1
|
Ho J, Yue D, Cheema U, Hsia HC, Dardik A. Innovations in Stem Cell Therapy for Diabetic Wound Healing. Adv Wound Care (New Rochelle) 2023; 12:626-643. [PMID: 35176896 PMCID: PMC10468561 DOI: 10.1089/wound.2021.0104] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 01/22/2022] [Indexed: 12/20/2022] Open
Abstract
Significance: The global burden of diabetic wounds, particularly diabetic foot ulcers, continues to have large economic and social impact throughout the world. Current strategies are not sufficient to overcome this burden of disease. Finding newer, more advanced regenerative cell and tissue-based strategies to reduce morbidity remains paramount. Recent Advances: Recent advances in stem cell therapies are discussed. We also highlight the practical issues of translating these advancing technologies into the clinical setting. Critical Issues: We discuss the use of somatic and induced pluripotent stem cells and the stromal vascular fraction, as well as innovations, including the use of 3D bioprinting of skin. We also explore related issues of using regenerative techniques in clinical practice, including the current regulatory landscape and translatability of in vivo research. Future Directions: Advances in stem cell manipulation showcase the best therapeutic resources available to enhance mechanisms of wound healing such as angiogenesis, cell proliferation, and collagen synthesis; potential methods include changing the scaffold microenvironment, including relative oxygen tension, and the use of gene modification and nanotechnology. Secretome engineering, particularly the use of extracellular vesicles, may be another potential cell-derived therapeutic that may enable use of cell-free translational therapy.
Collapse
Affiliation(s)
- Jasmine Ho
- UCL Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, London, United Kingdom
- Vascular Biology and Therapeutics Program and The Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Dominic Yue
- Plastic Surgery Unit, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Umber Cheema
- UCL Centre for 3D Models of Health and Disease, Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Henry C. Hsia
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Alan Dardik
- Vascular Biology and Therapeutics Program and The Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
2
|
Avrahami R, Silverberg D, Kolvenbach R, Elias S, Sivak G. Biological autologous excised varicose vein dressing compared to conservative dressing on the ulcer bed during endovenous ablation. Phlebology 2022; 37:386-392. [DOI: 10.1177/02683555221081635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To compare the use of biological autologous excised varicose vein dressing ( VenoDress) compared to conservative dressing on the ulcer bed during endovenous ablation Methods This retrospective non-blinded study included all consecutive patients with primary or recurrent venous leg ulcers (VLU) with superficial varices treated in one center between September 2019 and October 2020. They all underwent venous ablation, wound debridement, and when needed phlebectomy. On the study group, the excised veins were incised, formed into a sheet, and applied onto the debrided wound bed with the endothelial side facing the wound bed. Adhesion was assessed weekly for 3 weeks. The study group was compared to a control group that underwent similar procedures but with the debrided wound bed treated with low-adherent paraffin dressing. The primary outcome was complete wound healing at 1 and 3 months, and the secondary outcomes were wound-related pain and leg edema. Results Complete wound closure was documented in 17/26 study group patients at 1 month (65%) and in 25/26 (96%) at 3 months. Complete wound closure was documented in 37/82 patients in the control group (45%) and in 67/82 (82%) at 3 months. The 1-month healing rates were significantly in favor of the VenoDress group when adjusted to sex and diabetes: odds ratio = 2.81 (1.05–7.532), p = .04. The preoperative pain level of the study group (as measured by a visual analog scale VAS (0–10) decreased from 4.96 ± 2.71 to 0.73 ± 1.36 at 1 week and that of the control group from 4.8 ± 2 to 1.35 ± 1.38 at 1 week ( p < .001). Conclusion the use of autologous varicose veins as dressing effectively reduced pain in VLU patients compared to conventional techniques. Although its effects on wound closure appear highly promising, further validation is warranted in a randomized comparative study.
Collapse
Affiliation(s)
- Ram Avrahami
- T. L. M. Medical Center, Tel-Aviv, Israel
- Department of Vascular Surgery, Rabin Medical Center, Petach Tikva, Israel
| | - Daniel Silverberg
- Department of Vascular Surgery, the Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ralph Kolvenbach
- Department of Vascular Surgery and Endovascular Therapy, SANA Hospital Group, Düsseldorf, Germany
- Academic Teaching Hospital, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Steven Elias
- Center for Vein Disease, Englewood Health Network, Englewood, NJ, USA
| | - Galit Sivak
- T. L. M. Medical Center, Tel-Aviv, Israel
- Department of Vascular Surgery, Rabin Medical Center, Petach Tikva, Israel
| |
Collapse
|
3
|
Venous Ulcers: Review Article. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03064-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
|
4
|
Dearman BL, Boyce ST, Greenwood JE. Advances in Skin Tissue Bioengineering and the Challenges of Clinical Translation. Front Surg 2021; 8:640879. [PMID: 34504864 PMCID: PMC8421760 DOI: 10.3389/fsurg.2021.640879] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 07/31/2021] [Indexed: 01/17/2023] Open
Abstract
Skin tissue bioengineering is an emerging field that brings together interdisciplinary teams to promote successful translation to clinical care. Extensive deep tissue injuries, such as large burns and other major skin loss conditions, are medical indications where bioengineered skin substitutes (that restore both dermal and epidermal tissues) are being studied as alternatives. These may not only reduce mortality but also lessen morbidity to improve quality of life and functional outcome compared with the current standards of care. A common objective of dermal-epidermal therapies is to reduce the time required to accomplish stable closure of wounds with minimal scar in patients with insufficient donor sites for autologous split-thickness skin grafts. However, no commercially-available product has yet fully satisfied this objective. Tissue engineered skin may include cells, biopolymer scaffolds and drugs, and requires regulatory review to demonstrate safety and efficacy. They must be scalable for manufacturing and distribution. The advancement of technology and the introduction of bioreactors and bio-printing for skin tissue engineering may facilitate clinical products' availability. This mini-review elucidates the reasons for the few available commercial skin substitutes. In addition, it provides insights into the challenges faced by surgeons and scientists to develop new therapies and deliver the results of translational research to improve patient care.
Collapse
Affiliation(s)
- Bronwyn L. Dearman
- Skin Engineering Laboratory, Adult Burns Centre, Royal Adelaide Hospital, Adelaide, SA, Australia
- Adult Burns Centre, Royal Adelaide Hospital, Adelaide, SA, Australia
- Faculty of Health and Medical Science, The University of Adelaide, Adelaide, SA, Australia
| | - Steven T. Boyce
- Department of Surgery, University of Cincinnati, Cincinnati, OH, United States
| | - John E. Greenwood
- Skin Engineering Laboratory, Adult Burns Centre, Royal Adelaide Hospital, Adelaide, SA, Australia
- Adult Burns Centre, Royal Adelaide Hospital, Adelaide, SA, Australia
| |
Collapse
|
5
|
Onida S, Heatley F, Peerbux S, Bolton L, Lane T, Epstein D, Gohel M, Poskitt K, Cullum N, Norrie J, Lee RJ, Bradbury A, Dhillon K, Chandrasekar A, Lomas R, Davies AH. Study protocol for a multicentre, randomised controlled trial to compare the use of the decellularised dermis allograft in addition to standard care versus standard care alone for the treatment of venous leg ulceration: DAVE trial. BMJ Open 2021; 11:e041748. [PMID: 33811051 PMCID: PMC8023724 DOI: 10.1136/bmjopen-2020-041748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Venous leg ulceration (VLU), the most common type of chronic ulcer, can be difficult to heal and is a major cause of morbidity and reduced quality of life. Although compression bandaging is the principal treatment, it is time-consuming and bandage application requires specific training. There is evidence that intervention on superficial venous incompetence can help ulcer healing and recurrence, but this is not accessible to all patients. Hence, new treatments are required to address these chronic wounds. One possible adjuvant treatment for VLU is human decellularised dermis (DCD), a type of skin graft derived from skin from deceased tissue donors. Although DCD has the potential to promote ulcer healing, there is a paucity of data for its use in patients with VLU. METHODS AND ANALYSIS This is a multicentre, parallel group, pragmatic randomised controlled trial. One hundred and ninety-six patients with VLU will be randomly assigned to receive either the DCD allograft in addition to standard care or standard care alone. The primary outcome is the proportion of participants with a healed index ulcer at 12 weeks post-randomisation in each treatment arm. Secondary outcomes include the time to index ulcer healing and the proportion of participants with a healed index ulcer at 12 months. Changes in quality of life scores and cost-effectiveness will also be assessed. All analyses will be carried out on an intention-to-treat (ITT) basis. A mixed-effects, logistic regression on the outcome of the proportion of those with the index ulcer healed at 12 weeks will be performed. Secondary outcomes will be assessed using various statistical models appropriate to the distribution and nature of these outcomes. ETHICS AND DISSEMINATION Ethical approval was granted by the Bloomsbury Research Ethics Committee (19/LO/1271). Findings will be published in a peer-reviewed journal and presented at national and international conferences. TRIAL REGISTRATION NUMBER ISRCTN21541209.
