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Lu KW, Khachemoune A. Skin substitutes for the management of mohs micrographic surgery wounds: a systematic review. Arch Dermatol Res 2023; 315:17-31. [PMID: 35169876 DOI: 10.1007/s00403-022-02327-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/15/2021] [Accepted: 01/28/2022] [Indexed: 01/07/2023]
Abstract
The data on skin substitute usage for managing Mohs micrographic surgery (MMS) wounds remain limited. This systematic review aimed to provide an overview of skin substitutes employed for MMS reconstruction, summarize clinical characteristics of patients undergoing skin substitute-based repair after MMS, and identify advantages and limitations of skin substitute implementation. A systematic review of Ovid MEDLINE, EMBASE, Cochrane Library, and Web of Science databases, from inception to April 7, 2021, identified all cases of MMS defects repaired using skin substitutes. A total of 687 patients were included. The mean patient age was 70 years (range: 6-98 years). Commonly used skin substitutes were porcine collagen (n = 397), bovine collagen (n = 78), Integra (n = 53), Hyalofill (n = 43), amnion/chorion-derived grafts (n = 40), and allogeneic epidermal-dermal composite grafts (n = 35). Common factors influencing skin substitute selection were cost, healing efficacy, cosmetic outcome, patient comfort, and ease of use. Some articles did not specify patient and wound characteristics. Skin substitute usage in MMS reconstruction is not well-guided. Blinded randomized control trials comparing the efficacy of skin substitutes and traditional repair methods are imperative for establishing evidence-based guidelines on skin substitute usage following MMS.
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Affiliation(s)
- Kimberly W Lu
- Renaissance School of Medicine, Stony Brook University, 100 Nicolls Road, Stony Brook, NY, 11794, USA
| | - Amor Khachemoune
- Veterans Affairs Medical Center, Brooklyn, NY, USA. .,Department of Dermatology, SUNY Downstate, Brooklyn, NY, USA. .,Veterans Affairs Hospital and SUNY Downstate Dermatology Service, 800 Poly Place, Brooklyn, NY, 11209, USA.
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2
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Hodge JG, Zamierowski DS, Robinson JL, Mellott AJ. Evaluating polymeric biomaterials to improve next generation wound dressing design. Biomater Res 2022; 26:50. [PMID: 36183134 PMCID: PMC9526981 DOI: 10.1186/s40824-022-00291-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 08/28/2022] [Indexed: 11/24/2022] Open
Abstract
Wound healing is a dynamic series of interconnected events with the ultimate goal of promoting neotissue formation and restoration of anatomical function. Yet, the complexity of wound healing can often result in development of complex, chronic wounds, which currently results in a significant strain and burden to our healthcare system. The advancement of new and effective wound care therapies remains a critical issue, with the current therapeutic modalities often remaining inadequate. Notably, the field of tissue engineering has grown significantly in the last several years, in part, due to the diverse properties and applications of polymeric biomaterials. The interdisciplinary cohesion of the chemical, biological, physical, and material sciences is pertinent to advancing our current understanding of biomaterials and generating new wound care modalities. However, there is still room for closing the gap between the clinical and material science realms in order to more effectively develop novel wound care therapies that aid in the treatment of complex wounds. Thus, in this review, we discuss key material science principles in the context of polymeric biomaterials, provide a clinical breadth to discuss how these properties affect wound dressing design, and the role of polymeric biomaterials in the innovation and design of the next generation of wound dressings.
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Affiliation(s)
- Jacob G Hodge
- Bioengineering Graduate Program, University of Kansas, Lawrence, KS, USA.,Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - David S Zamierowski
- Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jennifer L Robinson
- Department of Chemical and Petroleum Engineering, University of Kansas, Mail Stop: 3051, 3901 Rainbow Blvd, Lawrence, KS, 66160, USA
| | - Adam J Mellott
- Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, KS, USA.
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3
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Evaluation of Magnesium-Phosphate Particle Incorporation into Co-Electrospun Chitosan-Elastin Membranes for Skin Wound Healing. Mar Drugs 2022; 20:md20100615. [PMID: 36286439 PMCID: PMC9604583 DOI: 10.3390/md20100615] [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: 08/25/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/24/2022] Open
Abstract
Major challenges facing clinicians treating burn wounds are the lack of integration of treatment to wound, inadequate mechanical properties of treatments, and high infection rates which ultimately lead to poor wound resolution. Electrospun chitosan membranes (ESCM) are gaining popularity for use in tissue engineering applications due to their drug loading ability, biocompatibility, biomimetic fibrous structure, and antimicrobial characteristics. This work aims to modify ESCMs for improved performance in burn wound applications by incorporating elastin and magnesium-phosphate particles (MgP) to improve mechanical and bioactive properties. The following ESCMs were made to evaluate the individual components’ effects; (C: chitosan, CE: chitosan-elastin, CMg: chitosan-MgP, and CEMg: chitosan-elastin-MgP). Membrane properties analyzed were fiber size and structure, hydrophilic properties, elastin incorporation, MgP incorporation and in vitro release, mechanical properties, degradation profiles, and in vitro cytocompatibility with NIH3T3 fibroblasts. The addition of both elastin and MgP increased the average fiber diameter of CE (~400 nm), CMg (~360 nm), and CEMg (565 nm) compared to C (255 nm). Water contact angle analysis showed elastin incorporated membranes (CE and CEMg) had increased hydrophilicity (~50°) compared to the other groups (C and CMg, ~110°). The results from the degradation study showed mass retention of ~50% for C and CMg groups, compared to ~ 30% seen in CE and CEMg after 4 weeks in a lysozyme/PBS solution. CMg and CEMg exhibited burst-release behavior of ~6 µg/ml or 0.25 mM magnesium within 72 h. In vitro analysis with NIH3T3 fibroblasts showed CE and CEMg groups had superior cytocompatibility compared to C and CMg. This work has demonstrated the successful incorporation of elastin and MgP into ESCMs and allows for future studies on burn wound applications.
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Cook KA, Martinez-Lozano E, Sheridan R, Rodriguez EK, Nazarian A, Grinstaff MW. Hydrogels for the management of second-degree burns: currently available options and future promise. BURNS & TRAUMA 2022; 10:tkac047. [PMCID: PMC9733594 DOI: 10.1093/burnst/tkac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/14/2022] [Accepted: 09/30/2022] [Indexed: 12/13/2022]
Abstract
Abstract
Burn wounds result from exposure to hot liquids, chemicals, fire, electric discharge or radiation. Wound severity ranges from first-degree injury, which is superficial, to fourth-degree injury, which exposes bone, tendons and muscles. Rapid assessment of burn depth and accurate wound management in the outpatient setting is critical to prevent injury progression into deeper layers of the dermis. Injury progression is of particular pertinence to second-degree burns, which are the most common form of thermal burn. As our understanding of wound healing advances, treatment options and technologies for second-degree burn management also evolve. Polymeric hydrogels are a class of burn wound dressings that adhere to tissue, absorb wound exudate, protect from the environment, can be transparent facilitating serial wound evaluation and, in some cases, enable facile removal for dressing changes. This review briefly describes the burn level classification and common, commercially available dressings used to treat second-degree burns, and then focuses on new polymeric hydrogel burn dressings under preclinical development analyzing their design, structure and performance. The review presents the follow key learning points: (1) introduction to the integument system and the wound-healing process; (2) classification of burns according to severity and clinical appearance; (3) available dressings currently used for second-degree burns; (4) introduction to hydrogels and their preparation and characterization techniques; and (5) pre-clinical hydrogel burn wound dressings currently being developed.
