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Mingqi Z, Le W, Yuqiang Z, Na L, Wei H, Zhuoshi W. The use of human-derived feeder layers for the cultivation of transplantable human epidermal cell sheet to repair second degree burn wounds. Skin Res Technol 2023; 29:e13290. [PMID: 36823513 PMCID: PMC10155851 DOI: 10.1111/srt.13290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 01/25/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Human epidermal cell sheet (human-ECS) is a feasible treatment option for wound injury. Traditionally, researchers often use murine 3T3 fibroblast cells as feeder layer to support human epidermal cell sheet grafts, thus increase risk to deliver animal-borne infection. To overcome the potential risks involved with xenotransplantation, we develop human foreskin fibroblast cell as feeder layer culture system and investigate the effects of human-ECS on second-degree burn wound healing in mini-pig in order to develop more effective and safer therapies to enhance wound healing in human. MATERIALS AND METHODS Human epidermal keratinocytes and fibroblasts were isolated from foreskin tissue and were co-cultured to manufacture human-ECS. The cell morphology was monitored with phase-contrast microscopy, the stem cell markers were assessed by flow cytometry, and by colony-forming efficiency (CFE) assay. The structure of human-ECS was observed by hematoxylin and eosin staining. Expression of cytokines in human-ECS was confirmed by enzyme-linked immunosorbent assay. Second-degree burn wounds were created on the dorsal of miniature pig to evaluate the effect of oil gauze, oil gauze combined with commercial epidermal growth factor (EGF) cream, and oil gauze combined with human-ECS. Wound healing rate, histological examination, and Masson staining were measured to observe the wound repair efficacy. Real-time PCR and Western blot were utilized to detect the expression level of EGF and interleukin 6 (IL-6). RESULTS Stratified human-ECS with 6-7 layers of epidermal cells was successfully cultivated with human-derived feeder cells, in which epidermal cell highly expressed CD49f and CFE was 3% ± 0.45%. Application of human-ECS induced a higher wound healing rate than commerical EGF cream and oil gauze control. The expression of EGF in human-ECS group was higher than those in the other groups; however, the expression of IL-6 was significantly decreased at day 14 by human-ECS treatment group. CONCLUSIONS Human-derived feeder cells are suitable for cultivation of human-ECS, avoiding pathogen transmission. Human-ECS could enhance second-degree burn wound healing, and its promoting effect involved secreting a variety of cytokines to regulate tissue reparative process.
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Affiliation(s)
- Zhang Mingqi
- Stem Cell Center of Precision Medicine Innovation InstituteHe UniversityShenyangChina
- Liaoning Key Lab of Ophthalmic Stem CellsHe UniversityShenyangChina
- Liaoning Province Ophthalmic Stem Cell Clinical Application Research CenterHe Eye Specialist HospitalShenyangChina
| | - Wang Le
- Stem Cell Center of Precision Medicine Innovation InstituteHe UniversityShenyangChina
- Liaoning Key Lab of Ophthalmic Stem CellsHe UniversityShenyangChina
| | - Zheng Yuqiang
- Stem Cell Center of Precision Medicine Innovation InstituteHe UniversityShenyangChina
- Liaoning Key Lab of Ophthalmic Stem CellsHe UniversityShenyangChina
| | - Li Na
- Stem Cell Center of Precision Medicine Innovation InstituteHe UniversityShenyangChina
- Liaoning Province Ophthalmic Stem Cell Clinical Application Research CenterHe Eye Specialist HospitalShenyangChina
| | - He Wei
- Stem Cell Center of Precision Medicine Innovation InstituteHe UniversityShenyangChina
- Liaoning Key Lab of Ophthalmic Stem CellsHe UniversityShenyangChina
- Liaoning Province Ophthalmic Stem Cell Clinical Application Research CenterHe Eye Specialist HospitalShenyangChina
| | - Wang Zhuoshi
- Stem Cell Center of Precision Medicine Innovation InstituteHe UniversityShenyangChina
- Liaoning Key Lab of Ophthalmic Stem CellsHe UniversityShenyangChina
- Liaoning Province Ophthalmic Stem Cell Clinical Application Research CenterHe Eye Specialist HospitalShenyangChina
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2
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Exploring the Concept of In Vivo Guided Tissue Engineering by a Single-Stage Surgical Procedure in a Rodent Model. Int J Mol Sci 2022; 23:ijms232012703. [PMID: 36293558 PMCID: PMC9604108 DOI: 10.3390/ijms232012703] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/09/2022] [Accepted: 10/15/2022] [Indexed: 11/17/2022] Open
Abstract
In severe malformations with a lack of native tissues, treatment options are limited. We aimed at expanding tissue in vivo using the body as a bioreactor and developing a sustainable single-staged procedure for autologous tissue reconstruction in malformation surgery. Autologous micro-epithelium from skin was integrated with plastically compressed collagen and a degradable knitted fabric mesh. Sixty-three scaffolds were implanted in nine rats for histological and mechanical analyses, up to 4 weeks after transplantation. Tissue integration, cell expansion, proliferation, inflammation, strength, and elasticity were evaluated over time in vivo and validated in vitro in a bladder wound healing model. After 5 days in vivo, we observed keratinocyte proliferation on top of the transplant, remodeling of the collagen, and neovascularization within the transplant. At 4 weeks, all transplants were fully integrated with the surrounding tissue. Tensile strength and elasticity were retained during the whole study period. In the in vitro models, a multilayered epithelium covered the defect after 4 weeks. Autologous micro-epithelial transplants allowed for cell expansion and reorganization in vivo without conventional pre-operative in vitro cell propagation. The method was easy to perform and did not require handling outside the operating theater.