Collapse
Affiliation(s)
- Sarah Onida
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Francine Heatley
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sarrah Peerbux
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Layla Bolton
- Vascular Surgery Research Department, Imperial College Healthcare NHS Trust, London, UK
| | - Tristan Lane
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Cambridge Vascular Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - David Epstein
- Faculty of Economic and Business Sciences, University of Granada, Granada, Andalucía, Spain
| | - Manjit Gohel
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Cambridge Vascular Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Keith Poskitt
- Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK
| | - Nicky Cullum
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
- Research and Innovation Division, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - John Norrie
- Usher Institute of Population Health Sciences and Informatics, Edinburgh Clinical Trials Unit, University of Edinburgh No 9, Bioquarter, Edinburgh, UK
| | - Robert J Lee
- Usher Institute of Population Health Sciences and Informatics, Edinburgh Clinical Trials Unit, University of Edinburgh No 9, Bioquarter, Edinburgh, UK
| | - Andrew Bradbury
- Birmingham University, Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Karen Dhillon
- Vascular Surgery Research Department, Imperial College Healthcare NHS Trust, London, UK
| | - Akila Chandrasekar
- Tissue and Eye Services, NHS Blood and Transplant, Liverpool, Merseyside, UK
| | - Richard Lomas
- Tissue and Eye Services, NHS Blood and Transplant, Liverpool, Merseyside, UK
| | - A H Davies
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| |
Collapse
|
6
|
Abstract
Purpose of Review Graft-versus-host disease (GVHD) is an immune mediated disorder affecting 30 - 70% of patients after allogeneic hematopoietic stem cell transplantation (alloHSCT), and is a major cause of morbidity and non-relapse mortality (NRM) [1]. Dermatologists play a critical role in acute and chronic GVHD, as skin involvement is common and often the earliest involved site of disease [2]. Recent Findings GVHD shares clinical and histopathological features with a variety of other skin diseases, requiring thorough consideration of differential diagnoses in hematopoietic stem cell transplantation (HSCT) recipients with lesions suggestive of cutaneous GVHD. Treatment considerations for GVHD are influenced by factors such as disease classification, overall grading, organ involvement, associated symptoms, and immunological anti-tumor effect. Several treatments are available and may be indicated as monotherapy or adjuvant therapy to allow faster withdrawal or tapering of immunosuppression. While corticosteroids are often first line therapy, oral ruxolitinib has been recently approved for treatment of steroid-refractory aGHVD, and oral ibrutinib has been approved for steroid-refractory cGHVD. Summary This article provides current clinical, diagnostic, and therapeutic considerations relevant to the hospitalist for both acute and chronic mucocutaneous GVHD. Optimal inpatient management of these diseases requires an interdisciplinary team.
Collapse
|
7
|
Ren SY, Liu YS, Zhu GJ, Liu M, Shi SH, Ren XD, Hao YG, Gao RD. Strategies and challenges in the treatment of chronic venous leg ulcers. World J Clin Cases 2020. [PMID: 33269244 DOI: 10.12998/wjcc.v8.i21.5070.pmid:] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Evaluating patients with chronic venous leg ulcers (CVLUs) is essential to find the underlying etiology. The basic tenets in managing CVLUs are to remove the etiological causes, to address systemic and metabolic conditions, to examine the ulcers and artery pulses, and to control wound infection with debridement and eliminating excessive pressure on the wound. The first-line treatments of CVLUs remain wound care, debridement, bed rest with leg elevation, and compression. Evidence to support the efficacy of silver-based dressings in healing CVLUs is unavailable. Hydrogen peroxide is harmful to the growth of granulation tissue in the wound. Surgery options include a high ligation with or without stripping or ablation of the GSVs depending on venous reflux or insufficiency. Yet, not all CVLUs are candidates for surgical treatment because of comorbidities. When standard care of wound for 4 wk failed to heal CVLUs effectively, use of advanced wound care should be considered based on the available evidence. Negative pressure wound therapy facilitates granulation tissue development, thereby helping closure of CVLUs. Autologous split-thickness skin grafting is still the gold standard approach to close huge CVLUs. Hair punch graft appears to have a better result than traditional hairless punch graft for CVLUs. Application of adipose tissue or placenta-derived mesenchymal stem cells is a promising therapy for wound healing. Autologous platelet-rich plasma provides an alternative strategy for surgery for safe and natural healing of the ulcer. The confirmative efficacy of current advanced ulcer therapies needs more robust evidence.
Collapse
Affiliation(s)
- Shi-Yan Ren
- Department of General Surgery and Vascular Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China.
| | - Yong-Sheng Liu
- Department of Dermatology, Aviation General Hospital, Beijing 100012, China
| | - Guo-Jian Zhu
- Department of General Surgery, Taian Communications Hospital, Taian 271000, Shandong Province, China
| | - Meng Liu
- Department of Surgery, Tianjin Hexi Hospital, Tianjin 300202, Tianjin, China
| | - Shao-Hui Shi
- Department of Orthopaedic Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Xiao-Dong Ren
- Department of Surgery, Wanquanqu Zhongyi Hospital, Zhangjiakou 076250, Hebei Province, China
| | - Ya-Guang Hao
- Department of Medical Administrative, Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Rong-Ding Gao
- Department of General Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China
| |
Collapse
|
8
|
Ren SY, Liu YS, Zhu GJ, Liu M, Shi SH, Ren XD, Hao YG, Gao RD. Strategies and challenges in the treatment of chronic venous leg ulcers. World J Clin Cases 2020; 8:5070-5085. [PMID: 33269244 PMCID: PMC7674718 DOI: 10.12998/wjcc.v8.i21.5070] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 08/06/2020] [Accepted: 09/28/2020] [Indexed: 02/05/2023] Open
Abstract
Evaluating patients with chronic venous leg ulcers (CVLUs) is essential to find the underlying etiology. The basic tenets in managing CVLUs are to remove the etiological causes, to address systemic and metabolic conditions, to examine the ulcers and artery pulses, and to control wound infection with debridement and eliminating excessive pressure on the wound. The first-line treatments of CVLUs remain wound care, debridement, bed rest with leg elevation, and compression. Evidence to support the efficacy of silver-based dressings in healing CVLUs is unavailable. Hydrogen peroxide is harmful to the growth of granulation tissue in the wound. Surgery options include a high ligation with or without stripping or ablation of the GSVs depending on venous reflux or insufficiency. Yet, not all CVLUs are candidates for surgical treatment because of comorbidities. When standard care of wound for 4 wk failed to heal CVLUs effectively, use of advanced wound care should be considered based on the available evidence. Negative pressure wound therapy facilitates granulation tissue development, thereby helping closure of CVLUs. Autologous split-thickness skin grafting is still the gold standard approach to close huge CVLUs. Hair punch graft appears to have a better result than traditional hairless punch graft for CVLUs. Application of adipose tissue or placenta-derived mesenchymal stem cells is a promising therapy for wound healing. Autologous platelet-rich plasma provides an alternative strategy for surgery for safe and natural healing of the ulcer. The confirmative efficacy of current advanced ulcer therapies needs more robust evidence.
