1
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Dhar S, Chrisman T, Simman R. Clinical Indications of Cultured Epithelial Autografts. Ann Plast Surg 2023; 91:433-440. [PMID: 37157145 DOI: 10.1097/sap.0000000000003558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
ABSTRACT Cultured epithelial autografts (CEAs) have been used for decades as a treatment for massive burn injuries. Cultured epithelial autografts allow for wounds to heal by taking a small sample and growing a patient's own epithelium in culture to create large, graftable sheets. This technique is especially useful in large wounds where donor sites are limited compared with conventional skin grafting. However, CEAs have a variety of uses in wound healing and reconstruction and have the potential to aid in the closure of several types of defects. Cultured epithelial autografts have shown applicability in large burns, chronic nonhealing wounds, ulcerating wounds of various etiologies, congenital defects, wounds requiring specialized epithelium to replace like by like, and wounds in critically ill patients. Several factors must be considered when using CEAs, such as time, cost, and outcomes. In this article, we detail the various clinical applications of CEAs and how they can be situationally advantageous outside of their original purpose.
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Affiliation(s)
- Sarit Dhar
- From the Department of Surgery, University of Toledo, College of Medicine and Life Science
| | - Timothy Chrisman
- From the Department of Surgery, University of Toledo, College of Medicine and Life Science
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2
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Riccio M, Bondioli E, Senesi L, Zingaretti N, Gargiulo P, De Francesco F, Parodi PC, Zavan B. Fragmented Dermo-Epidermal Units (FdeU) as an Emerging Strategy to Improve Wound Healing Process: An In Vitro Evaluation and a Pilot Clinical Study. J Clin Med 2023; 12:6165. [PMID: 37834809 PMCID: PMC10573238 DOI: 10.3390/jcm12196165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/06/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Innovative strategies have shown beneficial effects in healing wound management involving, however, a time-consuming and arduous process in clinical contexts. Micro-fragmented skin tissue acts as a slow-released natural scaffold and continuously delivers growth factors, and much other modulatory information, into the microenvironment surrounding damaged wounds by a paracrine function on the resident cells which supports the regenerative process. In this study, in vitro and in vivo investigations were conducted to ascertain improved effectiveness and velocity of the wound healing process with the application of fragmented dermo-epidermal units (FdeU), acquired via a novel medical device (Hy-Tissue® Micrograft Technology). MTT test; LDH test; ELISA for growth factor investigation (IL) IL-2, IL-6, IL-7 IL-8, IL-10; IGF-1; adiponectin; Fibroblast Growth Factor (FGF); Vascular Endothelial Growth Factor (VEGF); and Tumor Necrosis Factor (TNF) were assessed. Therefore, clinical evaluation in 11 patients affected by Chronic Wounds (CW) and treated with FdeU were investigated. Functional outcome was assessed pre-operatory, 2 months after treatment (T0), and 6 months after treatment (T1) using the Wound Bed Score (WBS) and Vancouver Scar Scale (VSS). In this current study, we demonstrate the potential of resident cells to proliferate from the clusters of FdeU seeded in a monolayer that efficiently propagate the chronic wound. Furthermore, in this study we report how the discharge of trophic/reparative proteins are able to mediate the in vitro paracrine function of proliferation, migration, and contraction rate in fibroblasts and keratinocytes. Our investigations recommend FdeU as a favorable tool in wound healing, displaying in vitro growth-promoting potential to enhance current therapeutic mechanisms.
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Affiliation(s)
- Michele Riccio
- Department of Reconstructive Surgery and Hand Surgery, University Hospital (AOU Ospedali Riuniti di Ancona), Via Conca 71, Torrette di Ancona, 60123 Ancona, Italy; (M.R.); (L.S.); (F.D.F.)
| | - Elena Bondioli
- Burn Center and Emilia Romagna Regional Skin Bank, Bufalini Hospital, AUSL della Romagna, 47521 Cesena, Italy;
| | - Letizia Senesi
- Department of Reconstructive Surgery and Hand Surgery, University Hospital (AOU Ospedali Riuniti di Ancona), Via Conca 71, Torrette di Ancona, 60123 Ancona, Italy; (M.R.); (L.S.); (F.D.F.)
| | - Nicola Zingaretti
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine, 33100 Udine, Italy; (N.Z.); (P.C.P.)
| | - Paolo Gargiulo
- Engineering Department, King’s College, London WC2R 2LS, UK;
- Institute for Biomedical and Neural Engineering, Reykjavík University, 101 Reykjavík, Iceland
| | - Francesco De Francesco
- Department of Reconstructive Surgery and Hand Surgery, University Hospital (AOU Ospedali Riuniti di Ancona), Via Conca 71, Torrette di Ancona, 60123 Ancona, Italy; (M.R.); (L.S.); (F.D.F.)
| | - Pier Camillo Parodi
- Clinic of Plastic and Reconstructive Surgery, Academic Hospital of Udine, Department of Medical Area (DAME), University of Udine, 33100 Udine, Italy; (N.Z.); (P.C.P.)
