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Godavarty A, Leiva K, Amadi N, Klonoff DC, Armstrong DG. Diabetic Foot Ulcer Imaging: An Overview and Future Directions. J Diabetes Sci Technol 2023; 17:1662-1675. [PMID: 37594136 PMCID: PMC10658670 DOI: 10.1177/19322968231187660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Diabetic foot ulcers (DFUs) affect one in every three people with diabetes. Imaging plays a vital role in objectively complementing the gold-standard visual yet subjective clinical assessments of DFUs during the wound treatment process. Herein, an overview of the various imaging techniques used to image DFUs is summarized. Conventional imaging modalities (e.g., computed tomography, magnetic resonance imaging, positron emission tomography, single-photon emitted computed tomography, and ultrasound) are used to diagnose infections, impact on the bones, foot deformities, and blood flow in patients with DFUs. Transcutaneous oximetry is a gold standard to assess perfusion in DFU cases with vascular issues. For a wound to heal, an adequate oxygen supply is needed to facilitate reparative processes. Several optical imaging modalities can assess tissue oxygenation changes in and around the wounds apart from perfusion measurements. These include hyperspectral imaging, multispectral imaging, diffuse reflectance spectroscopy, near-infrared (NIR) spectroscopy, laser Doppler flowmetry or imaging, and spatial frequency domain imaging. While perfusion measurements are dynamically monitored at point locations, tissue oxygenation measurements are static two-dimensional spatial maps. Recently, we developed a spatio-temporal NIR-based tissue oxygenation imaging approach to map for the extent of asynchrony in the oxygenation flow patterns in and around DFUs. Researchers also measure other parameters such as thermal maps, bacterial infections (from fluorescence maps), pH, collagen, and trans-epidermal water loss to assess DFUs. A future direction for DFU imaging would ideally be a low-cost, portable, multi-modal imaging platform that can provide a visual and physiological assessment of wounds for comprehensive wound care intervention and management.
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Affiliation(s)
- Anuradha Godavarty
- Optical Imaging Laboratory, Department of Biomedical Engineering, Florida International University, Miami, FL, USA
| | - Kevin Leiva
- Optical Imaging Laboratory, Department of Biomedical Engineering, Florida International University, Miami, FL, USA
| | - Noble Amadi
- Optical Imaging Laboratory, Department of Biomedical Engineering, Florida International University, Miami, FL, USA
| | - David C. Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
| | - David G. Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Keck School of Medicine of USC, Los Angeles, CA, USA
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Kianian S, Zhao K, Kaur J, Lu KW, Rathi S, Ghosh K, Rogoff H, Hays TR, Park J, Rafailovich M, Simon M, Bui DT, Khan SU, Dagum AB, Singh G. Autologous Skin Grafts, versus Tissue-engineered Skin Constructs: A Systematic Review and Meta-analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5100. [PMID: 37388427 PMCID: PMC10303215 DOI: 10.1097/gox.0000000000005100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/05/2023] [Indexed: 07/01/2023]
Abstract
For over 100 years, autologous skin grafts have remained the gold standard for the reconstruction of wounds but are limited in availability. Acellular tissue-engineered skin constructs (acellular TCs) and cellular tissue-engineered skin constructs (cellular TCs) may address these limitations. This systematic review and meta-analysis compare outcomes between them. Methods A systematic review was conducted using PRISMA guidelines, querying MEDLINE, Embase, Web of Science, and Cochrane to assess graft incorporation, failure, and wound healing. Case reports/series, reviews, in vitro/in vivo work, non-English articles or articles without full text were excluded. Results Sixty-six articles encompassing 4076 patients were included. No significant differences were found between graft failure rates (P = 0.07) and mean difference of percent reepithelialization (p = 0.92) when split-thickness skin grafts were applied alone versus co-grafted with acellular TCs. Similar mean Vancouver Scar Scale was found for these two groups (p = 0.09). Twenty-one studies used at least one cellular TC. Weighted averages from pooled results did not reveal statistically significant differences in mean reepithelialization or failure rates for epidermal cellular TCs compared with split-thickness skin grafts (p = 0.55). Conclusions This systematic review is the first to illustrate comparable functional and wound healing outcomes between split-thickness skin grafts alone and those co-grafted with acellular TCs. The use of cellular TCs seems promising from preliminary findings. However, these results are limited in clinical applicability due to the heterogeneity of study data, and further level 1 evidence is required to determine the safety and efficacy of these constructs.