Collapse
Affiliation(s)
- Shi-Yan Ren
- Department of General Surgery and Vascular Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Yong-Sheng Liu
- Department of Dermatology, Aviation General Hospital, Beijing 100012, China
| | - Guo-Jian Zhu
- Department of General Surgery, Taian Communications Hospital, Taian 271000, Shandong Province, China
| | - Meng Liu
- Department of Surgery, Tianjin Hexi Hospital, Tianjin 300202, Tianjin, China
| | - Shao-Hui Shi
- Department of Orthopaedic Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Xiao-Dong Ren
- Department of Surgery, Wanquanqu Zhongyi Hospital, Zhangjiakou 076250, Hebei Province, China
| | - Ya-Guang Hao
- Department of Medical Administrative, Aviation General Hospital, China Medical University, Beijing 100012, China
| | - Rong-Ding Gao
- Department of General Surgery, Aviation General Hospital, China Medical University, Beijing 100012, China
| |
Collapse
|
9
|
Abbade LPF, Frade MAC, Pegas JRP, Dadalti-Granja P, Garcia LC, Bueno Filho R, Parenti CEF. Consensus on the diagnosis and management of chronic leg ulcers - Brazilian Society of Dermatology. An Bras Dermatol 2020; 95 Suppl 1:1-18. [PMID: 33371937 PMCID: PMC7772605 DOI: 10.1016/j.abd.2020.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chronic leg ulcers affect a large portion of the adult population and cause a significant social and economic impact, related to outpatient and hospital care, absence from work, social security expenses, and reduced quality of life. The correct diagnosis and therapeutic approach are essential for a favorable evolution. OBJECTIVE To gather the experience of Brazilian dermatologists, reviewing the specialized literature to prepare recommendations for the diagnosis and treatment of the main types of chronic leg ulcers. METHODS Seven specialists from six university centers with experience in chronic leg ulcers were appointed by the Brazilian Society of Dermatology to reach a consensus on the diagnosis and therapeutic management of these ulcers. Based on the adapted DELPHI methodology, relevant elements were considered in the diagnosis and treatment of chronic leg ulcers of the most common causes; then, the recent literature was analyzed using the best scientific evidence. RESULTS The following themes were defined as relevant for this consensus - the most prevalent differential etiological diagnoses of chronic leg ulcers (venous, arterial, neuropathic, and hypertensive ulcers), as well as the management of each one. It also included the topic of general principles for local management, common to chronic ulcers, regardless of the etiology. CONCLUSION This consensus addressed the main etiologies of chronic leg ulcers and their management based on scientific evidence to assist dermatologists and other health professionals and benefit the greatest number of patients with this condition.
Collapse
Affiliation(s)
- Luciana Patricia Fernandes Abbade
- Department of Infectious Diseases, Dermatology, Diagnostic Imaging and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil.
| | - Marco Andrey Cipriani Frade
- Department of Internal Medicine (Dermatology Division), Faculty of Medicine, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - José Roberto Pereira Pegas
- Dermatology Service, Hospital Padre Bento de Guarulhos, Guarulhos, SP, Brazil; Discipline of Dermatology, Faculty of Medicine, Universidade da Cidade de São Paulo, São Paulo, SP, Brazil; Discipline of Dermatology, Faculty of Medicine, Jundiaí, SP, Brazil
| | - Paula Dadalti-Granja
- Department of Clinical Medicine (Discipline of Dermatology), Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Lucas Campos Garcia
- Dermatology Service, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Roberto Bueno Filho
- Dermatology Service, Hospital das Clínicas, Faculty of Medicine, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | |
Collapse
|
10
|
Chen J, Wan Y, Lin Y, Jiang H. The application of platelet-rich plasma for skin graft enrichment: A meta-analysis. Int Wound J 2020; 17:1650-1658. [PMID: 32633467 DOI: 10.1111/iwj.13445] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/11/2020] [Accepted: 06/16/2020] [Indexed: 02/06/2023] Open
Abstract
Existing evidence demonstrated that the role of platelet-rich plasma (PRP) in skin graft enrichment is uncertain. The aim of this study was to evaluate the efficacy and safety of PRP for skin graft. PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for randomised controlled trials that compared outcomes of skin graft treated with PRP versus those treated with blank controls. The outcomes mainly included the rate of skin graft take, number of skin graft loss and haematoma formation, and complications. There were 11 studies involving a total of 910 cases of skin grafts. Compared with the control group, PRP group had a significantly higher rate of skin graft take (mean difference = 5.47%; 95% confidence interval [CI], 2.80%-8.14%; P < .0001), fewer number of skin graft loss (risk ratio [RR] = 0.26; 95% CI, 0.13-0.55; P = .0004) and fewer cases of haematoma formation (RR = 0.24; 95% CI, 0.11-0.54; P = .0006). There was no significant difference in the incidence of complications between two groups. This meta-analysis summarises current evidence and indicates that PRP is a safe and effective adjuvant for skin graft enrichment.
Collapse
Affiliation(s)
- Jianguo Chen
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yingying Wan
- Department of Internal Medicine, Xi Yuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yan Lin
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haiyue Jiang
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
11
|
Armstrong DG, Orgill DP, Galiano RD, Glat PM, Carter MJ, Zelen CM. Open-label Venous Leg Ulcer Pilot Study Using a Novel Autolologous Homologous Skin Construct. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2972. [PMID: 32802665 PMCID: PMC7413806 DOI: 10.1097/gox.0000000000002972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/11/2020] [Indexed: 12/19/2022]
Abstract
Venous leg ulcers (VLUs) are often refractory to compression therapy, and their prevalence is increasing. An autologous homologous skin construct (AHSC) that uses the endogenous regenerative capacity of healthy skin has been developed to treat cutaneous defects, with a single application. The ability of AHSC to close VLUs with a single treatment was evaluated in an open-label, single-arm feasibility study to test the hypothesis that AHSC treatment will result in wound closure by providing healthy autologous tissue to the wound bed. METHODS Ten VLUs were treated with a single application of AHSC. A 1.5 cm2 full-thickness skin harvest from the proximal calf was collected and sent to a Food and Drug Administration-registered facility, where it was processed into AHSC and returned to the provider within 48 hours. AHSC was spread evenly across the wound and dressed with silicone. The primary endpoint was wound closure rate at 12 weeks. Wound closure was followed with 3-dimensional planimetry, and closure was confirmed by a panel of plastic surgeons. Additional endpoints followed for 12 weeks included graft take, harvest site closure, adverse event rate, complications, and patient-reported pain. RESULTS All 10 VLUs demonstrated successful graft take as evidenced by graft persisting in wound and harvest site closure. Eight VLUs exhibited complete closure within 12 weeks. One VLU that failed to heal with a prior split thickness skin graft closed within 13.5 weeks with AHSC. The mean time of closure was 34 days (95% confidence interval, 14-53). Pain improved by closure confirmation visit. There was 1 serious adverse event unrelated to the product or procedure. CONCLUSION This pilot study demonstrated that AHSC may be a viable single-application topical intervention for VLUs and warrants further investigation in larger, controlled studies.
Collapse
Affiliation(s)
- David G. Armstrong
- From the Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | | | | | | | | | - Charles M. Zelen
- The Professional Education and Research Institute (PERI), Roanoke, Va
| |
Collapse
|
12
|
Yang R, Liu F, Wang J, Chen X, Xie J, Xiong K. Epidermal stem cells in wound healing and their clinical applications. Stem Cell Res Ther 2019; 10:229. [PMID: 31358069 PMCID: PMC6664527 DOI: 10.1186/s13287-019-1312-z] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The skin has important barrier, sensory, and immune functions, contributing to the health and integrity of the organism. Extensive skin injuries that threaten the entire organism require immediate and effective treatment. Wound healing is a natural response, but in severe conditions, such as burns and diabetes, this process is insufficient to achieve effective treatment. Epidermal stem cells (EPSCs) are a multipotent cell type and are committed to the formation and differentiation of the functional epidermis. As the contributions of EPSCs in wound healing and tissue regeneration have been increasingly attracting the attention of researchers, a rising number of therapies based on EPSCs are currently under development. In this paper, we review the characteristics of EPSCs and the mechanisms underlying their functions during wound healing. Applications of EPSCs are also discussed to determine the potential and feasibility of using EPSCs clinically in wound healing.