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Affiliation(s)
- Katherine A Cook
- Department of Chemistry, Biomedical Engineering, and Medicine, Boston University , Boston, MA, 02215, USA
| | - Edith Martinez-Lozano
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School , Boston, MA, 02215, USA
| | - Robert Sheridan
- Shriners Hospitals for Children and Burns Service, Department of Surgery, Massachusetts General Hospital , Boston, MA, 02214, USA
| | - Edward K Rodriguez
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School , Boston, MA, 02215, USA
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School , Boston, MA, 02215, USA
- Department of Orthopaedic Surgery, Yerevan State Medical University , Yerevan, Armenia
| | - Mark W Grinstaff
- Department of Chemistry, Biomedical Engineering, and Medicine, Boston University , Boston, MA, 02215, USA
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5
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Yang MY, Liu BS, Huang HY, Yang YC, Chang KB, Kuo PY, Deng YH, Tang CM, Hsieh HH, Hung HS. Engineered Pullulan-Collagen-Gold Nano Composite Improves Mesenchymal Stem Cells Neural Differentiation and Inflammatory Regulation. Cells 2021; 10:cells10123276. [PMID: 34943784 PMCID: PMC8699622 DOI: 10.3390/cells10123276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 12/15/2022] Open
Abstract
Tissue repair engineering supported by nanoparticles and stem cells has been demonstrated as being an efficient strategy for promoting the healing potential during the regeneration of damaged tissues. In the current study, we prepared various nanomaterials including pure Pul, pure Col, Pul–Col, Pul–Au, Pul–Col–Au, and Col–Au to investigate their physicochemical properties, biocompatibility, biological functions, differentiation capacities, and anti-inflammatory abilities through in vitro and in vivo assessments. The physicochemical properties were characterized by SEM, DLS assay, contact angle measurements, UV-Vis spectra, FTIR spectra, SERS, and XPS analysis. The biocompatibility results demonstrated Pul–Col–Au enhanced cell viability, promoted anti-oxidative ability for MSCs and HSFs, and inhibited monocyte and platelet activation. Pul–Col–Au also induced the lowest cell apoptosis and facilitated the MMP activities. Moreover, we evaluated the efficacy of Pul–Col–Au in the enhancement of neuronal differentiation capacities for MSCs. Our animal models elucidated better biocompatibility, as well as the promotion of endothelialization after implanting Pul–Col–Au for a period of one month. The above evidence indicates the excellent biocompatibility, enhancement of neuronal differentiation, and anti-inflammatory capacities, suggesting that the combination of pullulan, collagen, and Au nanoparticles can be potential nanocomposites for neuronal repair, as well as skin tissue regeneration in any further clinical treatments.
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Affiliation(s)
- Meng-Yin Yang
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung 407204, Taiwan; (M.-Y.Y.); (Y.-C.Y.)
- National Defense Medical Center, Graduate Institute of Medical Sciences, Taipei 11490, Taiwan
- College of Nursing, Central Taiwan University of Science and Technology, Taichung 406053, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Bai-Shuan Liu
- Department of Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, Taichung 406053, Taiwan; (B.-S.L.); (P.-Y.K.); (Y.-H.D.)
| | - Hsiu-Yuan Huang
- Department of Cosmeceutics and Graduate, Institute of Cosmeceutics, China Medical University, Taichung 40402, Taiwan;
| | - Yi-Chin Yang
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung 407204, Taiwan; (M.-Y.Y.); (Y.-C.Y.)
| | - Kai-Bo Chang
- Graduate Institute of Biomedical Science, China Medical University, Taichung 40402, Taiwan;
| | - Pei-Yeh Kuo
- Department of Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, Taichung 406053, Taiwan; (B.-S.L.); (P.-Y.K.); (Y.-H.D.)
| | - You-Hao Deng
- Department of Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, Taichung 406053, Taiwan; (B.-S.L.); (P.-Y.K.); (Y.-H.D.)
| | - Cheng-Ming Tang
- College of Oral Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
| | - Hsien-Hsu Hsieh
- Blood Bank, Taichung Veterans General Hospital, Taichung 407024, Taiwan;
| | - Huey-Shan Hung
- Graduate Institute of Biomedical Science, China Medical University, Taichung 40402, Taiwan;
- Translational Medicine Research, China Medical University Hospital, Taichung 40402, Taiwan
- Correspondence: ; Tel.: +886-4-22052121 (ext. 7827); Fax: +886-4-22333641
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A novel technique of reducing full-thickness skin graft contraction using a dermal substitute: an animal model study. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-020-01661-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Ahangar P, Mills SJ, Cowin AJ. Mesenchymal Stem Cell Secretome as an Emerging Cell-Free Alternative for Improving Wound Repair. Int J Mol Sci 2020; 21:ijms21197038. [PMID: 32987830 PMCID: PMC7583030 DOI: 10.3390/ijms21197038] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022] Open
Abstract
The use of mesenchymal stem cells (MSC) for the treatment of cutaneous wounds is currently of enormous interest. However, the broad translation of cell therapies into clinical use is hampered by their efficacy, safety, manufacturing and cost. MSCs release a broad repertoire of trophic factors and immunomodulatory cytokines, referred to as the MSC secretome, that has considerable potential for the treatment of cutaneous wounds as a cell-free therapy. In this review, we outline the current status of MSCs as a treatment for cutaneous wounds and introduce the potential of the MSC secretome as a cell-free alternative for wound repair. We discuss the challenges and provide insights and perspectives for the future development of the MSC secretome as well as identify its potential clinical translation into a therapeutic treatment.
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Affiliation(s)
- Parinaz Ahangar
- Future Industries Institute, University of South Australia, Adelaide, SA 5000, Australia; (P.A.); (S.J.M.)
- Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Stuart J. Mills
- Future Industries Institute, University of South Australia, Adelaide, SA 5000, Australia; (P.A.); (S.J.M.)
| | - Allison J. Cowin
- Future Industries Institute, University of South Australia, Adelaide, SA 5000, Australia; (P.A.); (S.J.M.)
- Correspondence: ; Tel.: +61-8-8302-5018
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8
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Jyoti K, Malik G, Chaudhary M, Sharma M, Goswami M, Katare OP, Singh SB, Madan J. Chitosan and phospholipid assisted topical fusidic acid drug delivery in burn wound: Strategies to conquer pharmaceutical and clinical challenges, opportunities and future panorama. Int J Biol Macromol 2020; 161:325-335. [PMID: 32485249 DOI: 10.1016/j.ijbiomac.2020.05.230] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 02/08/2023]
Abstract
Burn is the immense public health issue globally. Low and middle income countries face extensive deaths owing to burn injuries. Availability of conventional therapies for burns has always been painful for patients as well as expensive for our health system. Pharmaceutical experts are still searching reliable, cheap, safe and effective treatment options for burn injuries. Fusidic acid is an antibiotic of choice for the management of burns. However, fusidic acid is encountering several pharmaceutical and clinical challenges like poor skin permeability and growing drug resistance against burn wound microbes like Methicillin resistant Staphylococcus aureus (MRSA). Therefore, an effort has been made to present a concise review about molecular pathway followed by fusidic acid in the treatment of burn wound infection in addition to associated pros and cons. Furthermore, we have also summarized chitosan and phospholipid based topical dermal delivery systems customized by our team for the delivery of fusidic acid in burn wound infections on case-to-case basis. However, every coin has two sides. We recommend the integration of in-silico docking techniques with natural biomacromolecules while designing stable, patient friendly and cost effective topical drug delivery systems of fusidic acid for the management of burn wound infection as future opportunities.