| | - Barbara Zavan
- Department of Translational Medicine, University of Ferrara, Via Fossato di Mortara 70, 44121 Ferrara, Italy
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Segni AD, BenShoshan M, Harats M, Melnikov N, Barzilay CM, Dothan D, Liaani A, Kornhaber R, Haik J. Personalised burn treatment: bedside electrospun nanofibre scaffold with cultured autologous keratinocytes: a case study. J Wound Care 2023; 32:428-436. [PMID: 37405944 DOI: 10.12968/jowc.2023.32.7.428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Nearly four decades after cultured epidermal autografts (CEA) were first used for the treatment of extensive burn wounds, the current gold standard treatment remains grafting healthy autologous skin from a donor site to the damaged areas, with current skin substitutes limited in their clinical use. We propose a novel treatment approach, using an electrospun polymer nanofibrous matrix (EPNM) applied on-site directly on the CEA-grafted areas. In addition, we propose a personalised treatment on hard-to-heal areas, in which we spray suspended autologous keratinocytes integrated with 3D EPNM applied on-site, directly onto the wound bed. This method enables the coverage of larger wound areas than possible with CEA. We present the case of a 26-year-old male patient with full-thickness burns covering 98% of his total body surface area (TBSA). We were able to show that this treatment approach resulted in good re-epithelialisation, seen as early as seven days post CEA grafting, with complete wound closure within three weeks, and to a lesser extent in areas treated with cell spraying. Moreover, in vitro experiments confirmed the feasibility of using keratinocytes embedded within the EPNM: cell and culture viability, identity, purity and potency were determined. These experiments show that the skin cells are viable and can proliferate within the EPNM. The results presented are of a promising novel strategy for the development of personalised wound treatment, integrating on-the-spot 'printed' EPNM with autologous skin cells, which will be applied at the bedside, over deep dermal wounds, to accelerate healing time and wound closure.
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Affiliation(s)
- Ayelet Di Segni
- The Green Skin Engineering Center, National Burn Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Marina BenShoshan
- The Green Skin Engineering Center, National Burn Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Moti Harats
- National Burn Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Talpiot Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
| | - Nir Melnikov
- The Green Skin Engineering Center, National Burn Center, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Daniel Dothan
- The Green Skin Engineering Center, National Burn Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Adi Liaani
- The Green Skin Engineering Center, National Burn Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Rachel Kornhaber
- National Burn Center, Sheba Medical Center, Tel Hashomer, Israel
- School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, NSW, Australia
| | - Josef Haik
- The Green Skin Engineering Center, National Burn Center, Sheba Medical Center, Tel Hashomer, Israel
- National Burn Center, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Talpiot Leadership Program, Sheba Medical Center, Tel Hashomer, Israel
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4
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Motamedi S, Esfandpour A, Babajani A, Jamshidi E, Bahrami S, Niknejad H. The Current Challenges on Spray-Based Cell Delivery to the Skin Wounds. Tissue Eng Part C Methods 2021; 27:543-558. [PMID: 34541897 DOI: 10.1089/ten.tec.2021.0158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Cell delivery through spray instruments is a promising and effective method in tissue engineering and regenerative medicine. It is used for treating different acute and chronic wounds, including burns with different etiologies, chronic diabetic or venous wounds, postcancer surgery, and hypopigmentation disorders. Cell spray can decrease the needed donor site area compared with conventional autologous skin grafting. Keratinocytes, fibroblasts, melanocytes, and mesenchymal stem cells are promising cell sources for cell spray procedures. Different spray instruments are designed and utilized to deliver the cells to the intended skin area. In an efficient spray instrument, cell viability and wound coverage are two determining parameters influenced by various physical and biological factors such as air pressure, spraying distance, viscosity of suspension, stiffness of the wound surface, and velocity of impact. Besides, to improve cell delivery by spray instruments, some matrices and growth factors can be added to cell suspensions. This review focuses on the different types of cells and spray instruments used in cell delivery procedures. It also discusses physical and biological parameters associated with cell viability and wound coverage in spray instruments. Moreover, the recent advances in codelivery of cells with biological glues and growth factors, as well as clinical translation of cell spraying, have been reviewed. Impact statement Skin wounds are a group of prevalent injuries that can lead to life-threatening complexities. As a focus of interest, stem cell therapy and spray-based cell delivery have effectively decreased associated morbidity and mortality. This review summarizes a broad scope of recent evidence related to spray-based cell therapy, instruments, and approaches adopted to make the process more efficient in treating skin wounds. An overview including utilized cell types, clinical cases, and current challenges is also provided.
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Affiliation(s)
- Shiva Motamedi
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arefeh Esfandpour
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirhesam Babajani
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Jamshidi
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheyl Bahrami
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in AUVA Research Center, Vienna, Austria
| | - Hassan Niknejad
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ning X, Wiraja C, Lio DCS, Xu C. A Double-Layered Microneedle Platform Fabricated through Frozen Spray-Coating. Adv Healthc Mater 2020; 9:e2000147. [PMID: 32323491 DOI: 10.1002/adhm.202000147] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/27/2020] [Indexed: 11/07/2022]
Abstract
This work reports a frozen spray-coating method for the fabrication of double-layered microneedles (MNs). Taking swellable methacrylated hyaluronic acid (MeHA)-derived MNs as the model, both hydrophobic molecules (Nile red, Cy5) and hydrophilic ones (FITC, FITC-Dextran, Insulin) can be homogeneously coated without impacting the mechanical properties of the original MeHA MNs. The prepared double-layered MNs can execute multiple roles. It is demonstrated that insulin-coated MeHA double-layered MNs allow the effective delivery of the insulin into circulation of mice for controlling the blood glucose level while they also permit the extraction of skin interstitial fluid for the timely analysis of the biomarker (glucose).