Collapse
Affiliation(s)
- Ronghua Yang
- Department of Burn Surgery, The First People's Hospital of Foshan, Foshan, 528000, China
| | - Fengxia Liu
- Department of Human Anatomy, School of Basic Medical Science, Xinjiang Medical University, Urumqi, 830001, China
| | - Jingru Wang
- Department of Burn Surgery, The First People's Hospital of Foshan, Foshan, 528000, China
| | - Xiaodong Chen
- Department of Burn Surgery, The First People's Hospital of Foshan, Foshan, 528000, China
| | - Julin Xie
- Department of Burn Surgery, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 512100, China.
| | - Kun Xiong
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Morphological Sciences Building, Central South University, 172 Tongzi Po Road, Changsha, 410013, Hunan, China.
| |
Collapse
|
13
|
Kekonen A, Bergelin M, Johansson M, Kumar Joon N, Bobacka J, Viik J. Bioimpedance Sensor Array for Long-Term Monitoring of Wound Healing from Beneath the Primary Dressings and Controlled Formation of H 2O 2 Using Low-Intensity Direct Current. SENSORS 2019; 19:s19112505. [PMID: 31159298 PMCID: PMC6603574 DOI: 10.3390/s19112505] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/29/2019] [Accepted: 05/30/2019] [Indexed: 11/16/2022]
Abstract
Chronic wounds impose a significant financial burden for the healthcare system. Currently, assessment and monitoring of hard-to-heal wounds are often based on visual means and measuring the size of the wound. The primary wound dressings must be removed before assessment can be done. We have developed a quasi-monopolar bioimpedance-measurement-based method and a measurement system to determine the status of wound healing. The objective of this study was to demonstrate that with an appropriate setup, long-term monitoring of wound healing from beneath the primary dressings is feasible. The developed multielectrode sensor array was applied on the wound area and left under the primary dressings for 142 h. The impedance of the wounds and the surrounding intact skin area was measured regularly during the study at 150 Hz, 300 Hz, 1 kHz, and 5 kHz frequencies. At the end of the follow-up period, the wound impedance had reached the impedance of the intact skin at the higher frequencies and increased significantly at the lowest frequencies. The measurement frequency affected the measurement sensitivity in wound monitoring. The skin impedance remained stable over the measurement period. The sensor array also enabled the administration of periodical low-intensity direct current (LIDC) stimulation in order to create an antimicrobial environment across the wound area via the controlled formation of hydrogen peroxide (H2O2).
Collapse
Affiliation(s)
- Atte Kekonen
- Faculty of Medicine and Health Technology, Tampere University, Korkeakoulunkatu 3, FI-33720 Tampere, Finland.
| | - Mikael Bergelin
- Turku PET Centre, Åbo Akademi Accelerator Laboratory, c/o Turku University Hospital, Kiinamyllynkatu 4-8, FI-20520 Turku, Finland.
| | - Max Johansson
- CutoSense Ltd., Kaarinantie 700, FI-20540 Turku, Finland.
| | - Narender Kumar Joon
- Laboratory of Analytical Chemistry, Johan Gadolin Process Chemistry Centre, Åbo Akademi University, Biskopsgatan 8, FI-20500 Turku, Finland.
| | - Johan Bobacka
- Laboratory of Analytical Chemistry, Johan Gadolin Process Chemistry Centre, Åbo Akademi University, Biskopsgatan 8, FI-20500 Turku, Finland.
| | - Jari Viik
- Faculty of Medicine and Health Technology, Tampere University, Korkeakoulunkatu 3, FI-33720 Tampere, Finland.
| |
Collapse
|
14
|
Cantin-Warren L, Guignard R, Cortez Ghio S, Larouche D, Auger FA, Germain L. Specialized Living Wound Dressing Based on the Self-Assembly Approach of Tissue Engineering. J Funct Biomater 2018; 9:jfb9030053. [PMID: 30223550 PMCID: PMC6165032 DOI: 10.3390/jfb9030053] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/30/2018] [Accepted: 09/10/2018] [Indexed: 12/24/2022] Open
Abstract
There is a high incidence of failure and recurrence for chronic skin wounds following conventional therapies. To promote healing, the use of skin substitutes containing living cells as wound dressings has been proposed. The aim of this study was to produce a scaffold-free cell-based bilayered tissue-engineered skin substitute (TES) containing living fibroblasts and keratinocytes suitable for use as wound dressing, while considering production time, handling effort during the manufacturing process, and stability of the final product. The self-assembly method, which relies on the ability of mesenchymal cells to secrete and organize connective tissue sheet sustaining keratinocyte growth, was used to produce TESs. Three fibroblast-seeding densities were tested to produce tissue sheets. At day 17, keratinocytes were added onto 1 or 3 (reference method) stacked tissue sheets. Four days later, TESs were subjected either to 4, 10, or 17 days of culture at the air–liquid interface (A/L). All resulting TESs were comparable in terms of their histological aspect, protein expression profile and contractile behavior in vitro. However, signs of extracellular matrix (ECM) digestion that progressed over culture time were noted in TESs produced with only one fibroblast-derived tissue sheet. With lower fibroblast density, the ECM of TESs was almost completely digested after 10 days A/L and lost histological integrity after grafting in athymic mice. Increasing the fibroblast seeding density 5 to 10 times solved this problem. We conclude that the proposed method allows for a 25-day production of a living TES, which retains its histological characteristics in vitro for at least two weeks.
Collapse
Affiliation(s)
- Laurence Cantin-Warren
- Centre de Recherche en Organogénèse Expérimentale de l'Université Laval/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Centre, Département de Chirurgie, Faculté de Médecine, Université Laval, 1401 18e Rue, Québec, Québec G1J 1Z4, Canada.
| | - Rina Guignard
- Centre de Recherche en Organogénèse Expérimentale de l'Université Laval/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Centre, Département de Chirurgie, Faculté de Médecine, Université Laval, 1401 18e Rue, Québec, Québec G1J 1Z4, Canada.
| | - Sergio Cortez Ghio
- Centre de Recherche en Organogénèse Expérimentale de l'Université Laval/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Centre, Département de Chirurgie, Faculté de Médecine, Université Laval, 1401 18e Rue, Québec, Québec G1J 1Z4, Canada.
| | - Danielle Larouche
- Centre de Recherche en Organogénèse Expérimentale de l'Université Laval/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Centre, Département de Chirurgie, Faculté de Médecine, Université Laval, 1401 18e Rue, Québec, Québec G1J 1Z4, Canada.
| | - François A Auger
- Centre de Recherche en Organogénèse Expérimentale de l'Université Laval/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Centre, Département de Chirurgie, Faculté de Médecine, Université Laval, 1401 18e Rue, Québec, Québec G1J 1Z4, Canada.
| | - Lucie Germain
- Centre de Recherche en Organogénèse Expérimentale de l'Université Laval/LOEX, Regenerative Medicine Division, CHU de Québec-Université Laval Research Centre, Département de Chirurgie, Faculté de Médecine, Université Laval, 1401 18e Rue, Québec, Québec G1J 1Z4, Canada.
| |
Collapse
|
15
|
Illescas-Montes R, Atkinson RA, Cullum N. Low-level light therapy for treating venous leg ulcers. Hippokratia 2018. [DOI: 10.1002/14651858.cd013061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Rebeca Illescas-Montes
- Universidad de Granada; Departamento de Enfermería, Facultad de Enfermería de Melilla; Granada Spain
| | - Ross A Atkinson
- University of Manchester, Manchester Academic Health Science Centre; Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health; Manchester UK M13 9PL
| | - Nicky Cullum
- University of Manchester, Manchester Academic Health Science Centre; Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health; Manchester UK M13 9PL
| |
Collapse
|
16
|
Wollina U, Heinig B, Stelzner C, Hansel G, Schönlebe J, Tchernev G, Lotti T. The Role of Complex Treatment in Mixed Leg Ulcers - A Case Report of Vascular, Surgical and Physical Therapy. Open Access Maced J Med Sci 2018; 6:67-70. [PMID: 29483986 PMCID: PMC5816320 DOI: 10.3889/oamjms.2018.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 11/12/2017] [Accepted: 10/29/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: Leg ulcers are a burden to patients, their families and society. The second most common cause of chronic leg ulcers is the mixed arterio-venous type. An 80-year-old female patient presented to our department due to painful enlarging chronic leg ulcer of mixed arteriovenous origin on her left lower leg. She suffered from peripheral arterial occlusive disease stage I and chronic venous insufficiency Widmer grade IIIa, and a number of comorbidities. AIM: The aim of our ulcer treatment was a complete and stable wound closure that was hampered by arterial occlusion, exposed tendon, and renal insiffuciency. CASE REPORT: To improve the prognosis for ulcer surgery, we performed percutaneous transluminal angioplasty, transcutaneous CO2 and deep ulcer shaving. The wound was closed by sandwich transplantation using elastin-collagen dermal template and meshed split skin graft. She had a 100% graft take with rapid reduction of severe wound pain. CONCLUSION: Complex approaches are necessary, to gain optimum results in leg ulcer therapy in mixed leg ulcers. Therapeutic nihilism should be abandonend.