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3
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Air-Pressure-Supported Application of Cultured Human Keratinocytes in a Fibrin Sealant Suspension as a Potential Clinical Tool for Large-Scale Wounds. J Clin Med 2022; 11:jcm11175032. [PMID: 36078961 PMCID: PMC9456662 DOI: 10.3390/jcm11175032] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/12/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
The treatment of large-scale skin wounds remains a therapeutic challenge. In most cases there is not enough autologous material available for full coverage. Cultured epithelial autografts are efficient in restoring the lost epidermal cover; however, they have some disadvantages, such as difficult application and protracted cell cultivation periods. Transplanting a sprayed keratinocyte suspension in fibrin sealant as biological carrier is an option to overcome those disadvantages. Here, we studied different seeding techniques regarding their applicability and advantages on cell survival, attachment, and outgrowth in vitro and thereby improve the cell transfer to the wound bed. Human primary keratinocytes were suspended in a fibrin sealant. WST-8 assay was used to evaluate the vitality for 7 days. Furthermore, the cells were labeled with CellTracker™ CM-Di-I and stained with a life/dead staining. Cell morphology, shape, and distribution were microscopically analyzed. There was a significant increase in vitality while cultivating the cells in fibrin. Sprayed cells were considerably more homogenously distributed. Sprayed cells reached the confluent state earlier than dripped cells. There was no difference in the vitality and morphology in both groups over the observation period. These findings indicate that the sprayed keratinocytes are superior to the application of the cells as droplets. The sprayed application may offer a promising therapeutic option in the treatment of large chronic wounds.
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4
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Fluid gels: A systematic review towards their application in pharmaceutical dosage forms and drug delivery systems. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2021.102947] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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5
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Hasegawa Y, Matsumine H, Osada A, Hayakawa N, Kamei W, Yosuke N, Sakurai H. Fibroblast growth factor-impregnated collagen-gelatin sponge improves keratinocyte sheet survival. Tissue Eng Part A 2021; 28:373-382. [PMID: 34598658 DOI: 10.1089/ten.tea.2021.0138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Commercially available cultured epithelial keratinocyte sheets (KSs) have played an essential role in wound healing over the last four decades. Despite the initial uptake by the dermal elements, the survival rate of KS on the dermis-like tissue generated by conventional artificial dermis (AD) is low, making this method unsuitable for standard treatments. Therefore, an innovative AD such as collagen/gelatin sponge (CGS) that maintains the release of human recombinant basic fibroblast growth factor (bFGF) may promote wound healing. In this study, we examined whether combination therapy with KSs and CGS with bFGF (bFGF-CGS) could enhance KS survival by heterologous grafting by transplantation of human-derived KSs in an athymic nude rat wound model of staged skin reconstruction. The CGSs were implanted into skin defect wounds on athymic nude rats, which were then divided into two experimental groups: the bFGF group (CGSs containing bFGF, n = 8) and control group (CGSs with saline, n = 8). Two weeks after implantation, human epithelial cell-derived KSs were grafted onto the dermis-like tissue, followed by assessment of the survival and morphology at one week later using digital imaging, histology (hematoxylin and eosin and Masson's trichrome staining), immunohistology (von Willebrand factor), immunohistochemistry (cytokeratin 1-5-6, Ki-67), and immunofluorescence (collagen IV, pan-cytokeratins) analyses. The bFGF group showed a significantly higher KS survival area (86 ± 58 vs. 32 ± 22 mm2; p < 0.05) and increased epidermal thickness (158 ± 66 vs. 86 ± 40 µm; p < 0.05) compared with the control group, along with higher dermis-like tissue regeneration, neovascularization, epidermal maturation, and basement membrane development. These results indicate that the survival rate of KSs in the dermis-like tissue formed by bFGF-CGS was significantly increased. Therefore, combination treatment of bFGF-CGS and KSs shows potential for full-thickness skin defect reconstruction in clinical situations.