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Affiliation(s)
- Sara Kianian
- From the Renaissance School of Medicine at Stony Brook University, Stony Brook, N.Y
| | - Kelley Zhao
- From the Renaissance School of Medicine at Stony Brook University, Stony Brook, N.Y
| | | | | | | | - Kanad Ghosh
- From the Renaissance School of Medicine at Stony Brook University, Stony Brook, N.Y
- Department of Plastic and Reconstructive Surgery, University of Chicago, Chicago, Ill
| | - Hunter Rogoff
- From the Renaissance School of Medicine at Stony Brook University, Stony Brook, N.Y
| | - Thomas R Hays
- From the Renaissance School of Medicine at Stony Brook University, Stony Brook, N.Y
- Orlando Health at Orlando Regional Medical Center, Orlando, Fla
| | | | - Miriam Rafailovich
- Department of Materials Science and Chemical Engineering, Stony Brook University Medical Center, Stony Brook, N.Y
| | - Marcia Simon
- Department of Oral Biology and Pathology, School of Dental Medicine, Stony Brook University, Stony Brook, N.Y
| | - Duc T Bui
- From the Renaissance School of Medicine at Stony Brook University, Stony Brook, N.Y
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stony Brook University, Stony Brook, N.Y.
| | - Sami U Khan
- From the Renaissance School of Medicine at Stony Brook University, Stony Brook, N.Y
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stony Brook University, Stony Brook, N.Y.
| | - Alexander B Dagum
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stony Brook University, Stony Brook, N.Y.
| | - Gurtej Singh
- From the Renaissance School of Medicine at Stony Brook University, Stony Brook, N.Y
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stony Brook University, Stony Brook, N.Y.
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Hama R, Reinhardt JW, Ulziibayar A, Watanabe T, Kelly J, Shinoka T. Recent Tissue Engineering Approaches to Mimicking the Extracellular Matrix Structure for Skin Regeneration. Biomimetics (Basel) 2023; 8:biomimetics8010130. [PMID: 36975360 PMCID: PMC10046023 DOI: 10.3390/biomimetics8010130] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
Inducing tissue regeneration in many skin defects, such as large traumatic wounds, burns, other physicochemical wounds, bedsores, and chronic diabetic ulcers, has become an important clinical issue in recent years. Cultured cell sheets and scaffolds containing growth factors are already in use but have yet to restore normal skin tissue structure and function. Many tissue engineering materials that focus on the regeneration process of living tissues have been developed for the more versatile and rapid initiation of treatment. Since the discovery that cells recognize the chemical-physical properties of their surrounding environment, there has been a great deal of work on mimicking the composition of the extracellular matrix (ECM) and its three-dimensional network structure. Approaches have used ECM constituent proteins as well as morphological processing methods, such as fiber sheets, sponges, and meshes. This review summarizes material design strategies in tissue engineering fields, ranging from the morphology of existing dressings and ECM structures to cellular-level microstructure mimicry, and explores directions for future approaches to precision skin tissue regeneration.
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Affiliation(s)
- Rikako Hama
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
- Department of Biotechnology and Life Science, Graduate School of Engineering, Tokyo University of Agriculture and Technology, 2-24-16 Naka-Cho, Koganei 184-8588, Japan
| | - James W Reinhardt
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Anudari Ulziibayar
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Tatsuya Watanabe
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - John Kelly
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Toshiharu Shinoka
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
- Department of Cardiothoracic Surgery, The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
- Department of Surgery, Cardiovascular Tissue Engineering Program, Ohio State University, Columbus, OH 43210, USA
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Low frequency oscillations assessed by diffuse speckle contrast analysis for foot angiosome concept. Sci Rep 2020; 10:17153. [PMID: 33051486 PMCID: PMC7553923 DOI: 10.1038/s41598-020-73604-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/03/2020] [Indexed: 12/14/2022] Open
Abstract
An angiosome refers to a 3D tissue volume that is vascularized by a single artery and is a relatively new concept that is useful in vascular surgery; however, the direct relationship between arterial blood flow and micro-perfusion is still controversial. Here, we propose a diffuse speckle contrast analysis (DSCA), which is an emerging tissue perfusion monitoring modality, to investigate the correlations among low frequency oscillations (LFOs) measured from different areas on the feet of healthy subjects. We obtained reproducible results from the correlation analyses of LFOs, and their physiological implications were discussed. In order to confirm the changes in the frequency oscillations, we analyzed and compared the power spectral density changes due to heart rate variability in the electrocardiographic signal during reactive hyperemia and head-up tilt protocols.
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Tchero H, Herlin C, Bekara F, Kangambega P, Sergiu F, Teot L. Failure rates of artificial dermis products in treatment of diabetic foot ulcer: A systematic review and network meta-analysis. Wound Repair Regen 2017; 25:691-696. [PMID: 28597935 DOI: 10.1111/wrr.12554] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/23/2017] [Indexed: 11/28/2022]
Abstract
Diabetic foot ulcer (DFU) is a frequent complication in diabetic patients, occurring in up to 25% of those affected. Among the treatments available to clinicians, the use of bioengineered skin substitutes is an attractive alternative. Artificial dermis functions as a matrix, covering the wound and supporting healing and reconstruction of the lost tissue. This study was aimed at reviewing the use of five regeneration matrices (namely, Integra, Nevelia, Matriderm, Pelnac, and Renoskin) as reported by clinical trials. We searched Medline, Embase, ISI Web of Science, Scopus, and Cochrane Central Register of Controlled Trials databases for relevant studies. Risk of failure rates was analysed by relative risk ratio method and complete ulcer healing was studied using network meta-analysis. Thirteen studies (12 randomized clinical trials and one cohort study) were eligible for analysis. The network meta-analysis based on a single study for Matriderm and 12 studies for other products showed that Matriderm was statistically inferior in achieving complete ulcer healing, as compared to all other products combined. In the second phase analysis, which was limited to three studies using artificial dermis products, there was a 57% reduction in the risk of reepithelialization failure for DFU patients who used Matriderm or Pelnac, compared to those who used Pelnac with basic fibroblast growth factor spray or skin grafting. The data showed an overall low failure rate suggesting that these bioengineered skin products provide a suitable support and microenvironment for healing of DFUs with low ulcer recurrence rates. This systematic review with meta-analysis highlights the pressing need for more studies investigating the safety, efficacy and failure rates of regeneration matrices in the treatment of DFUs.