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Affiliation(s)
- Xiaoyu Ning
- School of Chemical and Biomedical EngineeringNanyang Technological University 70 Nanyang Drive Singapore 637457 Singapore
| | - Christian Wiraja
- School of Chemical and Biomedical EngineeringNanyang Technological University 70 Nanyang Drive Singapore 637457 Singapore
| | - Daniel Chin Shiuan Lio
- School of Chemical and Biomedical EngineeringNanyang Technological University 70 Nanyang Drive Singapore 637457 Singapore
| | - Chenjie Xu
- School of Chemical and Biomedical EngineeringNanyang Technological University 70 Nanyang Drive Singapore 637457 Singapore
- National Dental Centre of Singapore 5 Second Hospital Ave Singapore 168938 Singapore
- Department of Biomedical EngineeringCity University of Hong Kong 83 Tat Chee Avenue Kowloon Hong Kong SAR China
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Larson KW, Austin CL, Thompson SJ. Treatment of a Full-Thickness Burn Injury With NovoSorb Biodegradable Temporizing Matrix and RECELL Autologous Skin Cell Suspension: A Case Series. J Burn Care Res 2020; 41:215-219. [PMID: 31765469 PMCID: PMC6990449 DOI: 10.1093/jbcr/irz179] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Dermal substitutes coupled with split thickness skin graft are the primary method of treating most severe full-thickness burns particularly when there is a lack of healthy donor skin. Although dermal replacements optimize functional and aesthetic outcomes in patients, the risk of infection and the amount of time required to process most dermal substitutes delay treatment potentially compromising graft take and the overall healing process. The purpose of this case series is to describe the treatment course of patients with severe burn injuries using a novel synthetic Biodegradable Temporizing Matrix (NovoSorb BTM) in conjunction with RECELL Autologous Cell Harvesting Device, a new methodology allowing for a timely point-of-care preparation of an autologous skin cell suspension in combination with a 3:1 split-thickness skin graft. To the best of our knowledge, this is the first reported case series to describe the treatment algorithm and clinical outcomes of deep full-thickness burns utilizing BTM in conjunction with RECELL ASCS.
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Affiliation(s)
- Kenneth W Larson
- Trauma and Burn Research, Mercy Hospital – Springfield, Missouri
| | - Cindy L Austin
- Trauma and Burn Research, Mercy Hospital – Springfield, Missouri
| | - Simon J Thompson
- Trauma and Burn Research, Mercy Hospital – Springfield, Missouri
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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: 81] [Impact Index Per Article: 16.2] [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.
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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.
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8
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Lo CH, Chong E, Akbarzadeh S, Brown WA, Cleland H. A systematic review: Current trends and take rates of cultured epithelial autografts in the treatment of patients with burn injuries. Wound Repair Regen 2019; 27:693-701. [DOI: 10.1111/wrr.12748] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/15/2019] [Accepted: 07/07/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Cheng H. Lo
- Victorian Adult Burns Service Melbourne Victoria Australia
- Department of Surgery, Central Clinical SchoolMonash University Melbourne Victoria Australia
| | - Elaine Chong
- Centre for Eye Research AustraliaRoyal Victorian Eye & Ear Hospital East Melbourne Victoria Australia
| | - Shiva Akbarzadeh
- Skin Bioengineering LaboratoryVictorian Adult Burns Service Melbourne Victoria Australia
| | - Wendy A. Brown
- Department of Surgery, Central Clinical SchoolMonash University Melbourne Victoria Australia
| | - Heather Cleland
- Victorian Adult Burns Service Melbourne Victoria Australia
- Department of Surgery, Central Clinical SchoolMonash University Melbourne Victoria Australia
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9
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Yeong EK, O'Boyle CP, Huang HF, Tai HC, Hsu YC, Chuang SY, Wu YF, Chang CW, Liu TJ, Lai HS. Response of a local hospital to a burn disaster: Contributory factors leading to zero mortality outcomes. Burns 2018; 44:1083-1090. [PMID: 29753454 DOI: 10.1016/j.burns.2018.03.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/13/2018] [Accepted: 03/21/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the outcomes of a local healthcare system in managing a burn mass casualty incident (BMCI). METHODS Thirty-three victims admitted to the National Taiwan University Hospital within 96h of the explosion were included in the study. Data were recorded on: patient demographics, Baux score, laboratory data, management response, treatment strategies, and outcomes. Case notes from June 27, 2015 to November 2015 were reviewed with a focus on fluid resuscitation, ventilation support, nutrition, infection control, sepsis treatment, and wound closure plan. RESULTS Female predominance (mean age: 21.7 years) and lower extremity circumferential flame burns were the characteristics of the burn injury. The mean Baux score was 70±18. The mean burn area was 42% of the total body surface area (TBSA). A total of 79% patients arrived at the hospital within 24h of sustaining injuries. Intensive care unit (ICU) admission criteria were modified to accommodate patients with 40% TBSA of burns, facilities were expanded from 4 ICU beds to 18 beds, and new staff was recruited. A total of 36% patients (n=12/33, 62±13 TBSA of burns) required fluid resuscitation. The mean volume of Lactate Ringer administered in the first 24h of burns was 3.34±2.18ml/kg/%TBSA, while the mean volume of fresh frozen plasma administered was 0.60±0.63ml/kg/h. Forty-two percent patients were intubated on the day of admission, and 71% of the intubated patients had inhalation injuries that were confirmed by diagnostic bronchoscopy. The mean intubation period was 17±9 days. The incidence of pulmonary edema was 58% (n=7/12), possibly due to sub-optimal monitoring. Of these, 57% (n=4/7) patients progressed to adult respiratory distress syndrome, but were successfully treated with early strict fluid restriction, systemic antibiotics, ventilation support, and bronchial lavage. A total of 94% patients received grafting. The mean grafted area was 4432.3±3891cm2. Tube feeding was provided to patients with burns >40% TBSA. All patients tolerated gastric tube feeding without conversion to duodenal switch. On admission, all patients received prophylactic antibiotics. Septic shock was noted in 12 patients, but no mortality occurred. The mean hospital stay was 1.5 days per percent burn. CONCLUSIONS This article highlights the value of precise triage, traffic control, and effective resource allocation in treating a BMCI. Effective supporting systems for facility expansion, staff recruitment, medical supplies and clear-cut treatment strategies for severely burned patients are contributory factors leading to zero mortalities in our series, in addition to young age and minimal inhalation injuries. The need for reevaluation of the safety of cornstarch powder in festival activities is clear.