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Affiliation(s)
- Kiran Jyoti
- Department of Pharmaceutics, Chandigarh College of Pharmacy, Mohali, Punjab, India; IKG Punjab Technical University, Jalandhar, Punjab, India
| | - Garima Malik
- Department of Pharmaceutics, Chandigarh College of Pharmacy, Mohali, Punjab, India
| | | | - Monika Sharma
- University Institute of Pharmaceutical Sciences, Chandigarh University, Mohali, Punjab, India
| | - Manish Goswami
- University Institute of Pharmaceutical Sciences, Chandigarh University, Mohali, Punjab, India
| | - Om Prakash Katare
- University Institute of Pharmaceutical Sciences, Punjab University, Chandigarh, India
| | - Shashi Bala Singh
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India
| | - Jitender Madan
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana, India.
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9
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Dai C, Shih S, Khachemoune A. Skin substitutes for acute and chronic wound healing: an updated review. J DERMATOL TREAT 2020; 31:639-648. [PMID: 30265595 DOI: 10.1080/09546634.2018.1530443] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Skin substitutes are designed to accelerate wound healing by providing replacement of extracellular matrix and can be used to promote healing of both acute and chronic wounds.Aim: To describe advantages, disadvantages, and indications for different skin substitutes with the intention of providing a systematic framework that clinicians can easily utilize in clinical practice.Materials and method: We conducted a PubMed, Cochrane Library, and company website search for publications using various search terms associated with skin substitutes.Results: Skin substitutes can be categorized as epidermal, dermal, and composite, depending on the skin component they contain, and further split into different categories depending on their composition and source of material, including xenograft, acellular allograft, cellular allograft, autograft, and synthetic skin substitutes. Because there is no ideal option for skin substitutes that meet all the criteria for optimal wound healing, there is ongoing research evaluating and developing different skin substitute options.Conclusion: Our model of skin substitutes was organized based on the different layers of cutaneous involvement and the origin of the product material. We believe that this framework provides a practical guide for selection of the most appropriate skin substitute based on clinical indication.
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Affiliation(s)
- Christina Dai
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Shawn Shih
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Amor Khachemoune
- Veterans Affairs Medical Center, Brooklyn, NY, USA.,Department of Dermatology, SUNY Downstate, Brooklyn, NY, USA
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Chong HP, Quinn L, Cooksey R, Molony D, Jeeves A, Lodge M, Carney B. Mortality in paediatric burns at the Women's and Children's Hospital (WCH), Adelaide, South Australia: 1960-2017. Burns 2019; 46:207-212. [PMID: 31787476 DOI: 10.1016/j.burns.2019.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 06/04/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Burn injuries are the third leading cause of preventable death in children worldwide, resulting in over 100 000 annual hospitalisations. In the paediatric population, scalds are the commonest mechanism and burn injuries of greater than 40% total burn surface area (TBSA) are associated with a high mortality and morbidity rate. AIMS The aim of this study was to review mortality in paediatric burns in a tertiary burns centre over a 60-year period, providing an understanding of local causes of mortality and directing future clinical research. METHODS We reviewed data collected prospectively from patients treated for burn injuries at the WCH from 1960 to 2017. Data of age, gender, mechanism of injury and TBSA were collected. TBSA of 40% and greater were included in the study. RESULTS All patients with total burn surface area (TBSA) less than 40% survived. There were a total of 75 patients who sustained burns of or greater than 40% TBSA. Overall mortality was 34% (26 of 75) of which 24 occurred in the 1960s. Of the 21 patients who died of flame burn injuries, 12 of them were described as clothes catching alight from being in close proximity to the source of flame. Average length of stay for patients who did not survive was 7 days (1-26). CONCLUSION Mortality has since declined and the prognosis for survival good, even in TBSA of greater than 90%. The investigations in fabric flammability led by Dr Thomas Pressley and Mr Murray Clarke prompted the rewriting of Australian standards for production of children's clothing. This, in combination with advances in paediatric resuscitation, surgical techniques as well as wound care has improved survival rates and outcomes in extensive burn injuries. Future studies focus to see not only better survival rates, but also better aesthetic and functional outcomes in burn survivors.
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Affiliation(s)
- Hsu Phie Chong
- Department of Burns Surgery, Women's and Children's Hospital (WCH), Australia.
| | - Linda Quinn
- Department of Burns Surgery, Women's and Children's Hospital (WCH), Australia
| | - Rebecca Cooksey
- Department of Burns Surgery, Women's and Children's Hospital (WCH), Australia
| | - Darren Molony
- Department of Burns Surgery, Women's and Children's Hospital (WCH), Australia
| | - Amy Jeeves
- Department of Burns Surgery, Women's and Children's Hospital (WCH), Australia
| | - Michelle Lodge
- Department of Burns Surgery, Women's and Children's Hospital (WCH), Australia
| | - Bernard Carney
- Department of Burns Surgery, Women's and Children's Hospital (WCH), Australia
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11
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Varkey M, Visscher DO, van Zuijlen PPM, Atala A, Yoo JJ. Skin bioprinting: the future of burn wound reconstruction? BURNS & TRAUMA 2019; 7:4. [PMID: 30805375 PMCID: PMC6371568 DOI: 10.1186/s41038-019-0142-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/08/2019] [Indexed: 01/17/2023]
Abstract
Burns are a significant cause of trauma, and over the years, the focus of patient care has shifted from just survival to facilitation of improved functional outcomes. Typically, burn treatment, especially in the case of extensive burn injuries, involves surgical excision of injured skin and reconstruction of the burn injury with the aid of skin substitutes. Conventional skin substitutes do not contain all skin cell types and do not facilitate recapitulation of native skin physiology. Three-dimensional (3D) bioprinting for reconstruction of burn injuries involves layer-by-layer deposition of cells along with scaffolding materials over the injured areas. Skin bioprinting can be done either in situ or in vitro. Both these approaches are similar except for the site of printing and tissue maturation. There are technological and regulatory challenges that need to be overcome for clinical translation of bioprinted skin for burn reconstruction. However, the use of bioprinting for skin reconstruction following burns is promising; bioprinting will enable accurate placement of cell types and precise and reproducible fabrication of constructs to replace the injured or damaged sites. Overall, 3D bioprinting is a very transformative technology, and its use for wound reconstruction will lead to a paradigm shift in patient outcomes. In this review, we aim to introduce bioprinting, the different stages involved, in vitro and in vivo skin bioprinting, and the various clinical and regulatory challenges in adoption of this technology.