Collapse
Affiliation(s)
- Uwe Wollina
- Städtisches Klinikum Dresden, Department of Dermatology and Allergology, 01067 Dresden, Germany
| | - Birgit Heinig
- Städtisches Klinikum Dresden - Center of Physical and Rehabilitative Medicine, Dresden, Germany
| | - Christian Stelzner
- Stadtisches Klinikum Dresden - Department of Internal Medicine II, Angiology Unit, Dresden, Sachsen, Germany
| | - Gesina Hansel
- Städtisches Klinikum Dresden, Department of Dermatology and Allergology, 01067 Dresden, Germany
| | - Jacqueline Schönlebe
- Städtisches Klinikum Dresden - Institute of Pathology "Georg Schmorl", Dresden, Germany
| | - Georgi Tchernev
- Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior, Sofia, Bulgaria.,Onkoderma Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
| | | |
Collapse
|
17
|
Abstract
Transplantation of cultured epidermal cell sheets (CES) has long been used to treat patients with burns, chronic wounds, and stable vitiligo. In patients with large area burns this can be a life-saving procedure. The ultimate goal, however, is to restore all normal functions of the skin and prevent scar formation. Increased focus on the incorporation of epidermal stem cells (EpiSCs) within CES transplants may ultimately prove to be key to achieving this. Transplanted EpiSCs contribute to restoring the complete epidermis and provide long-term renewal.Maintenance of the regenerative potential of EpiSCs is anchorage-dependent. The extracellular matrix (ECM) provides physical cues that are interpreted by EpiSCs and reciprocal signaling between cells and ECM are integrated to determine cell fate. Thus, the carrier scaffold chosen for culture and transplant influences maintenance of EpiSC phenotype and may enhance or detract from regenerative healing following transfer.Long-term effectiveness and safety of genetically modified EpiSCs to correct the severe skin blistering disease epidermolysis bullosa has been shown clinically. Furthermore, skin is gaining interest as an easily accessible source of adult epithelial stem cells potentially useful for restoration of other types of epithelia. This review highlights the role of EpiSCs in the current treatment of skin injury and disease, as well as their potential in novel regenerative medicine applications involving other epithelia.
Collapse
Affiliation(s)
- Catherine J Jackson
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway. .,Department of Plastic Surgery, Oslo University Hospital, Oslo, Norway. .,Institute of Oral biology, Faculty of Dentistry, University of Oslo, Oslo, Norway.
| | - Kim Alexander Tønseth
- Department of Plastic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tor Paaske Utheim
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,Department of Plastic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Oral biology, Faculty of Dentistry, University of Oslo, Oslo, Norway.,Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
18
|
Boink MA, Roffel S, Breetveld M, Thon M, Haasjes MSP, Waaijman T, Scheper RJ, Blok CS, Gibbs S. Comparison of advanced therapy medicinal product gingiva and skin substitutes and their in vitro wound healing potentials. J Tissue Eng Regen Med 2017; 12:e1088-e1097. [PMID: 28388010 PMCID: PMC5836907 DOI: 10.1002/term.2438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 01/25/2017] [Accepted: 04/03/2017] [Indexed: 01/23/2023]
Abstract
Skin and oral mucosa substitutes are a therapeutic option for closing hard‐to‐heal skin and oral wounds. Our aim was to develop bi‐layered skin and gingiva substitutes, from 3 mm diameter biopsies, cultured under identical conditions, which are compliant with current European regulations for advanced therapy medicinal products. We present in vitro mode of action methods to (i) determine viability: epithelial expansion, proliferation (Ki‐67), metabolic activity (MTT assay); (ii) characterize skin and gingiva substitutes: histology and immunohistochemistry; and (iii) determine potency: soluble wound healing mediator release (enzyme‐linked immunosorbent assay). Both skin and gingiva substitutes consist of metabolically active autologous reconstructed differentiated epithelium expanding from the original biopsy sheet on a fibroblast populated connective tissue matrix (donor dermis). Gingival epithelium expanded 1.7‐fold more than skin epithelium during the 3 week culture period. The percentage of proliferating Ki‐67‐positive cells located in the basal layer of the gingiva substitute was >1.5‐fold higher than in the skin substitute. Keratins 16 and 17, which are upregulated during normal wound healing, were expressed in both the skin and gingiva substitutes. Notably, the gingiva substitute secreted higher amounts of key cytokines involved in mitogenesis, motogenesis and chemotaxis (interleukin‐6 > 23‐fold, CXCL8 > 2.5‐fold) as well as higher amounts of the anti‐fibrotic growth factor, hepatocyte growth factor (>7‐fold), compared with the skin substitute. In conclusion, while addressing the viability, characterization and potency of the tissue substitutes, important intrinsic differences between skin and gingiva were discovered that may explain in part the superior quality of wound healing observed in the oral mucosa compared with skin.
Collapse
Affiliation(s)
- Mireille A Boink
- Department of Oral Biochemistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, the Netherlands.,Department of Dermatology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Sanne Roffel
- Department of Oral Biochemistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, the Netherlands.,Department of Dermatology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Melanie Breetveld
- Department of Dermatology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Maria Thon
- Department of Dermatology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,A-Skin BV, Amsterdam, the Netherlands
| | - Michiel S P Haasjes
- Department of Dermatology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Taco Waaijman
- Department of Dermatology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Rik J Scheper
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - Chantal S Blok
- Department of Dermatology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Susan Gibbs
- Department of Dermatology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Department of Oral Cell Biology, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, the Netherlands
| |
Collapse
|
19
|
Serra R, Rizzuto A, Rossi A, Perri P, Barbetta A, Abdalla K, Caroleo S, Longo C, Amantea B, Sammarco G, de Franciscis S. Skin grafting for the treatment of chronic leg ulcers - a systematic review in evidence-based medicine. Int Wound J 2017; 14:149-157. [PMID: 26940940 PMCID: PMC7949524 DOI: 10.1111/iwj.12575] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 12/31/2015] [Accepted: 02/04/2016] [Indexed: 12/13/2022] Open
Abstract
Skin grafting is one of the most common surgical procedures in the area of non-healing wounds by which skin or a skin substitute is placed over a wound to replace and regenerate the damaged skin. Chronic leg ulcers are an important problem and a major source of expense for Western countries and for which many different forms of treatment have been used. Skin grafting is a method of treatment that decreases the area of chronic leg ulcers or heals them completely, thus improving a patient's quality of life. Skin grafting is an old technique, rediscovered during the first and second world wars as the main treatment for wound closure. Nowadays, skin grafting has a pivotal role in the context of modern wound healing and tissue regeneration. The aim of this review was to track and to analyse the specific outcomes this technique achieved, especially in the last decade, in relation to venous, arterial, diabetic, rheumatoid and traumatic leg ulcers. Our main findings indicate that autologous split-thickness skin grafting still remains the gold standard in terms of safety and efficacy for chronic leg ulcers; skin grafting procedures have greater success rates in chronic venous leg ulcers compared to other types of chronic leg ulcers; skin tissue engineering, also supported by genetic manipulation, is quickly expanding and, in the near future, may provide even better outcomes in the area of treatments for long-lasting chronic wounds.