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Affiliation(s)
- Eng-Kean Yeong
- Department of Surgery, National Taiwan University Hospital, No. 7, Chung Shan South Road, Taipei, Taiwan; Department of Surgery, National Taiwan University Hospital, Yunlin Branch No. 95, Xuefu Rd, Huwei Township, Yunlin County, 632, Taiwan
| | - Ciaran P O'Boyle
- Department of Burns & Plastic Surgery, Nottingham University Hospitals NHS Trust, UK and School of Medicine, The University of Nottingham, Nottingham, Hucknall Rd, Nottingham NG5 1PB, UK
| | - Hui-Fu Huang
- Department of Surgery, National Taiwan University Hospital, No. 7, Chung Shan South Road, Taipei, Taiwan
| | - Hao-Chih Tai
- Department of Surgery, National Taiwan University Hospital, No. 7, Chung Shan South Road, Taipei, Taiwan
| | - Yen-Chun Hsu
- Department of Anesthesiology, National Taiwan University Hospital, No. 7, Chung Shan South Road, Taipei, Taiwan
| | - Shu-Yang Chuang
- Department of Surgery, National Taiwan University Hospital, No. 7, Chung Shan South Road, Taipei, Taiwan
| | - Yu-Feng Wu
- Department of Surgery, National Taiwan University Hospital, No. 7, Chung Shan South Road, Taipei, Taiwan
| | - Che-Wei Chang
- Department of Surgery, National Taiwan University Hospital, No. 7, Chung Shan South Road, Taipei, Taiwan
| | - Tom J Liu
- Department of Surgery, National Taiwan University Hospital, No. 7, Chung Shan South Road, Taipei, Taiwan
| | - Hong-Shiee Lai
- Department of Surgery, National Taiwan University Hospital, No. 7, Chung Shan South Road, Taipei, Taiwan.
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10
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Skin-Derived Stem Cells for Wound Treatment Using Cultured Epidermal Autografts: Clinical Applications and Challenges. Stem Cells Int 2018; 2018:4623615. [PMID: 29765411 PMCID: PMC5889868 DOI: 10.1155/2018/4623615] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/03/2018] [Indexed: 12/15/2022] Open
Abstract
The human skin fulfills important barrier, sensory, and immune functions-all of which contribute significantly to health and organism integrity. Widespread skin damage requires immediate treatment and coverage because massive skin loss fosters the invasion of pathogens, causes critical fluid loss, and may ultimately lead to death. Since the skin is a highly immunocompetent organ, autologous transplants are the only viable approach to permanently close a widespread skin wound. Despite the development of tissue-saving autologous transplantation techniques such as mesh and Meek grafts, treatment options for extensive skin damage remain severely limited. Yet, the skin is also a rich source of stem and progenitor cells. These cells promote wound healing under physiological conditions and are potential sources for tissue engineering approaches aiming to augment transplantable tissue by generating cultured epidermal autografts (CEAs). Here, we review autologous tissue engineering strategies as well as transplantation products based on skin-derived stem cells. We further provide an overview of clinical trial activities in the field and discuss relevant translational and clinical challenges associated with the use of these products.
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11
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Martin YH, Jubin K, Smalley S, Wong JPF, Brown RA, Metcalfe AD. A novel system for expansion and delivery of human keratinocytes for the treatment of severe cutaneous injuries using microcarriers and compressed collagen. J Tissue Eng Regen Med 2017; 11:3124-3133. [PMID: 28052577 DOI: 10.1002/term.2220] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 04/06/2016] [Accepted: 04/19/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Y. H. Martin
- Blond McIndoe Research Foundation; Queen Victoria Hospital; East Grinstead West Sussex UK
- Brighton Centre for Regenerative Medicine; University of Brighton; Brighton East Sussex UK
| | - K. Jubin
- Blond McIndoe Research Foundation; Queen Victoria Hospital; East Grinstead West Sussex UK
| | - S. Smalley
- Blond McIndoe Research Foundation; Queen Victoria Hospital; East Grinstead West Sussex UK
| | - J. P. F. Wong
- UCL Tissue Repair and Engineering Centre; University College London; London UK
| | - R. A. Brown
- UCL Tissue Repair and Engineering Centre; University College London; London UK
| | - A. D. Metcalfe
- Blond McIndoe Research Foundation; Queen Victoria Hospital; East Grinstead West Sussex UK
- Brighton Centre for Regenerative Medicine; University of Brighton; Brighton East Sussex UK
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12
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Esteban-Vives R, Young MT, Zhu T, Beiriger J, Pekor C, Ziembicki J, Corcos A, Rubin P, Gerlach JC. Calculations for reproducible autologous skin cell-spray grafting. Burns 2016; 42:1756-1765. [DOI: 10.1016/j.burns.2016.06.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 01/09/2023]
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13
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Ibrahim B, Sheerin AN, Jennert-Burston K, Bird JLE, Massala MV, Illsley M, James SE, Faragher RGA. Absence of premature senescence in Werner's syndrome keratinocytes. Exp Gerontol 2016; 83:139-47. [PMID: 27492502 DOI: 10.1016/j.exger.2016.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/29/2016] [Accepted: 07/31/2016] [Indexed: 11/29/2022]
Abstract
Werner's syndrome (WS) is an autosomal recessive genetic disorder caused by loss of function mutation in wrn and is a useful model of premature in vivo ageing. Cellular senescence is a plausible causal mechanism of mammalian ageing and, at the cellular level, WS fibroblasts show premature senescence resulting from a combination of telomeric attrition and replication fork stalling. Over 90% of WS fibroblast cultures achieve <20 population doublings (PD) in vitro compared to wild type human fibroblast cultures. It has been proposed that some cell types, capable of proliferation, will fail to show a premature senescence phenotype in response to wrn mutations. To test this hypothesis, human dermal keratinocytes (derived from both WS and wild type patients) were cultured long term. WS Keratinocytes showed a replicative lifespan in excess of 100 population doublings but maintained functional growth arrest mechanisms based on p16 and p53. The karyotype of the cells was superficially normal and the cultures retained markers characteristic of keratinocyte holoclones (stem cells) including p63 expression and telomerase activity. Accordingly we conclude that, in contrast to WS fibroblasts, WS keratinocytes do not demonstrate slow growth rates or features of premature senescence. These findings suggest that the epidermis is among the tissue types that do not display symptoms of premature ageing caused by loss of function of wrn. This is in support that Werner's syndrome is a segmental progeroid syndrome.