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Affiliation(s)
- Mathew Varkey
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27101 USA
| | - Dafydd O. Visscher
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Paul P. M. van Zuijlen
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
- Burn Center, Red Cross Hospital, 1942 LE Beverwijk, The Netherlands
- Association of Dutch Burn Centres, 1942 LE Beverwijk, The Netherlands
| | - Anthony Atala
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27101 USA
| | - James J. Yoo
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27101 USA
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12
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Qi C, Xu L, Deng Y, Wang G, Wang Z, Wang L. Sericin hydrogels promote skin wound healing with effective regeneration of hair follicles and sebaceous glands after complete loss of epidermis and dermis. Biomater Sci 2018; 6:2859-2870. [PMID: 30259043 DOI: 10.1039/c8bm00934a] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Full-thickness skin injury affects millions of people worldwide each year. It often leads to scar formation and loss of skin appendages even after clinical treatment. The majority of wound dressings currently used cannot achieve scarless skin regeneration with complete recovery of appendages such as hair follicles and sebaceous glands. Functional regeneration of these skin appendages is a great challenge. However, we achieved this goal by the successful development and utilization of a photo-crosslinkable sericin hydrogel (SMH) as a new type of wound dressing for repairing full-thickness skin injury. SMH implanted in a mouse full-thickness skin injury model promoted scarless wound healing with effective regeneration of hair follicles and sebaceous glands. By employing techniques of molecular biology, biochemistry, and in vivo cell tracing, we revealed the underlying repair mechanisms: SMH inhibited inflammation, stimulated angiogenesis during healing process, prevented scar tissue formation via regulating the expressions of TGF-β1 and TGF-β3, and recruited mesenchymal stem cells to injury sites for regeneration of skin appendages. Collectively, in this study, we developed a sericin-based hydrogel as a wound dressing for full-thickness skin injury repair, uncovered the functional roles of sericin hydrogels in promoting scarless skin regeneration along with effective recovery of skin appendages, and thus unveiled sericin's potential for skin wound healing.
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Affiliation(s)
- Chao Qi
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Luming Xu
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Yan Deng
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Guobin Wang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Zheng Wang
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China. and Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.
| | - Lin Wang
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China. and Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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13
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Idrees A, Chiono V, Ciardelli G, Shah S, Viebahn R, Zhang X, Salber J. Validation of in vitro assays in three-dimensional human dermal constructs. Int J Artif Organs 2018; 41:779-788. [PMID: 29843544 PMCID: PMC6210574 DOI: 10.1177/0391398818775519] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Three-dimensional cell culture systems are urgently needed for cytocompatibility testing of biomaterials. This work aimed at the development of three-dimensional in vitro dermal skin models and their optimization for cytocompatibility evaluation. Initially “murine in vitro dermal construct” based on L929 cells was generated, leading to the development of “human in vitro dermal construct” consisting of normal human dermal fibroblasts in rat tail tendon collagen type I. To assess the viability of the cells, different assays CellTiter-Blue®, RealTime-Glo™ MT, and CellTiter-Glo® (Promega) were evaluated to optimize the best-suited assay to the respective cell type and three-dimensional system. Z-stack imaging (Live/Dead and Phalloidin/DAPI-Promokine) was performed to visualize normal human dermal fibroblasts inside matrix revealing filopodia-like morphology and a uniform distribution of normal human dermal fibroblasts in matrix. CellTiter-Glo was found to be the optimal cell viability assay among those analyzed. CellTiter-Blue reagent affected the cell morphology of normal human dermal fibroblasts (unlike L929), suggesting an interference with cell biological activity, resulting in less reliable viability data. On the other hand, RealTime-Glo provided a linear signal only with a very low cell density, which made this assay unsuitable for this system. CellTiter-Glo adapted to three-dimensional dermal construct by optimizing the “shaking time” to enhance the reagent penetration and maximum adenosine triphosphate release, indicating 2.4 times higher viability value by shaking for 60 min than for 5 min. In addition, viability results showed that cells were viable inside the matrix. This model would be further advanced with more layers of skin to make a full thickness model.
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Affiliation(s)
- Ayesha Idrees
- 1 Department of Mechanical and Aerospace Engineering (DIMEAS), Politecnico di Torino, Turin, Italy.,2 Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr-Universität Bochum, Bochum, Germany.,3 Medical Biomaterials, Center for Clinical Research, Ruhr-University Bochum, Bochum, Germany
| | - Valeria Chiono
- 1 Department of Mechanical and Aerospace Engineering (DIMEAS), Politecnico di Torino, Turin, Italy
| | - Gianluca Ciardelli
- 1 Department of Mechanical and Aerospace Engineering (DIMEAS), Politecnico di Torino, Turin, Italy
| | - Siegfried Shah
- 2 Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr-Universität Bochum, Bochum, Germany
| | - Richard Viebahn
- 2 Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr-Universität Bochum, Bochum, Germany
| | | | - Jochen Salber
- 2 Universitätsklinikum Knappschaftskrankenhaus Bochum, Ruhr-Universität Bochum, Bochum, Germany.,3 Medical Biomaterials, Center for Clinical Research, Ruhr-University Bochum, Bochum, Germany
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Burn injury: Challenges and advances in burn wound healing, infection, pain and scarring. Adv Drug Deliv Rev 2018; 123:3-17. [PMID: 28941987 DOI: 10.1016/j.addr.2017.09.018] [Citation(s) in RCA: 291] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 12/18/2022]
Abstract
Severe burn injuries are the most traumatic and physically debilitating injuries affecting nearly every organ system and leading to significant morbidity and mortality. Early burn wound excision and skin grafting are common clinical practices that have significantly improved the outcomes for severe burn injured patients by reducing mortality rate and days of hospital stay. However, slow wound healing, infection, pain, and hypertrophic scarring continue to remain a major challenge in burn research and management. In the present article, we review and discuss issues in the current treatment of burn injuries; the advances and novel strategies developed in the past decade that have improved burn management; and also, pioneer ideas and studies in burn research which aims to enhance burn wound care with a focus on burn wound infection, pain management, treatments for scarring and skin tissue engineering.
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15
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MacEwan MR, MacEwan S, Kovacs TR, Batts J. What Makes the Optimal Wound Healing Material? A Review of Current Science and Introduction of a Synthetic Nanofabricated Wound Care Scaffold. Cureus 2017; 9:e1736. [PMID: 29209583 PMCID: PMC5711514 DOI: 10.7759/cureus.1736] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 10/02/2017] [Indexed: 11/05/2022] Open
Abstract
Wound matrix materials are used to improve the regeneration of dermal and epidermal layers in both acute and chronic wounds. Contemporary wound matrices are primarily composed of biologic materials such as processed xenogeneic and allogeneic tissues. Unfortunately, existing biologic wound matrices possess multiple limitations including poor longevity, durability, strength, and enzymatic resistance required for persistent support for new tissue formation. A fully-synthetic, resorbable electrospun material (Restrata Wound Matrix, Acera, St.Louis, Missouri ) that exhibits structural similarities to the native extracellular matrix offers a new approach to the treatment of acute and chronic wounds. This novel matrix is the first product to combine the advantages of synthetic construction (e.g. resistance to enzymatic degradation, excellent biocompatibility, strength/durability and controlled degradation) with the positive attributes of biologic materials (e.g. biomimetic architecture similar to human extracellular matrix (ECM), fibrous architecture optimized to support cellular migration and proliferation, engineered porosity to encourage tissue ingrowth and vascularization). These features allow RWM to achieve rapid and complete healing of full-thickness wounds that, in preclinical studies, is comparable to Integra Bilayer Wound Matrix (Integra LifeSciences, Plainsboro, New Jersey), a gold standard biologic material with diverse clinical indications in the wound care. Together, this review suggests that the RWM offers a unique fully-synthetic alternative to existing biologic matrices that is effective, widely available, easy to store, simple to apply and low cost.
