Keratinocyte grafts for wound healing

Updating on understanding and managing chronic wound

The art of healing wounds is quite complex. It requires the patient's local condition in conjunction with their systemic condition to provide the most ideal wound environment. As wound care is expanding with advances in technology, we are facing a variety of different wound care products based on an assortment of bioengineered skin substances, growth factors, oxygen therapies, low frequency ultrasound and even low energy light. While these emerging evidence-based treatments prove to be promising in improving clinical outcomes and quality of life, it challenges providers to provide cost-effective treatment plans. The goal of this paper is to introduce a discussion regarding practical clinical application of various forms of advanced wound technologies in order to optimize the art of wound healing.

The engineering of tissues using progenitor cells

The "engineering" of a tissue implies that it can be constructed by assembling the necessary components. However, tissues are formed through an evolving, interactive process, not through a collection of parts. This chapter focuses on the biology of the progenitor cell, the native precursor to new tissue, and its role in neogenesis, or the de novo generation of functional tissue. We present a working hypothesis for the generation of parenchymal cell populations and use this hypothesis as a basis for analysis of three parenchymal populations, epidermal cells, hepatocytes of the liver, and pancreatic islets, with a view toward what impact this information will have on the development of cell therapies. By comparing developmental processes, response to injury and disease, and behavior in vitro, we conclude that the adult progenitor cell retains the potential for substantial growth and organ neogenesis and that its biological properties make it the cell of first choice for the engineering of tissues.

Cultured autologous keratinocyte sheets: use on large area burns

The treatment of large burn areas can pose major problems if there are insufficient donor sites. In such cases, cultured autologous keratinocyte sheets present a viable alternative.

Current approaches to venous ulcers and compression

BACKGROUND

Venous ulcers affect as many as 2.5 million people in the United States and can cause substantial pain and loss of function.

OBJECTIVE

To review current approaches to venous ulcers and compression.

METHOD

Treatment options that have been proposed in the literature are discussed utilizing the Cochrane library database, Medline, and the author's clinical experience.

RESULTS

Diagnostic findings and management strategies for venous ulcers are reviewed.

CONCLUSION

Good wound care and compression therapy will heal the majority of small venous ulcers of short duration. For ulcers that are slow to heal, other approaches such as venous surgery and grafting with conventional or bioengineered skin substitutes should be considered.

Interactive wound dressings. A practical guide to their use in older patients

The properties of an ideal wound dressing do not change with the introduction of new types of wound dressing, but the range of effects on wound healing increases. The number of dressings available is enormous, and the choice between them is often bewildering. Because there is still no ideal dressing for all wound types, it is necessary to get to know a few well, and to avoid switching to new therapies solely on the basis of anecdotal reports. The adoption of novel dressings should be based on scientific evidence. At present, dressings are still chosen on the basis of local traditions and personal empirical experience, together with evidence from the few double-blind, placebo-controlled trials that have been performed. In the management of ulcers, a particular wound management plan should not be changed if the ulcer being treated is decreasing in size and the patient is comfortable. The dressing should be chosen with care. The type of chronic ulcer and its appearance, the amount of exudate and the presence or absence of pain all assist in the selection of an appropriate wound dressing product. Quality-of-life aspects are important. In the elderly, good quality of life may not necessarily require complete ulcer healing, although this is naturally desirable. Dressing changes should be minimised and the ulcer should be kept moist and the surrounding skin dry. The high cost of interactive dressings is a potential disadvantage of their use. However, if the wound can be re-dressed at longer intervals and if healing occurs more quickly, their use may be cost effective and associated with less pain and a better quality of life.

Tissue engineering and the development of Apligraf, a human skin equivalent

In recent years, skin grafting has evolved from the initial autograft and allograft preparations to biosynthetic and tissue-engineered living skin replacements. This review details the pioneering work of numerous investigators that led to the following precursors of tissue-engineered skin replacement: cultured autologous keratinocyte grafts, cultured allogeneic keratinocyte grafts, autologous/allogeneic composites, acellular collagen matrices, and cellular matrices. It also discusses the rationale for the development of the newer products and describes the technical advances leading to the development of Apligraf, a tissue-engineered human skin product.

What is new in clinical research in wound healing

Treating the underlying pathophysiology of the wound remains of utmost importance. Several new treatment modalities may soon be available as adjunctive treatments. The efficacy of some remains to be established in well-controlled clinical studies.