Collapse
Affiliation(s)
- Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental BiotechnologyUniversity Magna Graecia of CatanzaroCatanzaroItaly
- Department of Medical and Surgical SciencesUniversity of CatanzaroCatanzaroItaly
| | - Antonia Rizzuto
- Department of Medical and Surgical SciencesUniversity of CatanzaroCatanzaroItaly
| | - Alessio Rossi
- Department of Medicine and Health Sciences “Vincenzo Tiberio”University of MoliseCampobassoItaly
| | - Paolo Perri
- Department of Medical and Surgical SciencesUniversity of CatanzaroCatanzaroItaly
| | - Andrea Barbetta
- Department of Medical and Surgical SciencesUniversity of CatanzaroCatanzaroItaly
| | - Karim Abdalla
- Department of Medical and Surgical SciencesUniversity of CatanzaroCatanzaroItaly
| | - Santo Caroleo
- Department of Medical and Surgical SciencesUniversity of CatanzaroCatanzaroItaly
| | - Chiara Longo
- Department of Physical Medicine and RehabilitationHospital of Saint‐FlourSaint‐FlourFrance
| | - Bruno Amantea
- Department of Medical and Surgical SciencesUniversity of CatanzaroCatanzaroItaly
| | - Giuseppe Sammarco
- Department of Medical and Surgical SciencesUniversity of CatanzaroCatanzaroItaly
| | - Stefano de Franciscis
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental BiotechnologyUniversity Magna Graecia of CatanzaroCatanzaroItaly
- Department of Medical and Surgical SciencesUniversity of CatanzaroCatanzaroItaly
| |
Collapse
|
20
|
De Francesco F, Graziano A, Trovato L, Ceccarelli G, Romano M, Marcarelli M, Cusella De Angelis GM, Cillo U, Riccio M, Ferraro GA. A Regenerative Approach with Dermal Micrografts in the Treatment of Chronic Ulcers. Stem Cell Rev Rep 2016; 13:139-148. [DOI: 10.1007/s12015-016-9692-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
21
|
Powers JG, Higham C, Broussard K, Phillips TJ. Wound healing and treating wounds: Chronic wound care and management. J Am Acad Dermatol 2016; 74:607-25; quiz 625-6. [PMID: 26979353 DOI: 10.1016/j.jaad.2015.08.070] [Citation(s) in RCA: 343] [Impact Index Per Article: 42.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 08/12/2015] [Accepted: 08/15/2015] [Indexed: 12/15/2022]
Abstract
In the United States, chronic ulcers--including decubitus, vascular, inflammatory, and rheumatologic subtypes--affect >6 million people, with increasing numbers anticipated in our growing elderly and diabetic populations. These wounds cause significant morbidity and mortality and lead to significant medical costs. Preventative and treatment measures include disease-specific approaches and the use of moisture retentive dressings and adjunctive topical therapies to promote healing. In this article, we discuss recent advances in wound care technology and current management guidelines for the treatment of wounds and ulcers.
Collapse
Affiliation(s)
| | - Catherine Higham
- Vanderbilt School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Karen Broussard
- Division of Dermatology, Vanderbilt University, Nashville, Tennessee
| | - Tania J Phillips
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts; SkinCare Physicians, Chestnut Hill, Massachusetts
| |
Collapse
|
22
|
Otero-Viñas M, Falanga V. Mesenchymal Stem Cells in Chronic Wounds: The Spectrum from Basic to Advanced Therapy. Adv Wound Care (New Rochelle) 2016; 5:149-163. [PMID: 27076993 PMCID: PMC4817558 DOI: 10.1089/wound.2015.0627] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 03/03/2015] [Indexed: 02/06/2023] Open
Abstract
Significance: Almost 7 million Americans have chronic cutaneous wounds and billions of dollars are spent on their treatment. The number of patients with nonhealing wounds keeps increasing worldwide due to an ever-aging population, increasing number of obese and diabetic patients, and cardiovascular disease. Recent Advances: Advanced treatments for difficult wounds are needed. Therapy with mesenchymal stem cells (MSCs) is attractive due to their differentiating potential, their immunomodulating properties, and their paracrine effects. Critical Issues: New technologies (including growth factors and skin substitutes) are now widely used for stimulating wound healing. However, in spite of these advances, the percentage of complete wound closure in most clinical situations is around 50-60%. Moreover, there is a high rate of wound recurrence. Future Directions: Recently, it has been demonstrated that MSCs speed up wound healing by decreasing inflammation, by promoting angiogenesis, and by decreasing scarring. However, there are some potential limitations to successful MSC therapy. These limitations include the need to improve cell delivery methods, cell viability, heterogeneity in MSC preparations, and suboptimal wound bed preparation. Further large, controlled clinical trials are needed to establish the safety of MSCs before widespread clinical application.
Collapse
Affiliation(s)
- Marta Otero-Viñas
- Dermatology Department, Boston University School of Medicine, Boston, Massachusetts
- The Tissue Repair and Regeneration Laboratory, Department of Systems Biology, Universitat de Vic—Universitat Central de Catalunya, Vic, Spain
| | - Vincent Falanga
- Dermatology Department, Boston University School of Medicine, Boston, Massachusetts
| |
Collapse
|
23
|
Movahednia MM, Kidwai FK, Jokhun DS, Squier CA, Toh WS, Cao T. Potential applications of keratinocytes derived from human embryonic stem cells. Biotechnol J 2015; 11:58-70. [PMID: 26663861 DOI: 10.1002/biot.201500099] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 08/13/2015] [Accepted: 10/19/2015] [Indexed: 01/03/2023]
Abstract
Although skin grafting is one of the most advanced cell therapy technique, wide application of skin substitutes is hampered by the difficulty in securing sufficient amount of epidermal substitute. Additionally, in understanding the progression of skin aging and disease, and in screening the cosmetic and pharmaceutical products, there is lack of a satisfactory human skin-specific in vitro model. Recently, human embryonic stem cells (hESCs) have been proposed as an unlimited and reliable cell source to obtain almost all cell types present in the human body. This review focuses on the potential off-the-shelf use of hESC-derived keratinocytes for future clinical applications as well as a powerful in vitro skin model to study skin function and integrity, host-pathogen interactions and disease pathogenesis. Furthermore, we discuss the industrial applications of hESC-derived keratinized multi-layer epithelium which provides a human-like test platform for understanding disease pathogenesis, evaluation of new therapeutic modalities and assessment of the safety and efficacy of skin cosmetics and therapeutics. Overall, we conclude that the hESC-derived keratinocytes have great potential for clinical, research and industrial applications.
Collapse
Affiliation(s)
| | - Fahad K Kidwai
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore
| | - Doorgesh S Jokhun
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Christopher A Squier
- Department of Oral Pathology, Radiology & Medicine, and Dows, College of Dentistry, The University of Iowa, Iowa City, Iowa, USA
| | - Wei Seong Toh
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore.,Tissue Engineering Program, Life Sciences Institute, National University of Singapore, Singapore, Singapore
| | - Tong Cao
- Faculty of Dentistry, National University of Singapore, Singapore, Singapore. .,Tissue Engineering Program, Life Sciences Institute, National University of Singapore, Singapore, Singapore. .,National University of Singapore Graduate School for Integrative Sciences and Engineering (NGS), Singapore, Singapore.
| |
Collapse
|
24
|
Tilbrook H, Forsythe RO, Rolfe D, Clark L, Bland M, Buckley H, Chetter I, Cook L, Dumville J, Gabe R, Harding K, Layton A, Lindsay E, McDaid C, Moffatt C, Phillips C, Stansby G, Vowden P, Williams L, Torgerson D, Hinchliffe RJ. Aspirin for Venous Ulcers: Randomised Trial (AVURT): study protocol for a randomised controlled trial. Trials 2015; 16:513. [PMID: 26554558 PMCID: PMC4641424 DOI: 10.1186/s13063-015-1039-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/29/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Venous leg ulcers (VLUs) are the commonest cause of leg ulceration, affecting 1 in 100 adults. There is a significant health burden associated with VLUs - it is estimated that the cost of treatment for 1 ulcer is up to £1300 per year in the NHS. The mainstay of treatment is with graduated compression bandaging; however, treatment is often prolonged and up to one quarter of venous leg ulcers do not heal despite standard care. Two previous trials have suggested that low-dose aspirin, as an adjunct to standard care, may hasten healing, but these trials were small and of poor quality. Aspirin is an inexpensive, widely used medication but its safety and efficacy in the treatment of VLUs remains to be established. METHODS/DESIGN AVURT is a phase II randomised double blind, parallel-group, placebo-controlled efficacy trial. The primary objective is to examine whether aspirin, in addition to standard care, is effective in patients with chronic VLUs (i.e. over 6 weeks in duration or a history of VLU). Secondary objectives include feasibility and safety of aspirin in this population. A target of 100 participants, identified from community leg ulcer clinics and hospital clinics, will be randomised to receive either 300 mg of aspirin once daily or placebo. All participants will receive standard care with compression therapy. The primary outcome will be time to healing of the reference ulcer. Follow-up will occur for a maximum of 27 weeks. The primary analysis will use a Cox proportional hazards model to compare time to healing using the principles of intention-to-treat. Secondary outcomes will include ulcer size, pain evaluation, compliance and adverse events. DISCUSSION The AVURT trial will investigate the efficacy and safety of aspirin as a treatment for VLU and will inform on the feasibility of proceeding to a larger phase III study. This study will address the paucity of information currently available regarding aspirin therapy to treat VLU. TRIAL REGISTRATION The study is registered on a public database with clinicaltrials.gov ( NCT02333123 ; registered on 5 November 2014).