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Neonatal Soft Tissue Reconstruction Using a Bioengineered Skin Substitute. J Craniofac Surg 2017; 28:489-491. [DOI: 10.1097/scs.0000000000003346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Abstract
Pressure ulcers are a serious health concern for elders in acute care, long-term care, and home care settings. The occurrence of a pressure ulcer is considered a sentinel event in terms of quality of care. Pressure ulcers may result in significant morbidity and mortality and are associated with high cost in terms of human suffering, cost of treatment, and possible litigation. Several risk factors have been identified for the development of pressure ulcers. Identification of elderly patients at risk of pressure and implementation of preventative measures are essential. Management of a pressure ulcer involves debridement, cleansing, selection of an appropriate dressing, and prevention of infection. This article reviews suggested guidelines for the prevention and management of pressure ulcers.
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Affiliation(s)
- Christine K. O’Neil
- Division of Social, Clinical, and Administrative Science, Mylan School of Pharmacy, Duquesne University, Pittsburgh, Pennsylvania,
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Ali N, Hosseini M, Vainio S, Taïeb A, Cario‐André M, Rezvani H. Skin equivalents: skin from reconstructions as models to study skin development and diseases. Br J Dermatol 2015; 173:391-403. [DOI: 10.1111/bjd.13886] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2015] [Indexed: 12/17/2022]
Affiliation(s)
- N. Ali
- Laboratory of Developmental Biology Faculty of Biochemistry and Molecular Medicine University of Oulu and Biocenter Oulu Aapistie 5A 90220 Oulu Finland
- Inserm U 1035 33076 Bordeaux France
- Université de Bordeaux 146 rue Léo Saignat 33076 Bordeaux France
| | - M. Hosseini
- Inserm U 1035 33076 Bordeaux France
- Université de Bordeaux 146 rue Léo Saignat 33076 Bordeaux France
| | - S. Vainio
- Laboratory of Developmental Biology Faculty of Biochemistry and Molecular Medicine University of Oulu and Biocenter Oulu Aapistie 5A 90220 Oulu Finland
| | - A. Taïeb
- Inserm U 1035 33076 Bordeaux France
- Université de Bordeaux 146 rue Léo Saignat 33076 Bordeaux France
- Centre de Référence pour les Maladies Rares de la Peau Bordeaux France
- Département de Dermatologie & Dermatologie Pédiatrique CHU de Bordeaux Bordeaux France
| | - M. Cario‐André
- Inserm U 1035 33076 Bordeaux France
- Université de Bordeaux 146 rue Léo Saignat 33076 Bordeaux France
- Centre de Référence pour les Maladies Rares de la Peau Bordeaux France
| | - H.R. Rezvani
- Inserm U 1035 33076 Bordeaux France
- Université de Bordeaux 146 rue Léo Saignat 33076 Bordeaux France
- Centre de Référence pour les Maladies Rares de la Peau Bordeaux France
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19
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Naderi N, Ardehali B, Mosahebi A. Biomaterials and structural fat grafting. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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20
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Affiliation(s)
- Luigi Ambrosio
- Department of Chemical Science and Materials Technology, National Research Council, 00185 Rome, Italy
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21
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Shevchenko RV, Santin M. Pre-clinical evaluation of soybean-based wound dressings and dermal substitute formulations in pig healing and non-healing in vivo models. BURNS & TRAUMA 2014; 2:187-95. [PMID: 27602381 PMCID: PMC5012056 DOI: 10.4103/2321-3868.143624] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 09/15/2014] [Accepted: 09/21/2014] [Indexed: 11/04/2022]
Abstract
In the last decade, a new class of natural biomaterials derived from de-fatted soybean flour processed by either thermoset or extraction procedures has been developed. These biomaterials uniquely combine adaptability to various clinical applications to proven tissue regeneration properties. In the present work, the biomaterials were formulated either as hydrogel or as paste formulation and their potential as wound dressing material or as dermal substitute was assessed by two in vivo models in pig skin: The healing full-thickness punch biopsy model and the non-healing full-thickness polytetrafluoroethylene (PTFE) chamber model. The results clearly show that collagen deposition is induced by the presence of these biomaterials. A unique pattern of early inflammatory response, eliciting neutrophils and controlling macrophage infiltration, is followed by tissue cell colonization of the wound bed with a significant deposition of collagen fibers. The study also highlighted the importance in the use of optimal formulations and appropriate handling upon implantation. In large size, non-healing wounds, wound dermis was best obtained with the paste formulation as hydrogels appeared to be too loose to ensure lasting scaffolding properties. On the contrary, packing of the granules during the application of paste reduced biomaterial degradation rate and prevent the penetration of newly vascularized tissue, thus impeding grafting of split-thickness autologous skin grafts on the dermal substitute base.
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Affiliation(s)
| | - Matteo Santin
- Brighton Centre for Regenerative Medicine, University of Brighton, Huxely Building Lewes Road, Brighton, BN2 4GJ UK
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22
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Shahrokhi S, Arno A, Jeschke MG. The use of dermal substitutes in burn surgery: acute phase. Wound Repair Regen 2014; 22:14-22. [PMID: 24393152 DOI: 10.1111/wrr.12119] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 08/12/2013] [Indexed: 11/30/2022]
Abstract
Major burns represent a challenge in autologous skin coverage and may lead to severe functional and cosmetic sequelae. Dermal substitutes are increasingly becoming an essential part of burn care during the acute phase of treatment. In the long term dermal substitutes improve functional and cosmetic results and thus enhance quality of life. In the chronic wound setting, dermal substitutes are used to reconstruct and improve burn scars and defects. Despite the potential of dermal substitutes, further research is required to strengthen scientific evidence regarding their effects and also to develop new technologies and products. Furthermore, dermal substitutes have a pivotal role in future research strategies as they have the potential to provide adequate scaffold for stem cells, tissue engineering, and regenerative medicine with conceivable application of obtaining long-lasting and scarless artificial skin. This review discusses the status quo of dermal substitutes and novel strategies in the use of dermal substitutes with a focus on burn care.
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Affiliation(s)
- Shahriar Shahrokhi
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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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: 68] [Impact Index Per Article: 6.8] [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.
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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.
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24
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Capo JT, Kokko KP, Rizzo M, Adams JE, Shamian B, Abernathie B, Melamed E. The use of skin substitutes in the treatment of the hand and upper extremity. Hand (N Y) 2014; 9:156-65. [PMID: 24839416 PMCID: PMC4022963 DOI: 10.1007/s11552-013-9587-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The introduction of skin substitutes in the last decade has dramatically changed how we think about the concept of "non-healing" wounds. Their use has improved prognosis and reduced morbidity in the treatment of open wounds. This article aims to summarize the development of tissue-engineered skin substitutes, discuss their use, and highlight some specific applications in different clinical settings.