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Affiliation(s)
- Yuki Hasegawa
- Tokyo Women's Medical University, 13131, Department of Plastic and Reconstructive Surgery, Shinjuku-ku, Tokyo, Japan;
| | - Hajime Matsumine
- Tokyo Women's Medical University, 13131, Department of Plastic and Reconstructive Surgery, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan, 162-8666;
| | - Atsuyoshi Osada
- Tokyo Women's Medical University, 13131, Department of Plastic and Reconstructive Surgery, Shinjuku-ku, Tokyo, Japan;
| | - Nami Hayakawa
- Tokyo Women's Medical University, 13131, Shinjuku-ku, Tokyo, Japan;
| | - Wataru Kamei
- Tokyo Women's Medical University, 13131, Department of Plastic and Reconstructive Surgery, Shinjuku-ku, N/A = Not Applicable, Japan;
| | - Niimi Yosuke
- Tokyo Women's Medical University, 13131, Shinjuku-ku, Tokyo, Japan;
| | - Hiroyuki Sakurai
- Tokyo Women's Medical University, 13131, Department of Plastic and Reconstructive Surgery, Shinjuku-ku, Tokyo, Japan;
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6
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Milner S, Swanson E, Granick M, Sopko N. Addressing Full-Thickness Skin Defects: A Review of Clinically Available Autologous Skin Replacements. Surg Technol Int 2021; 38:73-78. [PMID: 33755940 DOI: 10.52198/21.sti.38.wh1403] [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: 06/12/2023]
Abstract
Autologous keratinocyte culture, and combinations of scaffolds, different cell types, solutions of macromolecules, or growth factors have contributed to the resurfacing of full-thickness skin defects. Ideally, a treatment for full-thickness skin defects should not merely reestablish continuity of the surface of the skin but should restore its structure to allow skin to function as a dynamic biological factory that can participate in protein synthesis, metabolism, and cell signaling, and form an essential part of the body's immune, nervous, and endocrine systems. This paper provides a review of clinically available autologous skin replacements, highlighting the importance of regenerating an organ that will function physiologically.
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Affiliation(s)
- Stephen Milner
- Department of Research and Development, PolarityTE, Salt Lake City, Utah
| | - Edward Swanson
- Department of Research and Development, PolarityTE, Salt Lake City, Utah
| | - Mark Granick
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Nikolai Sopko
- Department of Research and Development, PolarityTE, Salt Lake City, Utah
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7
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Desanlis A, Albouy M, Rousselle P, Thépot A, Santos MD, Auxenfans C, Marquette C. Validation of an implantable bioink using mechanical extraction of human skin cells: First steps to a 3D bioprinting treatment of deep second degree burn. J Tissue Eng Regen Med 2020; 15:37-48. [PMID: 33170542 DOI: 10.1002/term.3148] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 11/12/2022]
Abstract
Clinical grade cultured epithelial autograft (CEA) are routinely used to treat burns covering more than 60% of the total body surface area. However, although the epidermis may be efficiently repaired by CEA, the dermal layer, which is not spared in deep burns, requires additional treatment strategies. Our aim is to develop an innovative method of skin regeneration based on in situ 3D bioprinting of freshly isolated autologous skin cells. We describe herein bioink formulation and cell preparation steps together with experimental data validating a straightforward enzyme-free protocol of skin cell extraction. This procedure complies with both the specific needs of 3D bioprinting process and the stringent rules of good manufacturing practices. This mechanical extraction protocol, starting from human skin biopsies, allows harvesting a sufficient amount of both viable and growing keratinocytes and fibroblasts. We demonstrated that a dermis may be reconstituted in vitro starting from a medical grade bioink and mechanically extracted skin cells. In these experiments, proliferation of the extracted cells can be observed over the first 21 days period after 3D bioprinting and the analysis of type I collagen exhibited a de novo production of extracellular matrix proteins. Finally, in vivo experiments in a murine model of severe burn provided evidences that a topical application of our medical grade bioink was feasible and well-tolerated. Overall, these results represent a valuable groundwork for the design of future 3D bioprinting tissue engineering strategies aimed at treating, in a single intraoperative step, patients suffering from extended severe burns.
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Affiliation(s)
- Adeline Desanlis
- Hospices Civils de Lyon, Banque de Tissus et Cellules, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - Marion Albouy
- LabSkin Creations, Edouard Herriot Hospital, Lyon, France
| | - Patricia Rousselle
- Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305, CNRS - Université Lyon 1, Institut de Biologie et Chimie des Protéines, SFR BioSciences Gerland-Lyon Sud, Lyon, France
| | - Amélie Thépot
- LabSkin Creations, Edouard Herriot Hospital, Lyon, France
| | | | - Céline Auxenfans
- Hospices Civils de Lyon, Banque de Tissus et Cellules, Groupement Hospitalier Edouard Herriot, Lyon, France.,Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, UMR 5305, CNRS - Université Lyon 1, Institut de Biologie et Chimie des Protéines, SFR BioSciences Gerland-Lyon Sud, Lyon, France
| | - Christophe Marquette
- 3d.FAB, Univ Lyon, Université Lyon 1, CNRS, INSA, CPE-Lyon, ICBMS, UMR 5246, Villeurbanne, France
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8
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The Causes for the Loss of Cellular Material at the Qualification Stage and the Influence of the Patient's Flora on Culture Infection. Transplant Proc 2020; 52:2231-2235. [PMID: 32474001 DOI: 10.1016/j.transproceed.2020.02.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 02/13/2020] [Indexed: 11/21/2022]
Abstract
There are several causes leading to the loss of cellular material earmarked for transplantation. This paper aims to evaluate the number of lost donors and lost cells in the culture by means of verifying both the results of the qualification tests and the presence of microorganisms in the cellular material. The analysis involved 86 donors hospitalized for thermal burns, from whom cells were harvested for keratinocyte and fibroblast cultures in the years 2011 to 2015. All potential donors underwent qualification tests: Anti-HIV-1,2; HBsAg; Anti-HCV-Ab; HBc, and a specific test for syphilis. In the case of skin fragments collected for culturing, the microbiological tests included the carrying fluid, the medium after 1 change, and the medium during culturing and before transplantation. Skin donors for cell cultures were assigned to the groups based on if the skin was collected up to 7 days following the burn or later. On average, 12% of the disqualifications were reported among donors for cell culturing. The most frequent cause of donor disqualification (54% of all disqualifications) was a positive HBc(+). The occurrence of fungal infections detected in the cellular material was over 30%. Establishing the culture after day 7 following the injury immediately increases the risk of infection by 25% in comparison to those cultures established before or on day 7 following the injury. Proper disinfection of donor place is crucial, but sometimes insufficient for maintenance sterility in cell culture. The risk of infection increases 25% after 7 following the injury.