Collapse
Affiliation(s)
- Helen Tilbrook
- Department of Health Sciences, York Trials Unit, University of York, York, UK.
| | - Rachael O Forsythe
- St George's Vascular Institute, St George's Healthcare NHS Trust, Blackshaw Road, London, SW17 0QT, UK.
| | | | - Laura Clark
- Department of Health Sciences, York Trials Unit, University of York, York, UK.
| | - Martin Bland
- Department of Health Sciences, York Trials Unit, University of York, York, UK.
| | - Hannah Buckley
- Department of Health Sciences, York Trials Unit, University of York, York, UK.
| | - Ian Chetter
- Hull York Medical School, University of Hull, Kingston upon Hull, UK.
| | - Liz Cook
- Department of Health Sciences, York Trials Unit, University of York, York, UK.
| | - Jo Dumville
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
| | - Rhian Gabe
- Department of Health Sciences, York Trials Unit, University of York, York, UK.
| | - Keith Harding
- Wound Healing Research Unit, Cardiff University, Cardiff, UK.
| | - Alison Layton
- Harrogate and District NHS Foundation Trust, London, UK.
| | | | - Catriona McDaid
- Department of Health Sciences, York Trials Unit, University of York, York, UK.
| | - Christine Moffatt
- School of Health Sciences, University of Nottingham, Nottingham, UK.
| | - Ceri Phillips
- Swansea Centre for Health Economics, Swansea University, Swansea, UK.
| | - Gerard Stansby
- School of Surgical and Reproductive Sciences, Newcastle University, Newcastle upon Tyne, UK.
| | | | - Laurie Williams
- St George's Vascular Institute, St George's Healthcare NHS Trust, Blackshaw Road, London, SW17 0QT, UK.
| | - David Torgerson
- Department of Health Sciences, York Trials Unit, University of York, York, UK.
| | - Robert J Hinchliffe
- St George's Vascular Institute, St George's Healthcare NHS Trust, Blackshaw Road, London, SW17 0QT, UK.
- St George's University of London, London, UK.
| |
Collapse
|
25
|
Amato B, Compagna R, Amato M, Butrico L, Fugetto F, Chibireva MD, Barbetta A, Cannistrà M, de Franciscis S, Serra R. The role of adult tissue-derived stem cells in chronic leg ulcers: a systematic review focused on tissue regeneration medicine. Int Wound J 2015; 13:1289-1298. [PMID: 26399452 DOI: 10.1111/iwj.12499] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/10/2015] [Accepted: 08/16/2015] [Indexed: 12/12/2022] Open
Abstract
Wound healing is an articulated process that can be impaired in different steps in chronic wounds. Chronic leg ulcers are a special type of non-healing wounds that represent an important cause of morbidity and public cost in western countries. Because of their common recurrence after conventional managements and increasing prevalence due to an ageing population, newer approaches are needed. Over the last decade, the research has been focused on innovative treatment strategies, including stem-cell-based therapies. After the initial interest in embryonic pluripotent cells, several different types of adult stem cells have been studied because of ethical issues. Specific types of adult stem cells have shown a high potentiality in tissue healing, in both in vitro and in vivo studies. Aim of this review is to clearly report the newest insights on tissue regeneration medicine, with particular regard for chronic leg ulcers.
Collapse
Affiliation(s)
- Bruno Amato
- Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology, Headquarters, University Magna Graecia of Catanzaro, Catanzaro, Italy.,Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Rita Compagna
- Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology, Headquarters, University Magna Graecia of Catanzaro, Catanzaro, Italy.,Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Maurizio Amato
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Lucia Butrico
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Francesco Fugetto
- School of Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Mariia D Chibireva
- School of Medicine, Kazan State Medical University, Kazan, Tatarstan Republic, Russian Federation
| | - Andrea Barbetta
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Marco Cannistrà
- Department of Surgery, Annunziata Hospital of Cosenza, Cosenza, Italy
| | - Stefano de Franciscis
- Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology, Headquarters, University Magna Graecia of Catanzaro, Catanzaro, Italy.,Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL). International Research and Educational Program in Clinical and Experimental Biotechnology, Headquarters, University Magna Graecia of Catanzaro, Catanzaro, Italy.,Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| |
Collapse
|
26
|
Golinski P, Menke H, Hofmann M, Valesky E, Butting M, Kippenberger S, Bereiter-Hahn J, Bernd A, Kaufmann R, Zoeller NN. Development and Characterization of an Engraftable Tissue-Cultured Skin Autograft: Alternative Treatment for Severe Electrical Injuries. Cells Tissues Organs 2015; 200:227-39. [PMID: 26303436 DOI: 10.1159/000433519] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Optimizing the treatment regimens of extensive or nonhealing defects is a constant challenge. Tissue-cultured skin autografts may be an alternative to mesh grafts and keratinocyte suspensions that are applied during surgical defect coverage. METHODS Autologous epidermal and dermal cells were isolated, in vitro expanded and seeded on collagen-elastin scaffolds. The developed autograft was immunohistochemically and electron microscopically characterized. Subsequently, it was transplanted onto lesions of a severely burned patient. RESULTS Comparability of the skin equivalent to healthy human skin could be shown due to the epidermal strata, differentiation, proliferation markers and development of characteristics of a functional basal lamina. Approximately 2 weeks after skin equivalent transplantation the emerging new skin correlated closely to the adjacent normal skin. CONCLUSION The present study demonstrates the comparability of the developed organotypic skin equivalent to healthy human skin and its versatility for clinical applications.
Collapse
Affiliation(s)
- Peter Golinski
- Department of Dermatology, Venereology and Allergology, University Hospital, Goethe University, Frankfurt am Main, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Greaves NS, Morris J, Benatar B, Alonso-Rasgado T, Baguneid M, Bayat A. Acute cutaneous wounds treated with human decellularised dermis show enhanced angiogenesis during healing. PLoS One 2015; 10:e0113209. [PMID: 25602294 PMCID: PMC4300088 DOI: 10.1371/journal.pone.0113209] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 10/20/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The influence of skin substitutes upon angiogenesis during wound healing is unclear. OBJECTIVES To compare the angiogenic response in acute cutaneous human wounds treated with autogenic, allogenic and xenogenic skin substitutes to those left to heal by secondary intention. METHODS On day 0, four 5mm full-thickness punch biopsies were harvested from fifty healthy volunteers (sites 1-4). In all cases, site 1 healed by secondary intention (control), site 2 was treated with collagen-GAG scaffold (CG), cadaveric decellularised dermis (DCD) was applied to site 3, whilst excised tissue was re-inserted into site 4 (autograft). Depending on study group allocation, healing tissue from sites 1-4 was excised on day 7, 14, 21 or 28. All specimens were bisected, with half used in histological and immunohistochemical evaluation whilst extracted RNA from the remainder enabled whole genome microarrays and qRT-PCR of highlighted angiogenesis-related genes. All wounds were serially imaged over 6 weeks using laser-doppler imaging and spectrophotometric intracutaneous analysis. RESULTS Inherent structural differences between skin substitutes influenced the distribution and organisation of capillary networks within regenerating dermis. Haemoglobin flux (p = 0.0035), oxyhaemoglobin concentration (p = 0.0005), and vessel number derived from CD31-based immunohistochemistry (p = 0.046) were significantly greater in DCD wounds at later time points. This correlated with time-matched increases in mRNA expression of membrane-type 6 matrix metalloproteinase (MT6-MMP) (p = 0.021) and prokineticin 2 (PROK2) (p = 0.004). CONCLUSION Corroborating evidence from invasive and non-invasive modalities demonstrated that treatment with DCD resulted in increased angiogenesis after wounding. Significantly elevated mRNA expression of pro-angiogenic PROK2 and extracellular matrix protease MT6-MMP seen only in the DCD group may contribute to observed responses.