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Affiliation(s)
- John T. Capo
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 240 East 18th Street, New York, NY 10003 USA
| | - Kyle P. Kokko
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003 USA
| | - Marco Rizzo
- Department of Orthopaedic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 USA
| | - Julie E. Adams
- Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street Suite R200, Minneapolis, MN 55454 USA
| | - Ben Shamian
- Department of Orthopaedic Surgery, University of Medicine and Dentistry of New Jersey, Doctor’s Office Center 90 Bergen Street, Newark, NJ 07101-1709 USA
| | - Brenon Abernathie
- Division of Plastic Surgery, Department of Surgery, University of Medicine and Dentistry of New Jersey, 140 Bergen Street, Suite E1620, Newark, NJ 07101-1709 USA
| | - Eitan Melamed
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003 USA
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Abstract
Significant progress has been made over the years in the development of in vitro-engineered substitutes that mimic human skin, either to be used as grafts for the replacement of lost skin or for the establishment of human-based in vitro skin models. This review summarizes these advances in in vivo and in vitro applications of tissue-engineered skin. We further highlight novel efforts in the design of complex disease-in-a-dish models for studies ranging from disease etiology to drug development and screening.
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26
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Advances in wound healing: a review of current wound healing products. PLASTIC SURGERY INTERNATIONAL 2012; 2012:190436. [PMID: 22567251 PMCID: PMC3335515 DOI: 10.1155/2012/190436] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 01/16/2012] [Indexed: 01/20/2023]
Abstract
Successful wound care involves optimizing patient local and systemic conditions in conjunction with an ideal wound healing environment. Many different products have been developed to influence this wound environment to provide a pathogen-free, protected, and moist area for healing to occur. Newer products are currently being used to replace or augment various substrates in the wound healing cascade. This review of the current state of the art in wound-healing products looks at the latest applications of silver in microbial prophylaxis and treatment, including issues involving resistance and side effects, the latest uses of negative pressure wound devices, advanced dressings and skin substitutes, biologic wound products including growth factor applications, and hyperbaric oxygen as an adjunct in wound healing. With the abundance of available products, the goal is to find the most appropriate modality or combination of modalities to optimize healing.
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27
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Halim AS, Khoo TL, Mohd Yussof SJ. Biologic and synthetic skin substitutes: An overview. Indian J Plast Surg 2011; 43:S23-8. [PMID: 21321652 PMCID: PMC3038402 DOI: 10.4103/0970-0358.70712] [Citation(s) in RCA: 206] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The current trend of burn wound care has shifted to more holistic approach of improvement in the long-term form and function of the healed burn wounds and quality of life. This has demanded the emergence of various skin substitutes in the management of acute burn injury as well as post burn reconstructions. Skin substitutes have important roles in the treatment of deep dermal and full thickness wounds of various aetiologies. At present, there is no ideal substitute in the market. Skin substitutes can be divided into two main classes, namely, biological and synthetic substitutes. The biological skin substitutes have a more intact extracellular matrix structure, while the synthetic skin substitutes can be synthesised on demand and can be modulated for specific purposes. Each class has its advantages and disadvantages. The biological skin substitutes may allow the construction of a more natural new dermis and allow excellent re-epithelialisation characteristics due to the presence of a basement membrane. Synthetic skin substitutes demonstrate the advantages of increase control over scaffold composition. The ultimate goal is to achieve an ideal skin substitute that provides an effective and scar-free wound healing.
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Affiliation(s)
- Ahmad Sukari Halim
- Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
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28
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Skin tissue engineering--in vivo and in vitro applications. Adv Drug Deliv Rev 2011; 63:352-66. [PMID: 21241756 DOI: 10.1016/j.addr.2011.01.005] [Citation(s) in RCA: 350] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 12/19/2010] [Accepted: 01/05/2011] [Indexed: 12/21/2022]
Abstract
Significant progress has been made over the years in the development of in vitro-engineered substitutes that mimic human skin, either to be used as grafts for the replacement of lost skin or for the establishment of human-based in vitro skin models. This review summarizes these advances in in vivo and in vitro applications of tissue-engineered skin. We further highlight novel efforts in the design of complex disease-in-a-dish models for studies ranging from disease etiology to drug development and screening.
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29
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Rnjak J, Wise SG, Mithieux SM, Weiss AS. Severe Burn Injuries and the Role of Elastin in the Design of Dermal Substitutes. TISSUE ENGINEERING PART B-REVIEWS 2011; 17:81-91. [DOI: 10.1089/ten.teb.2010.0452] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Jelena Rnjak
- School of Molecular Bioscience, University of Sydney, Sydney, Australia
| | - Steven G. Wise
- School of Molecular Bioscience, University of Sydney, Sydney, Australia
| | | | - Anthony S. Weiss
- School of Molecular Bioscience, University of Sydney, Sydney, Australia
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32
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Brohem CA, Cardeal LBDS, Tiago M, Soengas MS, Barros SBDM, Maria-Engler SS. Artificial skin in perspective: concepts and applications. Pigment Cell Melanoma Res 2010; 24:35-50. [PMID: 21029393 DOI: 10.1111/j.1755-148x.2010.00786.x] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Skin, the largest organ of the human body, is organized into an elaborate layered structure consisting mainly of the outermost epidermis and the underlying dermis. A subcutaneous adipose-storing hypodermis layer and various appendages such as hair follicles, sweat glands, sebaceous glands, nerves, lymphatics, and blood vessels are also present in the skin. These multiple components of the skin ensure survival by carrying out critical functions such as protection, thermoregulation, excretion, absorption, metabolic functions, sensation, evaporation management, and aesthetics. The study of how these biological functions are performed is critical to our understanding of basic skin biology such as regulation of pigmentation and wound repair. Impairment of any of these functions may lead to pathogenic alterations, including skin cancers. Therefore, the development of genetically controlled and well characterized skin models can have important implications, not only for scientists and physicians, but also for manufacturers, consumers, governing regulatory boards and animal welfare organizations. As cells making up human skin tissue grow within an organized three-dimensional (3D) matrix surrounded by neighboring cells, standard monolayer (2D) cell cultures do not recapitulate the physiological architecture of the skin. Several types of human skin recombinants, also called artificial skin, that provide this critical 3D structure have now been reconstructed in vitro. This review contemplates the use of these organotypic skin models in different applications, including substitutes to animal testing.