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9
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Abstract
Cadaveric skin allograft is the current standard of treatment for temporary coverage of large burn wounds. Porcine xenografts are viable alternatives but undergo α-1,3-galactose (Gal)-mediated hyperacute rejection and are lost by post-operative day (POD) 3 because of naturally occurring antibodies to Gal in primate recipients. Using baboons, we previously demonstrated that xenografts from GalT-KO swine (lacking Gal) provided wound coverage comparable with allografts with systemic immunosuppression. In this study, we investigate topical immunosuppression as an alternative to prolong xenograft survival. Full-thickness wounds in baboons were created and covered with xenogeneic and allogeneic split-thickness skin grafts (STSGs). Animals were treated with slow-release (TyroSphere-encapsulated) topical formulations (cyclosporine-A [CSA] or Tacrolimus) applied 1) directly to the STSGs only, or 2) additionally to the wound bed before STSG and 1). Topical CSA did not improve either xenograft or allograft survival (median: treated grafts = 12.5 days, control = 14 days; P = 0.27) with similar results when topical Tacrolimus was used. Pretreatment of wound beds resulted in a significant reduction of xenograft survival compared with controls (10 vs 14 days; P = 0.0002), with comparable results observed in allografts. This observation was associated with marked reduction of inflammation on histology with Tacrolimus and not CSA. Prolongation of allograft and xenograft survival after application to full-thickness wound beds was not achieved with the current formulation of topical immunosuppressants. Modulation of inflammation within the wound bed was effective with Tacrolimus pretreatment before STSG application and may serve as a treatment strategy in related fields.
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10
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Lotfi M, Naderi-Meshkin H, Mahdipour E, Mafinezhad A, Bagherzadeh R, Sadeghnia HR, Esmaily H, Maleki M, Hasssanzadeh H, Ghayaour-Mobarhan M, Bidkhori HR, Bahrami AR. Adipose tissue-derived mesenchymal stem cells and keratinocytes co-culture on gelatin/chitosan/β-glycerol phosphate nanoscaffold in skin regeneration. Cell Biol Int 2019; 43:1365-1378. [PMID: 30791186 DOI: 10.1002/cbin.11119] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Using cell-based engineered skin is an emerging strategy for treating difficult-to-heal wounds. To date, much endeavor has been devoted to the fabrication of appropriate scaffolds with suitable biomechanical properties to support cell viability and growth in the microenvironment of a wound. The aim of this research was to assess the impact of adipose tissue-derived mesenchymal stem cells (AD-MSCs) and keratinocytes on gelatin/chitosan/β-glycerol phosphate (GCGP) nanoscaffold in full-thickness excisional skin wound healing of rats. For this purpose, AD-MSCs and keratinocytes were isolated from rats and GCGP nanoscaffolds were electrospun. Through an in vivo study, the percentage of wound closure was assessed on days 7, 14, and 21 after wound induction. Samples were taken from the wound sites in order to evaluate the density of collagen fibers and vessels at 7 and 14 days. Moreover, sampling was done on days 7 and 14 from wound sites to assess the density of collagen fibers and vessels. The wound closure rate was significantly increased in the keratinocytes-AD-MSCs-scaffold (KMS) group compared with other groups. The expressions of vascular endothelial growth factor, collagen type 1, and CD34 were also significantly higher in the KMS group compared with the other groups. These results suggest that the combination of AD-MSCs and keratinocytes seeded onto GCGP nanoscaffold provides a promising treatment for wound healing.