Collapse
Affiliation(s)
- Nicholas S. Greaves
- Plastic and Reconstructive Surgery Research, Manchester Institute of Biotechnology (MIB), The University of Manchester, Manchester, Lancashire, United Kingdom
- University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester, Lancashire, United Kingdom
| | - Julie Morris
- University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester, Lancashire, United Kingdom
| | - Brian Benatar
- Department of Histopatholgy, Pennine Acute Hospitals NHS Trust, Royal Oldham Hospital, Rochdale Road, Oldham, Lancashire, United Kingdom
| | - Teresa Alonso-Rasgado
- School of Materials, University of Manchester, Manchester, Lancashire, United Kingdom
| | - Mohamed Baguneid
- University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester, Lancashire, United Kingdom
| | - Ardeshir Bayat
- Plastic and Reconstructive Surgery Research, Manchester Institute of Biotechnology (MIB), The University of Manchester, Manchester, Lancashire, United Kingdom
- Centre for Dermatology, Institute of Inflammation and Repair, Faculty of Medicine and Human Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| |
Collapse
|
28
|
Sun BK, Siprashvili Z, Khavari PA. Advances in skin grafting and treatment of cutaneous wounds. Science 2014; 346:941-5. [PMID: 25414301 DOI: 10.1126/science.1253836] [Citation(s) in RCA: 508] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The ability of the skin to repair itself after injury is vital to human survival and is disrupted in a spectrum of disorders. The process of cutaneous wound healing is complex, requiring a coordinated response by immune cells, hematopoietic cells, and resident cells of the skin. We review the classic paradigms of wound healing and evaluate how recent discoveries have enriched our understanding of this process. We evaluate current and experimental approaches to treating cutaneous wounds, with an emphasis on cell-based therapies and skin transplantation.
Collapse
Affiliation(s)
- Bryan K Sun
- Program in Epithelial Biology, Stanford University, Stanford, CA 94305, USA
| | - Zurab Siprashvili
- Program in Epithelial Biology, Stanford University, Stanford, CA 94305, USA
| | - Paul A Khavari
- Program in Epithelial Biology, Stanford University, Stanford, CA 94305, USA. Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94304, USA.
| |
Collapse
|
29
|
Vyas KS, Vasconez HC. Wound Healing: Biologics, Skin Substitutes, Biomembranes and Scaffolds. Healthcare (Basel) 2014; 2:356-400. [PMID: 27429283 PMCID: PMC4934597 DOI: 10.3390/healthcare2030356] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/08/2014] [Accepted: 08/19/2014] [Indexed: 12/25/2022] Open
Abstract
This review will explore the latest advancements spanning several facets of wound healing, including biologics, skin substitutes, biomembranes and scaffolds.
Collapse
Affiliation(s)
- Krishna S Vyas
- Division of Plastic Surgery, Department of Surgery, University of Kentucky, Kentucky Clinic K454, 740 South Limestone, Lexington, KY 40536, USA.
| | - Henry C Vasconez
- Division of Plastic Surgery, Department of Surgery, University of Kentucky, Kentucky Clinic K454, 740 South Limestone, Lexington, KY 40536, USA.
| |
Collapse
|
30
|
Zöller N, Valesky E, Butting M, Hofmann M, Kippenberger S, Bereiter-Hahn J, Bernd A, Kaufmann R. Clinical application of a tissue-cultured skin autograft: an alternative for the treatment of non-healing or slowly healing wounds? Dermatology 2014; 229:190-8. [PMID: 25227494 DOI: 10.1159/000362927] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 04/17/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The treatment regime of non-healing or slowly healing wounds is constantly improving. One aspect is surgical defect coverage whereby mesh grafts and keratinocyte suspension are applied. OBJECTIVE Tissue-cultured skin autografts may be an alternative for the treatment of full-thickness wounds and wounds that cover large areas of the body surface. METHODS Autologous epidermal and dermal cells were isolated, expanded in vitro and seeded on collagen-elastin scaffolds. The developed autograft was immunohistochemically characterized and subsequently transplanted onto a facial chronic ulceration of a 71-year-old patient with vulnerable atrophic skin. RESULTS Characterization of the skin equivalent revealed comparability to healthy human skin due to the epidermal strata, differentiation and proliferation markers. Within 138 days, the skin structure at the transplantation site closely correlated with the adjacent undisturbed skin. CONCLUSION The present study demonstrates the comparability of the developed organotypic skin equivalent to healthy human skin and the versatility for clinical applications.
Collapse
Affiliation(s)
- Nadja Zöller
- Department of Dermatology, Venereology and Allergology, Goethe University Medical School, Frankfurt/Main, Germany
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Sun X, Cheng L, Zhao J, Jin R, Sun B, Shi Y, Zhang L, Zhang Y, Cui W. bFGF-grafted electrospun fibrous scaffolds via poly(dopamine) for skin wound healing. J Mater Chem B 2014; 2:3636-3645. [PMID: 32263800 DOI: 10.1039/c3tb21814g] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Electrospun fibrous membranes coated with basic fibroblast growth factor (bFGF) are effective medical devices to promote wound healing. However, the current strategies of adding bFGF generally cause degradation of electrospun materials or damage to the bioactivity of the biomolecules. Here, we have developed a simple strategy for surface bFGF-functionalization of electrospun fibers in an aqueous solution, which maintained original fiber properties and growth factor bioactivity. Polydopamine (PDA) forming the mussel foot protein was chosen as an adhesive polymeric bridge-layer between substrate poly(lactide-co-glycolide) (PLGA) fibers and bFGF. The bFGF-grafted PDA was analyzed using scanning electron microscopy, water contact angle measurements, and X-ray photoelectron spectroscopy. Improved hydrophilicity together with a stable fibrous structure and biodegradable fibrous matrix suggested that the PLGA/PDA-bFGF electrospun fibrous scaffolds have great potential for promoting wound healing. In vitro experiments showed that the bFGF-grafted PLGA electrospun fibrous scaffolds have highly enhanced adhesion, viability, and proliferation of human dermal fibroblasts. In vivo results showed that such scaffolds shortened wound healing time, accelerated epithelialization and promoted skin remodeling. Therefore, this PDA modification method can be a useful tool to graft biomolecules onto polymeric electrospun fibrous scaffolds which are potential scaffold candidates for repairing skin tissue.
Collapse
Affiliation(s)
- Xiaoming Sun
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital affiliated to Medical School of Shanghai Jiao Tong University, 639 Zhi Zao Ju Road, Shanghai 200011, People's Republic of China.
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Abstract
The contributions of murine models to elucidation of processes central to tumor growth are reviewed. Localized acidosis, increased interstitial pressure, perturbations in structure and function of the extracellular matrix, hypoxia, angiogenesis, and co-optation of the immune response are all phenomena that promote tumor survival and metastasis. The use of animal models is critical to understanding the pathophysiology of these processes and the development of more effective cancer therapies.
Collapse
Affiliation(s)
- Daniel Lindner
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Case Comprehensive Cancer, Cleveland, OH.
| |
Collapse
|
33
|
White-Chu EF, Conner-Kerr TA. Overview of guidelines for the prevention and treatment of venous leg ulcers: a US perspective. J Multidiscip Healthc 2014; 7:111-7. [PMID: 24596466 PMCID: PMC3930479 DOI: 10.2147/jmdh.s38616] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Comprehensive care of chronic venous insufficiency and associated ulcers requires a multipronged and interprofessional approach to care. A comprehensive treatment approach includes exercise, nutritional assessment, compression therapy, vascular reconstruction, and advanced treatment modalities. National guidelines, meta-analyses, and original research studies provide evidence for the inclusion of these approaches in the patient plan of care. The purpose of this paper is to review present guidelines for prevention and treatment of venous leg ulcers as followed in the US. The paper further explores evidence-based yet pragmatic tools for the interprofessional team to use in the management of this complex disorder.
Collapse
Affiliation(s)
- E Foy White-Chu
- Oregon Health and Science University, Portland VA Medical Center, Portland, OR
| | - Teresa A Conner-Kerr
- Winston-Salem State University, Department of Physical Therapy, Winston Salem, NC, USA
| |
Collapse
|
34
|
Abstract
Appropriate wound dressing selection is guided by an understanding of wound dressing properties and an ability to match the level of drainage and depth of a wound. Wounds should be assessed for necrosis and infection, which need to be addressed prior to selecting an ideal dressing. Moisture-retentive dressings include films, hydrogels, hydrocolloids, foams, alginates, and hydrofibers and are useful in a variety of clinical settings. Antimicrobial-impregnated dressings can be useful in wounds that are superficially infected or are at higher risk for infection. For refractory wounds that need more growth stimulation, tissue-engineered dressings have become a viable option in the past few decades, especially those that have been approved for burns, venous ulcers, and diabetic ulcers. As wounds heal, the ideal dressing type may change, depending on the amount of exudate and depth of the wound; thus success in wound dressing selection hinges on recognition of the changing healing environment.
Collapse
|