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Affiliation(s)
- Carla A Brohem
- Department of Clinical Chemistry & Toxicology, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
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Bujang-Safawi E, Halim AS, Khoo TL, Dorai AA. Dried irradiated human amniotic membrane as a biological dressing for facial burns--a 7-year case series. Burns 2010; 36:876-82. [PMID: 20236771 DOI: 10.1016/j.burns.2009.07.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2009] [Revised: 07/08/2009] [Accepted: 07/09/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Facial burns are common and have a significant impact on patient function and psychosocial well being. Human amnion has been used for many years as a temporary biological wound dressing in the management of partial thickness burns. The observed advantages of human amnion treatment include pain relief, ease of use, prevention of infection and acceleration of wound healing. OBJECTIVE This study evaluated our 7 years of working with dried irradiated human amnion in the treatment of facial burns. METHOD A review of patients, treated with dried human amnion for facial burns between 2001 and 2008. Demographic details collected included age, gender, total facial surface area burned, type of burn and cause of injury. The effectiveness of the treatment was determined by wound infection rate, frequency of dressing reapplication, healing time and resulting scarring. RESULTS Thirty-three patients with superficial partial thickness burn were identified (25 males, 8 females). The average age of the patients was 16.5 years (range: 8 months to 64 years). The causes included scalding (n=15), contact burning (n=13) and flash burning (n=5). The mean percent total facial surface area burned was 2.7% (range: 0.5-8.5%). None of the patients developed facial wound infections. Eighty-five percent (n=28) of the patients needed a single application of the dried amnion. The average healing time was 5.4 days (range: 2-14 days). Thirteen patients (39%) had burns confined to the facial area, of which three were discharged and treated as outpatients. Long-term follow up showed two hypopigmented scars, one hyperpigmented scar and one hypertrophic scar. CONCLUSION Superficial partial thickness facial burns can be effectively treated with dried irradiated human amnion membrane.
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Affiliation(s)
- E Bujang-Safawi
- Burn Unit, Reconstructive Sciences Department, Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
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Rnjak J, Li Z, Maitz PKM, Wise SG, Weiss AS. Primary human dermal fibroblast interactions with open weave three-dimensional scaffolds prepared from synthetic human elastin. Biomaterials 2009; 30:6469-77. [PMID: 19712968 DOI: 10.1016/j.biomaterials.2009.08.017] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Accepted: 08/08/2009] [Indexed: 11/19/2022]
Abstract
We present an elastic, fibrous human protein-based and cell-interactive dermal substitute scaffold based on synthetic human elastin. Recombinant human tropoelastin promoted primary human dermal fibroblast attachment, spreading and proliferation. Tropoelastin was cross-linked to form a synthetic elastin (SE) hydrogel matrix and electrospun into fibrous SE scaffolds. Fibroblasts attached to and proliferated across SE hydrogel scaffold surfaces for at least 14 days and deposited the extracellular matrix proteins fibronectin and collagen type I. To allow for the benefit of greater cell infiltration, SE was electrospun into open weave, fibrous scaffolds that closely mimic the fibrous nature of the skin dermis. 3D SE scaffolds were robust and consisted of flat, ribbon-like fibers with widths that are similar to native dermal elastic fibers. The scaffolds displayed elasticity close to that of natural elastin. 3D SE retained the ability to interact with primary human dermal fibroblasts, which consistently attached and proliferated to form monolayers spanning the entire scaffold surface. The open weave design, with larger spaces between individual fibers and greater fiber diameters beneficially allowed for substantial cell infiltration throughout the scaffolds.
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Affiliation(s)
- Jelena Rnjak
- School of Molecular & Microbial Biosciences, University of Sydney, New South Wales 2006, Australia
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35
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Shevchenko RV, Sibbons PD, Sharpe JR, James SE. Use of a novel porcine collagen paste as a dermal substitute in full-thickness wounds. Wound Repair Regen 2008; 16:198-207. [PMID: 18318805 DOI: 10.1111/j.1524-475x.2008.00360.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A commercially available porcine collagen sheet material has been found previously to be useful as an implant for reconstructive surgery. However, its use as a dermal substitute has been hindered by slow cell penetration and vascularization. A novel paste formulation of this material was investigated for its potential role as a dermal substitute in full-thickness wounds. A porcine punch biopsy model was initially used to assess the integration of a wide range of material formulations. Selected formulations were then assessed further in a larger wound-chamber model. Paste formulations were compared with those of sheet and another commercially available dermal regeneration template. The porcine collagen paste became integrated into full-thickness wounds without rejection and without excessive inflammation. It was detected in wounds up to day 27 postimplantation. Porcine collagen paste was readily infiltrated by host cells by day 2 and supported migrating keratinocytes on its surface. Staining for endothelial cells indicated neovasculature formation as early as day 4 and functional newly formed microvessels were noted at day 7. This was comparable with neovascularization of an alternative and clinically proven dermal regeneration template and was significantly superior to the sheet material formulation at the same time points. Our findings suggest that porcine collagen paste may be suitable as an alternative to current dermal substitutes in full-thickness wounds.
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Affiliation(s)
- Rostislav V Shevchenko
- Blond McIndoe Research Foundation, Queen Victoria Hospital, East Grinstead, Sussex, United Kingdom
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Marx G, Hotovely-Salomon A, Levdansky L, Gaberman E, Snir G, Sievner Z, Klauzner Y, Silberklang M, Thomas D, Hoffman N, Luke S, Lesnoy D, Gorodetsky R. Haptide-coated collagen sponge as a bioactive matrix for tissue regeneration. J Biomed Mater Res B Appl Biomater 2008; 84:571-83. [PMID: 17680668 DOI: 10.1002/jbm.b.30905] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We previously described a new class of conserved, cell adhesive (haptotactic) peptides, termed Haptides, based on sequences first identified in fibrinogen. Here, we describe a new biomaterial, Haptide-coated Collagen, in which the carbodiimide reagent, EDC, was used to covalently couple a Haptide (preC gamma), equivalent to the carboxy terminus of the fibrinogen gamma chain, to a cross-linked sponge composed of bovine collagen type I. The dose response of Haptide bound to collagen on cell attachment response reached a plateau at a concentration of 5-10 mg Haptide/g collagen. The Haptized-collagen was more stable to 1N NaOH, with a degradation half-time (T(1/2)) of 1.7 h, compared to 0.9 h for untreated control. Haptized collagen discs could be loaded with approximately 30% more human dermal fibroblasts or bovine aortic endothelial cells than unmodified collagen discs (p < 0.001). After a proliferation phase, Haptized collagen discs contained approximately 45% more fibroblasts than non-Haptized discs (p < 0.01). Histological analysis following sub-dermal implantation in rats indicated that at day 8, Haptized collagen sponge was less degraded than unmodified collagen sponge, attracted more endogenous fibroblasts with newly deposited collagen, and provoked less inflammatory or other adverse reactions. These results suggest potential clinical applications for Haptized collagen sponge for tissue regeneration, soft tissue augmentation, skin repair, and wound healing.
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Affiliation(s)
- Gerard Marx
- Hapto Biotech Israel Ltd., Jerusalem, Israel
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Pham C, Greenwood J, Cleland H, Woodruff P, Maddern G. Bioengineered skin substitutes for the management of burns: A systematic review. Burns 2007; 33:946-57. [PMID: 17825993 DOI: 10.1016/j.burns.2007.03.020] [Citation(s) in RCA: 211] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Accepted: 03/26/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the safety and efficacy of bioengineered skin substitutes in comparison with biological skin replacements and/or standard dressing methods in the management of burns, through a systematic review of the literature. METHODS Literature databases were searched up to April 2006, identifying randomised controlled trials. RESULTS Twenty randomised controlled trials were included in this review. The numerous sub-group analyses and the diversity of skin substitutes limited the ability to draw any conclusions from it. However, the evidence suggested that bioengineered skin substitutes, namely Biobrane, TransCyte, Dermagraft, Apligraf, autologous cultured skin, and allogeneic cultured skin, were at least as safe as biological skin replacements or topical agents/wound dressings. The safety of Integra could not be determined. For the management of partial thickness burns, the evidence suggested that bioengineered skin substitutes, namely Biobrane, TransCyte, Dermagraft, and allogeneic cultured skin, were at least as efficacious as topical agents/wound dressings or allograft. Apligraf combined with autograft was at least as efficacious as autograft alone. For the management of full thickness burns, the efficacy of autologous cultured skin could not be determined based on the available evidence. The efficacy of Integra could not be determined based on the available evidence. CONCLUSIONS Additional methodologically rigorous randomised controlled trials with long-term follow-up would strengthen the evidence base for the use of bioengineered skin substitutes.