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Affiliation(s)
- Marzieh Lotfi
- Department of Genetics, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Department of Modern Sciences & Technologies School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hojjat Naderi-Meshkin
- Stem Cell and Regenerative Medicine Research Group, Academic Center for Education, Culture and Research (ACECR), Razavi Khorasan Branch, Mashhad, Iran
| | - Elahe Mahdipour
- Department of Medical Biotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asghar Mafinezhad
- Pathology Department of Shahid Kamyab (Emdadi) Hospitals, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Roohollah Bagherzadeh
- Department of Textile Engineering, Advanced Textile Materials and Technology Research Institute (ATMT), Amirkabir University of Technology, Tehran, Iran
| | - Hamid Reza Sadeghnia
- Neurocognitive Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Habibollah Esmaily
- Department of Biostatistics and Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoud Maleki
- Cutaneous Leishmaniasis Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Halimeh Hasssanzadeh
- Stem Cell and Regenerative Medicine Research Group, Academic Center for Education, Culture and Research (ACECR), Razavi Khorasan Branch, Mashhad, Iran
| | - Majid Ghayaour-Mobarhan
- Biochemistry of Nutrition Research Center, School of Medicine, Mashhad University of Medicine, Mashhad, Iran
| | - Hamid Reza Bidkhori
- Stem Cell and Regenerative Medicine Research Group, Academic Center for Education, Culture and Research (ACECR), Razavi Khorasan Branch, Mashhad, Iran
| | - Ahmad Reza Bahrami
- Stem Cell and Regenerative Medicine Research Group, Academic Center for Education, Culture and Research (ACECR), Razavi Khorasan Branch, Mashhad, Iran.,Industrial Biotechnology Research Group, Institute of Biotechnology, Ferdowsi University of Mashhad, Mashhad, Iran
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11
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Kathawala MH, Ng WL, Liu D, Naing MW, Yeong WY, Spiller KL, Van Dyke M, Ng KW. Healing of Chronic Wounds: An Update of Recent Developments and Future Possibilities. TISSUE ENGINEERING PART B-REVIEWS 2019; 25:429-444. [PMID: 31068101 DOI: 10.1089/ten.teb.2019.0019] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Chronic wounds are the result of disruptions in the body's usual process of healing. They are not only a source of significant pain and discomfort but also, more importantly, an unguarded port of entry for pathogens into the body. While our current understanding of this phenomenon is far from complete, findings in physiological patterns and advancements in wound healing technologies have helped develop wound management and healing solutions to this long-standing medical challenge. This review presents an overview of known wound healing mechanics, abnormalities that lead to chronic wounds, and a summary of established and new wound healing technologies. Various approaches to heal wounds are discussed, from dermal replacements to advanced biomaterial-based treatments, from cell-, synthetic-, and composite-based approaches to preclinical approaches, which make developing such products possible. While tested breakthrough products are described, the authors focused more on recently developed innovations, which are at varying stages of maturity. The review concludes with a note on future perspectives and opinions on where the field and industry are headed and where they should be. Impact Statement Wound healing is an important area of research and clinical practice, and has captured the attention of tissue engineers since the nascent beginnings of the discipline. Tissue-engineered skin was the first FDA-approved product, achieved in 1996. Despite this success, and the passage of time, healing wounds, particularly chronic wounds, remains a vexing challenge. This comprehensive review article will provide readers with a synopsis of current issues, research approaches, animal models, technologies, and products that span the continuum from early development to clinical studies, in the hope of fueling new interests and ideas to overcome this long-standing medical challenge.
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Affiliation(s)
| | - Wei Long Ng
- Singapore Centre for 3D Printing (SC3DP), School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Dan Liu
- Singapore Institute of Manufacturing Technology (SIMTECH), Singapore, Singapore
| | - May Win Naing
- Singapore Institute of Manufacturing Technology (SIMTECH), Singapore, Singapore
| | - Wai Yee Yeong
- Singapore Centre for 3D Printing (SC3DP), School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Kara L Spiller
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania
| | - Mark Van Dyke
- Department of Biomedical Engineering and Mechanics (BEAM), Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Kee Woei Ng
- School of Materials Science and Engineering, Nanyang Technological University, Singapore, Singapore.,Skin Research Institute of Singapore (SRIS), Singapore, Singapore.,Environmental Chemistry & Materials Centre, Nanyang Environment and Water Research Institute (NEWRI), Singapore, Singapore
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12
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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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13
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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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14
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Effect of Mature Adipocyte-Derived Dedifferentiated Fat Cells on Formation of Basement Membrane after Cultured Epithelial Autograft on Artificial Dermis. Plast Reconstr Surg 2019; 143:983e-992e. [PMID: 30807494 DOI: 10.1097/prs.0000000000005514] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Artificial dermis is an important option for preparing full-thickness wounds for cultured epithelial autografting. Long-term fragility after cultured epithelial autografting remains a problem, probably because of the lack of basement membrane proteins. The authors hypothesized that treating artificial dermis with mesenchymal stem cells would promote basement membrane protein production. The authors tested this using dedifferentiated fat cells in a porcine experimental model. METHODS This study used four male crossbred (Landrace, Large White, and Duroc) swine. Cultured epithelium and dedifferentiated fat cells were prepared from skin and subcutaneous fat tissue harvested from the cervical region. Full-thickness open dorsal wounds were created and treated with artificial dermis to prepare a graft bed for cultured epithelial autograft. Two groups were established: the control group (artificial dermis treated with 0.5 ml of normal saline solution applied to the wounds) and the dedifferentiated fat group (artificial dermis treated with 0.5 × 10 dedifferentiated fat cells suspended in 0.5 ml of normal saline solution sprayed onto the wounds). On postoperative day 10, the prepared cultured epithelium was grafted onto the generated dermis-like tissue. Fourteen days later, tissue specimens were harvested and evaluated histologically. RESULTS Light microscopy of hematoxylin and eosin-stained sections revealed the beginning of rete ridge formation in the dedifferentiated fat group. Synthesis of both collagen IV and laminin-5 was significantly enhanced in the dedifferentiated fat group. Transmission electron microscopy revealed a nearly mature basement membrane, including anchoring fibrils in the dedifferentiated fat group. CONCLUSION Combined use of artificial dermis and dedifferentiated fat cells promotes post-cultured epithelial autograft production and deposition of basement membrane proteins at the dermal-epidermal junction and basement membrane development, including anchoring fibrils.