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Affiliation(s)
- Huidi Tchero
- Department of Trauma and Orthopedic Surgery, CH Saint Martin, Guadeloupe, France
| | - Christian Herlin
- Department of Reconstructive and Plastic Surgery, Montpellier, France
| | - Farid Bekara
- Department of Reconstructive and Plastic Surgery, Montpellier, France
| | - Pauline Kangambega
- Department of Division of Diabetes, Endocrinology and Metabolism, CHRU de Pointe-A-Pitre, Pointe-A-Pitre, Guadeloupe, France
| | - Fluieraru Sergiu
- Department of Reconstructive and Plastic Surgery, Montpellier, France
| | - Luc Teot
- Department of Reconstructive and Plastic Surgery, Montpellier, France
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Nicholas MN, Jeschke MG, Amini-Nik S. Methodologies in creating skin substitutes. Cell Mol Life Sci 2016; 73:3453-72. [PMID: 27154041 PMCID: PMC4982839 DOI: 10.1007/s00018-016-2252-8] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 04/21/2016] [Accepted: 04/22/2016] [Indexed: 12/14/2022]
Abstract
The creation of skin substitutes has significantly decreased morbidity and mortality of skin wounds. Although there are still a number of disadvantages of currently available skin substitutes, there has been a significant decline in research advances over the past several years in improving these skin substitutes. Clinically most skin substitutes used are acellular and do not use growth factors to assist wound healing, key areas of potential in this field of research. This article discusses the five necessary attributes of an ideal skin substitute. It comprehensively discusses the three major basic components of currently available skin substitutes: scaffold materials, growth factors, and cells, comparing and contrasting what has been used so far. It then examines a variety of techniques in how to incorporate these basic components together to act as a guide for further research in the field to create cellular skin substitutes with better clinical results.
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Affiliation(s)
- Mathew N Nicholas
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Ross Tilley Burn Centre, Sunnybrook Research Institute, Room: M7-140, 2075 Bayview Ave., Toronto, ON, M4N 3M5, Canada
| | - Marc G Jeschke
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Ross Tilley Burn Centre, Sunnybrook Research Institute, Room: M7-140, 2075 Bayview Ave., Toronto, ON, M4N 3M5, Canada
| | - Saeid Amini-Nik
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Ross Tilley Burn Centre, Sunnybrook Research Institute, Room: M7-140, 2075 Bayview Ave., Toronto, ON, M4N 3M5, Canada.
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Yoon H, Lee JS, Yim H, Kim G, Chun W. Development of cell-laden 3D scaffolds for efficient engineered skin substitutes by collagen gelation. RSC Adv 2016. [DOI: 10.1039/c5ra19532b] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Cell-laden layered scaffolds containing keratinocytes and fibroblasts were fabricated using a 3D cell-printing technique. The scaffolds effectively promoted proliferation and migration, and can be efficiently used as engineered skin substitutes.
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Affiliation(s)
- Hyeon Yoon
- Burn Institute
- Hangang Sacred Heart Hospital
- College of Medicine
- Hallym Univeristy
- Seoul 150-719
| | - Ji-Seon Lee
- Burn Institute
- Hangang Sacred Heart Hospital
- College of Medicine
- Hallym Univeristy
- Seoul 150-719
| | - Haejun Yim
- Department of Surgery
- Hangang Sacred Heart Hospital
- College of Medicine
- Hallym Univeristy
- Seoul 150-719
| | - Geunhyung Kim
- Department of Biomechatronic Eng
- Sungkyunkwan University (SKKU)
- Suwon 440-746
- South Korea
| | - Wook Chun
- Burn Institute
- Hangang Sacred Heart Hospital
- College of Medicine
- Hallym Univeristy
- Seoul 150-719
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Yoon H, Yang HT, Yim H, Kym D, Hur J, Yang E, Jung S, Yang S, Kim G, Kim JB, Chun W, Cho YS. Effectiveness of wound healing using the novel collagen dermal substitute INSUREGRAF®. RSC Adv 2016. [DOI: 10.1039/c5ra27423k] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The pore structure of INSUREGRAF® built up from parallel collagen layers connected by single fivers and sizes are very uniform. Therefore, this is more suitable with respect to cell penetration, distribution, and acceleration of skin regeneration.
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