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Affiliation(s)
- Clarabelle Pham
- ASERNIP-S, Royal Australasian College of Surgeons, and Burns Unit, Royal Adelaide Hospital, South Australia, Australia
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Gravante G, Di Fede MC, Araco A, Grimaldi M, De Angelis B, Arpino A, Cervelli V, Montone A. A randomized trial comparing ReCell system of epidermal cells delivery versus classic skin grafts for the treatment of deep partial thickness burns. Burns 2007; 33:966-72. [PMID: 17904748 DOI: 10.1016/j.burns.2007.04.011] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 04/11/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Our purpose was to directly compare results obtained with the ReCell system and the classic skin grafting for epidermal replacement in deep partial thickness burns. MATERIALS AND METHODS We recruited all patients with deep partial thickness burns admitted at the Burn Centre of S. Eugenio Hospital in Rome over 2 years. Enrollment was conducted with a controlled strategy--sampling chart--that allowed homogeneous groups (ReCell and skin grafting) for age, gender, type of burns and total burn surface area (TBSA). We evaluated as primary endpoints of the study the (i) time for complete epithelization (both treated area and biopsy site) and (ii) aesthetic and functional quality of the epithelization (color, joint contractures). Secondary endpoints were the assessment of infections, inflammations or any adverse effects of the ReCell procedure, particular medications assumed, postoperative pain. RESULTS Eighty-two patients were analyzed in two homogeneous groups. All of them received adequate epidermal replacement, but skin grafting was faster than ReCell (p<0.05). On the contrary, ReCell biopsy areas and postoperative pain were smaller than classic grafting (p<0.05). The aesthetic and functional outcomes were similar between procedures. CONCLUSIONS ReCell is a feasible, simple and safe technique. It gives similar results to skin grafting but, harvesting minor areas, can open possible future applications in the management of large-burns patients.
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Affiliation(s)
- G Gravante
- Department of Surgery, University of Tor Vergata in Rome, via U. Maddalena 40/a, 00043 Ciampino, and Burn Center S. Eugenio Hospital, Roma, Italy.
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Rouabhia M, Gilbert V, Wang H, Subirade M. In vivo
evaluation of whey protein-based biofilms as scaffolds for cutaneous cell cultures and biomedical applications. Biomed Mater 2007; 2:S38-44. [DOI: 10.1088/1748-6041/2/1/s06] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Singh R, Purohit S, Chacharkar MP, Bhandari PS, Bath AS. Microbiological safety and clinical efficacy of radiation sterilized amniotic membranes for treatment of second-degree burns. Burns 2006; 33:505-10. [PMID: 17182190 DOI: 10.1016/j.burns.2006.08.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Accepted: 08/05/2006] [Indexed: 02/07/2023]
Abstract
Amniotic membranes collected from the placentae of screened donors were processed and sterilized by gamma irradiation at 25 kGy. The sterility assurance level (SAL) of gamma irradiated amniotic membranes and clinical efficacy in second-degree burn wound healing were evaluated. Processed air-dried amniotic tissue from 159 batches of processing was checked for the bioburden level before sterilization. About 39% of the tissues had bioburden in the range of 10(1)-10(2)/100 cm(2) and 54.8% in the range of 10(2)-10(3)/100 cm(2). Based on the bioburden of the processed tissue prior to sterilization and the D(10) value of 2.3 kGy for the radiation resistant reference strain Bacillus pumilus, the sterility assurance level of the amniotic membranes irradiated at 25 kGy is found to be 10(-7) to 10(-11). The burn wound healing rate was compared between the radiation sterilized amniotic membranes and glycerol preserved amniotic membranes. Fifty patients with partial-thickness burns (up to 70% TBSA) were selected for the study. The scalds constituted 82% (41 patients) whereas flame burns accounted for 18% (9 patients). Various aspects like ease of application, patient comfort, development of fluid under the membrane, bacterial culture of drained fluid, rate of epithelialization, development of hypertrophic scars, keloids, unstable scars and restriction of joint movements were recorded with the application of gamma irradiated and glycerol preserved membranes. Radiation sterilized amniotic membranes had advantage over the glycerolized membranes with respect to the ease of application. Five patients with glycerol preserved membranes and four with gamma irradiated membranes developed fluid. The bacteriology of fluid showed Pseudomonas aeruginosa in four cases, Staphylococcus aureus in two cases, Escherichia coli in two cases and Acinetobacter in one case. The application of radiation sterilized amniotic membranes on the burn wound favoured epithelialization. In all the patients, membranes dessicated and separated in 10-14 days time leaving behind an epithelialized surface.
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Affiliation(s)
- Rita Singh
- Defence Laboratory, Defence Research & Development Organization, Jodhpur 342011, India
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Affiliation(s)
- D Q A Nguyen
- D.Q.A Nguyen, MB, Morriston Hospital, Swansea, UK.
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Saap LJ, Donohue K, Falanga V. Clinical classification of bioengineered skin use and its correlation with healing of diabetic and venous ulcers. Dermatol Surg 2004; 30:1095-100. [PMID: 15274699 DOI: 10.1111/j.1524-4725.2004.30334.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic wounds are being treated with bioengineering skin constructs. Yet, there is no standard way of assessing these wounds. We developed a classification system to evaluate wounds after construct application. The classification system evaluates the early clinical effect of bioengineered skin and early construct appearance giving a total score named the skin substitute score. OBJECTIVE Apply classification system to both venous and diabetic foot ulcers and determine whether classification system has validity and predictability for healing. METHODS Evaluated serial photographs in 83 and 78 patients with diabetic foot ulcers and in 84 and 83 patients with venous ulcer on Days 7 and 14, respectively, treated with a bilayered bioengineered skin construct. Applied the classification system and determined the percentages of healed patients. RESULTS There was a significant correlation between better skin substitute score and complete wound closure for both venous ulcers p=0.002 on Day 7 and p=0.01 on Day 14) and diabetic foot ulcers p=0.0005 on Day 7 and p<0.0001 on Day 14). CONCLUSION Optimal clinical effect was associated with complete wound closure. As the clinical effect becomes less than optimal continued clinical persistence of the construct becomes important. This classification system seems to have validity in predicting complete wound closure in wounds treated with a bilayered bioengineered skin construct.
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Affiliation(s)
- Liliana J Saap
- Department of Dermatology and Skin Surgery, Roger Williams Medical Center, Providence, Rhode Island 02908, USA
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Clinical Classification of Bioengineered Skin Use and Its Correlation with Healing of Diabetic and Venous Ulcers. Dermatol Surg 2004. [DOI: 10.1097/00042728-200408000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Current Trends in Wound Care Management. Orthop Nurs 2002. [DOI: 10.1097/00006416-200211000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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