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Ter Horst B, Moakes RJA, Chouhan G, Williams RL, Moiemen NS, Grover LM. A gellan-based fluid gel carrier to enhance topical spray delivery. Acta Biomater 2019; 89:166-179. [PMID: 30904549 DOI: 10.1016/j.actbio.2019.03.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 03/10/2019] [Accepted: 03/19/2019] [Indexed: 12/27/2022]
Abstract
Autologous cell transplantation was introduced to clinical practice nearly four decades ago to enhance burn wound re-epithelialisation. Autologous cultured or uncultured cells are often delivered to the surface in saline-like suspensions. This delivery method is limited because droplets of the sprayed suspension form upon deposition and run across the wound bed, leading to uneven coverage and cell loss. One way to circumvent this problem would be to use a gel-based material to enhance surface retention. Fibrin systems have been explored as co-delivery system with keratinocytes or as adjunct to 'seal' the cells following spray delivery, but the high costs and need for autologous blood has impeded its widespread use. Aside from fibrin gel, which can exhibit variable properties, it has not been possible to develop a gel-based carrier that solidifies on the skin surface. This is because it is challenging to develop a material that is sprayable but gels on contact with the skin surface. The manuscript reports the use of an engineered carrier device to deliver cells via spraying, to enhance retention upon a wound. The device involves shear-structuring of a gelling biopolymer, gellan, during the gelation process; forming a yield-stress fluid with shear-sensitive behaviours, known as a fluid gel. In this study, a formulation of gellan gum fluid gels are reported, formed with from 0.75 or 0.9% (w/v) polymer and varying the salt concentrations. The rheological properties and the propensity of the material to wet a surface were determined for polymer modified and non-polymer modified cell suspensions. The gellan fluid gels had a significantly higher viscosity and contact angle when compared to the non-polymer carrier. Viability of cells was not impeded by encapsulation in the gellan fluid gel or spraying. The shear thinning property of the material enabled it to be applied using an airbrush and spray angle, distance and air pressure were optimised for coverage and viability. STATEMENT OF SIGNIFICANCE: Spray delivery of skin cells has successfully translated to clinical practice. However, it has not yet been widely accepted due to limited retention and disputable cell viability in the wound. Here, we report a method for delivering cells onto wound surfaces using a gellan-based shear-thinning gel system. The viscoelastic properties allow the material to liquefy upon spraying and restructure rapidly on the surface. Our results demonstrate reduced run-off from the surface compared to currently used low-viscosity cell carriers. Moreover, encapsulated cells remain viable throughout the process. Although this paper studies the encapsulation of one cell type, a similar approach could potentially be adopted for other cell types. Our data supports further studies to confirm these results in in vivo models.
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Affiliation(s)
- B Ter Horst
- School of Chemical Engineering, University of Birmingham, Edgbaston, B15 2TT, United Kingdom; University Hospital Birmingham Foundation Trust, Burns Centre, Mindelsohn Way, B15 2TH Birmingham, United Kingdom; The Scar Free Foundation Birmingham Burn Research Centre, United Kingdom.