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Affiliation(s)
- Badr Ibrahim
- School of Pharmacy and biomolecular sciences, stress, ageing and diseases research group, College of life, health and physical sciences, University of Brighton, Cockcroft Building, Brighton, BN149HJ, England.
| | - Angela N Sheerin
- School of Pharmacy and biomolecular sciences, stress, ageing and diseases research group, College of life, health and physical sciences, University of Brighton, Cockcroft Building, Brighton, BN149HJ, England.
| | - Katrin Jennert-Burston
- School of Pharmacy and biomolecular sciences, stress, ageing and diseases research group, College of life, health and physical sciences, University of Brighton, Cockcroft Building, Brighton, BN149HJ, England.
| | - Joe L E Bird
- School of Pharmacy and biomolecular sciences, stress, ageing and diseases research group, College of life, health and physical sciences, University of Brighton, Cockcroft Building, Brighton, BN149HJ, England.
| | - M V Massala
- Department of Dermatology, University of Sassari, Viale S Pietro No 43, 09100 Sassari, Italy, Department of Human and Hereditary Pathology, Section of General Biology and Medical Genetics, University of Pavia, Pavia
| | - Matthew Illsley
- School of Pharmacy and biomolecular sciences, stress, ageing and diseases research group, College of life, health and physical sciences, University of Brighton, Cockcroft Building, Brighton, BN149HJ, England.
| | - S Elizabeth James
- School of Pharmacy and biomolecular sciences, stress, ageing and diseases research group, College of life, health and physical sciences, University of Brighton, Cockcroft Building, Brighton, BN149HJ, England.
| | - Richard G A Faragher
- School of Pharmacy and biomolecular sciences, stress, ageing and diseases research group, College of life, health and physical sciences, University of Brighton, Cockcroft Building, Brighton, BN149HJ, England.
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Chua AWC, Khoo YC, Tan BK, Tan KC, Foo CL, Chong SJ. Skin tissue engineering advances in severe burns: review and therapeutic applications. BURNS & TRAUMA 2016; 4:3. [PMID: 27574673 PMCID: PMC4963933 DOI: 10.1186/s41038-016-0027-y] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/11/2016] [Indexed: 01/13/2023]
Abstract
Current advances in basic stem cell research and tissue engineering augur well for the development of improved cultured skin tissue substitutes: a class of products that is still fraught with limitations for clinical use. Although the ability to grow autologous keratinocytes in-vitro from a small skin biopsy into sheets of stratified epithelium (within 3 to 4 weeks) helped alleviate the problem of insufficient donor site for extensive burn, many burn units still have to grapple with insufficient skin allografts which are used as intermediate wound coverage after burn excision. Alternatives offered by tissue-engineered skin dermal replacements to meet emergency demand have been used fairly successfully. Despite the availability of these commercial products, they all suffer from the same problems of extremely high cost, sub-normal skin microstructure and inconsistent engraftment, especially in full thickness burns. Clinical practice for severe burn treatment has since evolved to incorporate these tissue-engineered skin substitutes, usually as an adjunct to speed up epithelization for wound closure and/or to improve quality of life by improving the functional and cosmetic results long-term. This review seeks to bring the reader through the beginnings of skin tissue engineering, the utilization of some of the key products developed for the treatment of severe burns and the hope of harnessing stem cells to improve on current practice.
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Affiliation(s)
- Alvin Wen Choong Chua
- Singapore General Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, 20 College Road, Academia Level 4, Singapore, 169845 Singapore ; Singapore General Hospital, Skin Bank Unit, Block 4 Level 3 Room 15, Outram Road, Singapore, 169608 Singapore ; Transplant Tissue Centre, c/o Skin Bank Unit, Singapore General Hospital, Block 4 Level 3 Room A7, Outram Road, Singapore, 169608 Singapore
| | - Yik Cheong Khoo
- Singapore General Hospital, Skin Bank Unit, Block 4 Level 3 Room 15, Outram Road, Singapore, 169608 Singapore ; Transplant Tissue Centre, c/o Skin Bank Unit, Singapore General Hospital, Block 4 Level 3 Room A7, Outram Road, Singapore, 169608 Singapore
| | - Bien Keem Tan
- Singapore General Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, 20 College Road, Academia Level 4, Singapore, 169845 Singapore ; Singapore General Hospital, Skin Bank Unit, Block 4 Level 3 Room 15, Outram Road, Singapore, 169608 Singapore ; Transplant Tissue Centre, c/o Skin Bank Unit, Singapore General Hospital, Block 4 Level 3 Room A7, Outram Road, Singapore, 169608 Singapore
| | - Kok Chai Tan
- Singapore General Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, 20 College Road, Academia Level 4, Singapore, 169845 Singapore ; Singapore General Hospital, Skin Bank Unit, Block 4 Level 3 Room 15, Outram Road, Singapore, 169608 Singapore
| | - Chee Liam Foo
- Singapore General Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, 20 College Road, Academia Level 4, Singapore, 169845 Singapore ; Singapore General Hospital, Skin Bank Unit, Block 4 Level 3 Room 15, Outram Road, Singapore, 169608 Singapore
| | - Si Jack Chong
- Singapore General Hospital, Department of Plastic, Reconstructive and Aesthetic Surgery, 20 College Road, Academia Level 4, Singapore, 169845 Singapore ; Singapore General Hospital, Skin Bank Unit, Block 4 Level 3 Room 15, Outram Road, Singapore, 169608 Singapore ; Transplant Tissue Centre, c/o Skin Bank Unit, Singapore General Hospital, Block 4 Level 3 Room A7, Outram Road, Singapore, 169608 Singapore
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15
