. Biopsy results Non-MSCs group and MSCs will be compared to teaching preparations normal skin biopsy or Normal Skin (NS) of the Anatomical Pathology Laboratory of the University of Airlangga. The assessment and comparison of the epithelial layers of the epidermis then performed with Hematoxylin eosin staining, and collagen density with Mason Trichrome staining dermis and then analyzed using a light microscope type CX 21. Data were analyzed using ANOVA. Variables that balanced will be judged statistics. (P <0.05) will appear if the variable balanced. Hypothesis 1.The mesenchymal stem cells can restore the number of epithelial layers of theepidermis in the wound healing process of full-thickness donor compared to thewound healing process of normal full-thickness donor. 2.The mesenchymal stem cells can restore the collagen density of the dermis in thewound healing process of full-thickness donor compared to the wound healingprocess of normal full-thickness donor. Result Grossly, on day 14 in the Non-MSCs group, surgical wound surface is irregular, dehisence in some places, and hyperemia can be seen at the edge of stitches hyperemia. Whereas in the group MSCs, the wound surface slightly raised, no dehisence obtained, and the color of the skin is the same color with surroundings. On day 45 macroscopically in Non-MSCs group, it can seen scarring along the stitches in the groin, with scar width of 3-4mm, darker than the surrounding skin and more elevated. While In the group of Non-MSCs, the color is paler, and the surface is at the same level with surroundings. The mean number of epithelial layers in Non MSCs group on day 14 was 8.50 ± 1.19 and the MSCs group was 10.28 ± 1.36, the value of both groups increased by 1.8x compared to the average value of the number of layers of epithelial Normal Skin ( 5.6). The mean number of epithelial layers in the group of Non MSCs last day 45th was 8.24 ± 0.76, an increase of 1.5 times the number of layers of the epithelium in the group of Normal skin (5,6). While in the MSCs group the mean number of epithelial layers at day 45 was 10.9 ± 1.16, twice increase compared to the number of layers of the epithelium in the group of Normal Skin (5.6). Percentage of collagen density in Non MSCs group on day 14 was 33.24 ± 2.99, lower than the percentage of collagen density in Normal Skin (53.7%), then on day 45 the percentage increased to 73.4 ± 1.63, or 1.3 times the density of collagen in Normal Skin Skin (53.7%). Meanwhile, the percentage of collagen density MSCs group on day 14 was 45.7 ± 5.84 and on day 45 the percentage has not increased significantly, namely 49.24 ± 3.28, and the value is closer to the density of collagen in Normal Skin (53,7%). Conclusion 7.Mesenchymal stem cells did not affect the structure of epithelial in wound healingprocess of full-thickness donor during the observation period H-14 (proliferation phase)to the H-45 (early phase of maturation). 8.The mesenchymal stem cells are capable of influencing the density of collagen in thewound healing process full-thickness donor to 91.6% near normal dermis structurecompared to wound healing without the administration of mesenchymal stem cells. 9.The mesenchymal stem cells regulate the density of collagen in the proliferative phaseand the initial phase of maturation in full-thickness wounds donor.

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