| | - R J A Moakes
- School of Chemical Engineering, University of Birmingham, Edgbaston, B15 2TT, United Kingdom
| | - G Chouhan
- School of Chemical Engineering, University of Birmingham, Edgbaston, B15 2TT, United Kingdom
| | - R L Williams
- School of Chemical Engineering, University of Birmingham, Edgbaston, B15 2TT, United Kingdom
| | - N S Moiemen
- University Hospital Birmingham Foundation Trust, Burns Centre, Mindelsohn Way, B15 2TH Birmingham, United Kingdom
| | - L M Grover
- School of Chemical Engineering, University of Birmingham, Edgbaston, B15 2TT, United Kingdom
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Pramotton FM, Robotti F, Giampietro C, Lendenmann T, Poulikakos D, Ferrari A. Optimized Topological and Topographical Expansion of Epithelia. ACS Biomater Sci Eng 2019; 5:3922-3934. [DOI: 10.1021/acsbiomaterials.8b01346] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Francesca Michela Pramotton
- Laboratory of Thermodynamics in Emerging Technologies, Department of Mechanical and Process Engineering, ETH Zurich, Sonneggstrasse 3, Zurich CH-8092, Switzerland
| | - Francesco Robotti
- Laboratory of Thermodynamics in Emerging Technologies, Department of Mechanical and Process Engineering, ETH Zurich, Sonneggstrasse 3, Zurich CH-8092, Switzerland
| | - Costanza Giampietro
- Laboratory of Thermodynamics in Emerging Technologies, Department of Mechanical and Process Engineering, ETH Zurich, Sonneggstrasse 3, Zurich CH-8092, Switzerland
- EMPA, Swiss Federal Laboratories for Material Science and Technologies, Überlandstrasse 129, Dübendorf 8600, Switzerland
| | - Tobias Lendenmann
- Laboratory of Thermodynamics in Emerging Technologies, Department of Mechanical and Process Engineering, ETH Zurich, Sonneggstrasse 3, Zurich CH-8092, Switzerland
| | - Dimos Poulikakos
- Laboratory of Thermodynamics in Emerging Technologies, Department of Mechanical and Process Engineering, ETH Zurich, Sonneggstrasse 3, Zurich CH-8092, Switzerland
| | - Aldo Ferrari
- Laboratory of Thermodynamics in Emerging Technologies, Department of Mechanical and Process Engineering, ETH Zurich, Sonneggstrasse 3, Zurich CH-8092, Switzerland
- EMPA, Swiss Federal Laboratories for Material Science and Technologies, Überlandstrasse 129, Dübendorf 8600, Switzerland
- Institute for Mechanical Systems, ETH Zurich, Leonhardstrasse 21, Zurich CH-8092, Switzerland
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17
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Wound healing after cultured epithelial autografting in patients with massive burn injury: A cohort study. J Plast Reconstr Aesthet Surg 2019; 72:427-437. [DOI: 10.1016/j.bjps.2018.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/12/2018] [Accepted: 11/03/2018] [Indexed: 01/26/2023]
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18
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Esteban-Vives R, Corcos A, Choi MS, Young MT, Over P, Ziembicki J, Gerlach JC. Cell-spray auto-grafting technology for deep partial-thickness burns: Problems and solutions during clinical implementation. Burns 2018; 44:549-559. [DOI: 10.1016/j.burns.2017.10.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/11/2017] [Accepted: 10/14/2017] [Indexed: 10/18/2022]
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19
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Cooke ME, Jones SW, Ter Horst B, Moiemen N, Snow M, Chouhan G, Hill LJ, Esmaeli M, Moakes RJA, Holton J, Nandra R, Williams RL, Smith AM, Grover LM. Structuring of Hydrogels across Multiple Length Scales for Biomedical Applications. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2018; 30:e1705013. [PMID: 29430770 DOI: 10.1002/adma.201705013] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 10/20/2017] [Indexed: 06/08/2023]
Abstract
The development of new materials for clinical use is limited by an onerous regulatory framework, which means that taking a completely new material into the clinic can make translation economically unfeasible. One way to get around this issue is to structure materials that are already approved by the regulator, such that they exhibit very distinct physical properties and can be used in a broader range of clinical applications. Here, the focus is on the structuring of soft materials at multiple length scales by modifying processing conditions. By applying shear to newly forming materials, it is possible to trigger molecular reorganization of polymer chains, such that they aggregate to form particles and ribbon-like structures. These structures then weakly interact at zero shear forming a solid-like material. The resulting self-healing network is of particular use for a range of different biomedical applications. How these materials are used to allow the delivery of therapeutic entities (cells and proteins) and as a support for additive layer manufacturing of larger-scale tissue constructs is discussed. This technology enables the development of a range of novel materials and structures for tissue augmentation and regeneration.