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Lenihan C, Rogers C, Metcalfe AD, Martin YH. The effect of isolation and culture methods on epithelial stem cell populations and their progeny—toward an improved cell expansion protocol for clinical application. Cytotherapy 2014; 16:1750-9. [DOI: 10.1016/j.jcyt.2014.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/09/2014] [Accepted: 06/08/2014] [Indexed: 01/01/2023]
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16
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Mcheik JN, Barrault C, Pedretti N, Garnier J, Juchaux F, Levard G, Morel F, Bernard FX, Lecron JC. Study of proliferation and 3D epidermal reconstruction from foreskin, auricular and trunk keratinocytes in children. Burns 2014; 41:352-8. [PMID: 25234956 DOI: 10.1016/j.burns.2014.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 05/31/2014] [Accepted: 07/06/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Severe burns in children are conventionally treated with split-thickness skin autografts or epidermal sheets. An alternative approach is to graft isolated keratinocytes. We evaluated foreskin and other anatomic sites as donor sources for autologous keratinocyte graft in children. We studied in vitro capacities of isolated keratinocytes to divide and reconstitute epidermal tissue. METHODS Keratinocytes were isolated from foreskin, auricular skin, chest and abdominal skin by enzymatic digestion. Living cell recovery, in vitro proliferation, epidermal reconstruction capacities and differentiation status were analyzed. RESULTS In vitro studies revealed the higher yield of living keratinocyte recovery from foreskin and higher potential in terms of proliferative capacity, regeneration and differentiation. Cultured keratinocytes from foreskin express lower amounts of differentiation markers than those isolated from trunk and ear. Histological analysis of reconstituted human epidermis derived from foreskin and inguinal keratinocytes showed a structured multilayered epithelium, whereas those obtained from ear pinna-derived keratinocytes were unstructured. CONCLUSION Our studies highlight the potential of foreskin tissue for autograft applications in boys. A suitable alternative donor site for autologous cell transplantation in female paediatric burn patients remains an open question in our department. We tested the hypothesis that in vitro studies and RHE reconstructive capacities of cells from different body sites can be helpful to select an optimal site for keratinocyte isolation before considering graft protocols for girls.
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Affiliation(s)
- Jiad N Mcheik
- Service de Chirurgie Pédiatrique, CHU de Poitiers, Poitiers, France; Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), Université de Poitiers, Poitiers, France.
| | | | | | | | | | - Guillaume Levard
- Service de Chirurgie Pédiatrique, CHU de Poitiers, Poitiers, France
| | - Frank Morel
- Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), Université de Poitiers, Poitiers, France
| | - François-Xavier Bernard
- Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), Université de Poitiers, Poitiers, France; BIOalternatives, Gençay, France
| | - Jean-Claude Lecron
- Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), Université de Poitiers, Poitiers, France; Laboratoire d'Immunologie et Inflammation, CHU de Poitiers, Poitiers, France
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17
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Li M, Ti D, Han W, Fu X. Microenvironment-induced myofibroblast-like conversion of engrafted keratinocytes. SCIENCE CHINA-LIFE SCIENCES 2014; 57:209-20. [PMID: 24443179 DOI: 10.1007/s11427-014-4613-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 09/12/2013] [Indexed: 12/16/2022]
Abstract
Myofibroblasts, recognized classically by α-smooth muscle actin (α-SMA) expression, play a key role in the wound-healing process, promoting wound closure and matrix deposition. Although a body of evidence shows that keratinocytes explanted onto a wound bed promote closure of a skin injury, the underlying mechanisms are not well understood. The basal layer of epidermis is rich in undifferentiated keratinocytes (UKs). We showed that UKs injected into granulation tissue could switch into α-SMA positive cells, and accelerate the rate of skin wound healing. In addition, when the epidermis sheets isolated from foreskin cover up the wound bed or are induced in vitro, keratinocytes located at the basal layers or adjacent sites were observed to convert into myofibroblast-like cells. Thus, UKs have a potential for myofibroblastic transition, which provides a novel mechanism by which keratinocyte explants accelerate skin wound healing.
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Affiliation(s)
- MeiRong Li
- Wound Healing and Cell Biology Laboratory, Institute of Basic Medical Science, Chinese PLA General Hospital, Beijing, 100853, China
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18
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Jeschke MG, Finnerty CC, Shahrokhi S, Branski LK, Dibildox M. Wound coverage technologies in burn care: novel techniques. J Burn Care Res 2013; 34:612-20. [PMID: 23877140 PMCID: PMC3819403 DOI: 10.1097/bcr.0b013e31829b0075] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Improvements in burn wound care have vastly decreased morbidity and mortality in severely burned patients. Development of new therapeutic approaches to increase wound repair has the potential to reduce infection, graft rejection, and hypertrophic scarring. The incorporation of tissue-engineering techniques, along with the use of exogenous proteins, genes, or stem cells to enhance wound healing, heralds new treatment regimens based on the modification of already existing biological activity. Refinements to surgical techniques have enabled the creation of protocols for full facial transplantation. With new technologies and advances such as these, care of the severely burned will undergo massive changes over the next decade. This review centers on new developments that have recently shown great promise in the investigational arena.
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Affiliation(s)
- Marc G. Jeschke
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Department of Surgery and Plastic Surgery, University of Toronto, Toronto, Canada
| | - Celeste C. Finnerty
- Department of Surgery, Sealy Center for Molecular Medicine, and the Institute for Translational Science, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, Texas, USA
| | - Shahriar Shahrokhi
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Department of Surgery and Plastic Surgery, University of Toronto, Toronto, Canada
| | - Ludwik K. Branski
- Department of Plastic and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Manuel Dibildox
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Department of Surgery and Plastic Surgery, University of Toronto, Toronto, Canada
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19
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Sharpe JR, Martin Y. Strategies Demonstrating Efficacy in Reducing Wound Contraction In Vivo.. Adv Wound Care (New Rochelle) 2013; 2:167-175. [PMID: 24527340 DOI: 10.1089/wound.2012.0378] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Indexed: 01/27/2023] Open
Abstract
SIGNIFICANCE Scarring continues to present a significant clinical problem. Wound contraction leads to scarring and is mediated by myofibroblasts and contractile forces across the wound bed. Contracture formation can have a significant impact on the quality of life of the patient, particularly where function and appearance are affected. RECENT ADVANCES Novel tissue-engineered matrices, cell-based therapies, and medicinal therapeutics have shown significant reduction in wound contraction in in-vivo models, particularly at early time points. These have been accompanied in many cases by reduced numbers of myofibroblasts, and in some by increased angiogenesis and improved neodermal architecture. CRITICAL ISSUES There are no animal models that replicate all aspects of wound healing as seen in patients. Therefore, information obtained from in vivo studies should be assessed critically. Additional studies, in particular those that seek to elucidate the mechanisms by which novel therapies reduce contraction, are needed to gain sufficient confidence to move into clinical testing. FUTURE DIRECTIONS The use of knockout mouse models in particular has generated significant advances in knowledge of the mechanisms behind myofibroblast conversion and other factors involved in generating tension across the wound. Medicinal therapeutics and tissue-engineering approaches that seek to disrupt/alter these pathways hold much promise for future development and translation to clinical practice.
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Affiliation(s)
- Justin R. Sharpe
- Blond McIndoe Research Foundation, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Yella Martin
- Blond McIndoe Research Foundation, Queen Victoria Hospital, East Grinstead, United Kingdom
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21
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Mcheik JN, Barrault C, Pedretti N, Garnier J, Juchaux F, Levard G, Morel F, Lecron JC, Bernard FX. Foreskin-isolated keratinocytes provide successful extemporaneous autologous paediatric skin grafts. J Tissue Eng Regen Med 2013; 10:252-60. [PMID: 23495214 DOI: 10.1002/term.1690] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 10/09/2012] [Accepted: 12/20/2012] [Indexed: 11/06/2022]
Abstract
Severe burns in children are conventionally treated with split-thickness skin autografts or epidermal sheets. However, neither early complete healing nor quality of epithelialization is satisfactory. An alternative approach is to graft isolated keratinocytes. We evaluated paediatric foreskin and auricular skin as donor sources, autologous keratinocyte transplantation, and compared the graft efficiency to the in vitro capacities of isolated keratinocytes to divide and reconstitute epidermal tissue. Keratinocytes were isolated from surgical samples by enzymatic digestion. Living cell recovery, in vitro proliferation and epidermal reconstruction capacities were evaluated. Differentiation status was analysed, using qRT-PCR and immunolabelling. Eleven children were grafted with foreskin-derived (boys) or auricular (girls) keratinocyte suspensions dripped onto deep severe burns. The aesthetic and functional quality of epithelialization was monitored in a standardized way. Foreskin keratinocyte graft in male children provides for the re-epithelialization of partial deep severe burns and accelerates wound healing, thus allowing successful wound closure, and improves the quality of scars. In accordance, in vitro studies have revealed a high yield of living keratinocyte recovery from foreskin and their potential in terms of regeneration and differentiation. We report a successful method for grafting paediatric males presenting large severe burns through direct spreading of autologous foreskin keratinocytes. This alternative method is easy to implement, improves the quality of skin and minimizes associated donor site morbidity. In vitro studies have highlighted the potential of foreskin tissue for graft applications and could help in tissue selection with the prospect of grafting burns for girls.
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Affiliation(s)
- Jiad N Mcheik
- Service de Chirurgie Pédiatrique, CHU de Poitiers, France.,Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), Université de Poitiers, France
| | | | | | | | | | | | - Franck Morel
- Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), Université de Poitiers, France
| | - Jean-Claude Lecron
- Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), Université de Poitiers, France.,Laboratoire d'Immunologie et Inflammation, CHU de Poitiers, France
| | - François-Xavier Bernard
- Laboratoire Inflammation, Tissus Epithéliaux et Cytokines (LITEC), Université de Poitiers, France.,BIOalternatives, Gençay, France
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22
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Menon S, Li Z, Harvey JG, Holland AJA. The use of the Meek technique in conjunction with cultured epithelial autograft in the management of major paediatric burns. Burns 2012; 39:674-9. [PMID: 23026638 DOI: 10.1016/j.burns.2012.09.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 07/30/2012] [Accepted: 09/06/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The management of major paediatric burns remains challenging, in part due to limited donor sites. Skin graft expansion facilitates rapid closure of the burn wound, reducing the risk of sepsis. We reviewed our unit's experience with a combined modified Meek technique and cultured epithelial autograft (CEA). METHODS A retrospective chart review over a seven year period from April 2004 to April 2011 was conducted of patients whose burns were treated with Meek and CEA. RESULTS The Meek technique was combined with meshed split skin grafts and CEA to either donor, graft site or both in 7 cases. One case had Meek skin grafts alone with cultured cells applied to both donor and graft sites. There were two scald burns and five flame burns, with total body surface area ranging from 30% to 70%. Mean length of stay was 51 days (range 41-74 days). The average number of surgical procedures undergone to obtain good coverage was 3.3. There were small (1-3%) areas of breakdown in six cases which received regrafting. Two of these patients had confirmed wound infections. All patients had varying degrees of hypertrophic scarring (HTS) but remained well at follow up. CONCLUSIONS The Meek technique facilitates high expansion ratios, allowing for a greater area of skin coverage. Epithelialisation in the burn wound appeared to be enhanced by the application of CEA. The Meek technique in combination with CEA would appear a useful additional option in achieving wound closure in the severely burned paediatric patient.
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Affiliation(s)
- Seema Menon
- The Burns Unit and The Children's Hospital at Westmead Burns Research Institute, Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, NSW, Australia
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23
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Skin explant cultures as a source of keratinocytes for cultivation. Cell Tissue Bank 2012; 14:317-24. [PMID: 22850975 DOI: 10.1007/s10561-012-9330-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 07/13/2012] [Indexed: 10/28/2022]
Abstract
Cultivated human keratinocytes can be used successfully in the treatment of burn patients, but efforts to heal burns and other wounds can be hampered by the very small skin biopsies available for cultivation of transplantable keratinocyte sheets. A small biopsy (and correspondingly small number of enzymatically isolated keratinocytes for use in classical cultivation techniques) can lead to a low yield of multilayer sheets for clinical application or unacceptably long cultivation times. One way of addressing this is to make use of skin remnants remaining after enzymatic digestion and culture cells migrating out of these skin explants. Sufficient numbers of explant-derived keratinocytes can be obtained to facilitate additional routine cultivation of these cells. Biopsy remnants can be used to initiate explant cultures repeatedly (we were able to re-use pieces of skin 10 times and still obtain useful numbers of keratinocytes) and this "passaging" yields substantially more cells for classical cultivation than would be available from conventional methodology alone, and in a comparable timeframe. Another advantage of this method is that it does not require additional biopsies to be procured from already-compromised patients and overcomes problems associated with contamination of skin samples with resistant hospital-acquired bacterial infections common during prolonged hospitalization.
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24
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Eldardiri M, Martin Y, Roxburgh J, Lawrence-Watt DJ, Sharpe JR. Wound contraction is significantly reduced by the use of microcarriers to deliver keratinocytes and fibroblasts in an in vivo pig model of wound repair and regeneration. Tissue Eng Part A 2011; 18:587-97. [PMID: 21939396 DOI: 10.1089/ten.tea.2011.0258] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In full-thickness injuries caused by extensive burns or penetrating traumatic injuries, the natural epidermal stem cell niche is destroyed, and wound healing occurs through migration of cells from the wound edges and wound contraction. This can lead to significant contracture formation, especially in large full-thickness injuries, causing lack of mobility and pain. Contraction is reduced when wounds are treated using split-thickness skin grafts (STSG) or dermal substitutes, particularly in combination with cultured autologous keratinocytes, delivered as confluent sheets or sprayed as a single cell suspension (SAK). Here, we show that the application of keratinocytes alone or keratinocytes with fibroblasts, delivered on microcarriers, in combination with STSG or a dermal substitute, significantly reduces contraction of wounds in vivo in a porcine model of wound repair and regeneration. A decrease in alpha-smooth muscle actin-positive myofibroblasts, the cell type responsible for wound contraction, accompanies the reduction in contraction. These findings demonstrate the potential for a significant clinical advantage in the treatment of full-thickness injuries.
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Affiliation(s)
- Mohamed Eldardiri
- Blond McIndoe Research Foundation, Queen Victoria Hospital, East Grinstead, West Sussex, United Kingdom
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25
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Jubin K, Martin Y, Lawrence-Watt DJ, Sharpe JR. A fully autologous co-culture system utilising non-irradiated autologous fibroblasts to support the expansion of human keratinocytes for clinical use. Cytotechnology 2011; 63:655-62. [PMID: 21822682 DOI: 10.1007/s10616-011-9382-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 07/19/2011] [Indexed: 10/17/2022] Open
Abstract
Autologous keratinocytes can be used to augment cutaneous repair, such as in the treatment of severe burns and recalcitrant ulcers. Such cells can be delivered to the wound bed either as a confluent sheet of cells or in single-cell suspension. The standard method for expanding primary human keratinocytes in culture uses lethally irradiated mouse 3T3 fibroblasts as feeder cells to support keratinocyte attachment and growth. In an effort to eliminate xenobiotic cells from clinical culture protocols where keratinocytes are applied to patients, we investigated whether human autologous primary fibroblasts could be used to expand keratinocytes in culture. At a defined ratio of a 6:1 excess of keratinocytes to fibroblasts, this co-culture method displayed a population doubling rate comparable to culture with lethally irradiated 3T3 cells. Furthermore, morphological and molecular analysis showed that human keratinocytes expanded in co-culture with autologous human fibroblasts were positive for proliferation markers and negative for differentiation markers. Keratinocytes expanded by this method thus retain their proliferative phenotype, an important feature in enhancing rapid wound closure. We suggest that this novel co-culture method is therefore suitable for clinical use as it dispenses with the need for lethally irradiated 3T3 cells in the rapid expansion of autologous human keratinocytes.
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Affiliation(s)
- K Jubin
- Blond McIndoe Research Foundation, Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex, RH19 3DZ, UK
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26
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Bargues L, Prat M, Leclerc T, Bey E, Lataillade JJ. Présent et futur de la thérapie cellulaire des brûlures. ACTA ACUST UNITED AC 2011; 59:e49-56. [PMID: 20167439 DOI: 10.1016/j.patbio.2009.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 12/29/2009] [Indexed: 01/09/2023]
Affiliation(s)
- L Bargues
- Centre de traitement des brûlés, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92141 Clamart, France.
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