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Affiliation(s)
- Megan E Cooke
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Institute of Inflammation and Ageing, MRC Musculoskeletal Ageing Centre, QE Hospital, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Simon W Jones
- Institute of Inflammation and Ageing, MRC Musculoskeletal Ageing Centre, QE Hospital, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Britt Ter Horst
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Scar Free Foundation Centre for Burns Research, QE Hospital, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Naiem Moiemen
- Scar Free Foundation Centre for Burns Research, QE Hospital, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Martyn Snow
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Gurpreet Chouhan
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Lisa J Hill
- Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Maryam Esmaeli
- Institute of Inflammation and Ageing, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Richard J A Moakes
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - James Holton
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Rajpal Nandra
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Richard L Williams
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Alan M Smith
- Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK
| | - Liam M Grover
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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20
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Randomized, Paired-Site Comparison of Autologous Engineered Skin Substitutes and Split-Thickness Skin Graft for Closure of Extensive, Full-Thickness Burns. J Burn Care Res 2018; 38:61-70. [PMID: 27404165 DOI: 10.1097/bcr.0000000000000401] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Stable closure of full-thickness burn wounds remains a limitation to recovery from burns of greater than 50% of the total body surface area (TBSA). Hypothetically, engineered skin substitutes (ESS) consisting of autologous keratinocytes and fibroblasts attached to collagen-based scaffolds may reduce requirements for donor skin, and decrease mortality. ESS were prepared from split-thickness skin biopsies collected after enrollment of 16 pediatric burn patients into an approved study protocol. ESS and split-thickness autograft (AG) were applied to 15 subjects with full-thickness burns involving a mean of 76.9% TBSA. Data consisted of photographs, tracings of donor skin and healed wounds, comparison of mortality with the National Burn Repository, correlation of TBSA closed wounds with TBSA full-thickness burn, frequencies of regrafting, and immunoreactivity to the biopolymer scaffold. One subject expired before ESS application, and 15 subjects received 2056 ESS grafts. The ratio of closed wound to donor areas was 108.7 ± 9.7 for ESS compared with a maximum of 4.0 ± 0.0 for AG. Mortality for enrolled subjects was 6.25%, and 30.3% for a comparable population from the National Burn Repository (P < .05). Engraftment was 83.5 ± 2.0% for ESS and 96.5 ± 0.9% for AG. Percentage TBSA closed was 29.9 ± 3.3% for ESS, and 47.0 ± 2.0% for AG. These values were significantly different between the graft types. Correlation of % TBSA closed with ESS with % TBSA full-thickness burn generated an R value of 0.65 (P < .001). These results indicate that autologous ESS reduce mortality and requirements for donor skin harvesting, for grafting of full-thickness burns of greater than 50% TBSA.
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21
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Ter Horst B, Chouhan G, Moiemen NS, Grover LM. Advances in keratinocyte delivery in burn wound care. Adv Drug Deliv Rev 2018; 123:18-32. [PMID: 28668483 PMCID: PMC5764224 DOI: 10.1016/j.addr.2017.06.012] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/14/2017] [Accepted: 06/23/2017] [Indexed: 12/19/2022]
Abstract
This review gives an updated overview on keratinocyte transplantation in burn wounds concentrating on application methods and future therapeutic cell delivery options with a special interest in hydrogels and spray devices for cell delivery. To achieve faster re-epithelialisation of burn wounds, the original autologous keratinocyte culture and transplantation technique was introduced over 3 decades ago. Application types of keratinocytes transplantation have improved from cell sheets to single-cell solutions delivered with a spray system. However, further enhancement of cell culture, cell viability and function in vivo, cell carrier and cell delivery systems remain themes of interest. Hydrogels such as chitosan, alginate, fibrin and collagen are frequently used in burn wound care and have advantageous characteristics as cell carriers. Future approaches of keratinocyte transplantation involve spray devices, but optimisation of application technique and carrier type is necessary.
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Affiliation(s)
- Britt Ter Horst
- School of Chemical Engineering, University of Birmingham, Edgbaston B15 2TT, United Kingdom; University Hospital Birmingham Foundation Trust, Burns Centre, Mindelsohn Way, B15 2TH Birmingham, United Kingdom
| | - Gurpreet Chouhan
- School of Chemical Engineering, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Naiem S Moiemen
- University Hospital Birmingham Foundation Trust, Burns Centre, Mindelsohn Way, B15 2TH Birmingham, United Kingdom
| | - Liam M Grover
- School of Chemical Engineering, University of Birmingham, Edgbaston B15 2TT, United Kingdom.
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22
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23
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Lataillade JJ, Magne B, Bey E, Leclerc T, Trouillas M. [Skin engineering for severe burns]. Transfus Clin Biol 2017; 24:245-250. [PMID: 28736162 DOI: 10.1016/j.tracli.2017.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Severe burned patients need definitive and efficient wound coverage. Outcome of massive burns has been improved by using cultured epithelial autografts (CEA). Despite fragility, percentages of success take, cost of treatment and long-term tendency to contracture, this surgical technique has been developed in few burn centres. First improvements were to combine CEA and dermis-like substitute. Cultured skin substitutes provide earlier skin closure and satisfying functional result. These methods have been used successfully in massive burns. Second improvement was to allow skin regeneration by using epidermal stem cells. Stem cells have capacity to differentiate into keratinocytes, to promote wound repair and to regenerate skin appendages. Human mesenchymal stem cells contribute to wound healing and were evaluated in cutaneous radiation syndrome. Skin regeneration and tissue engineering methods remain a complex challenge and offer the possibility of new treatment for injured and burned patients.
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Affiliation(s)
- J-J Lataillade
- Unité de thérapie cellulaire et tissulaire et traumatologie de guerre, département soutien médical chirurgical des forces, CTS des armées/institut de recherche biomédicale des armées, BP 410, 92141 Clamart cedex, France.
| | - B Magne
- Unité de thérapie cellulaire et tissulaire et traumatologie de guerre, département soutien médical chirurgical des forces, CTS des armées/institut de recherche biomédicale des armées, BP 410, 92141 Clamart cedex, France
| | - E Bey
- Service de chirurgie plastique, hôpital d'instruction des armées Percy, rue du Lieutenant-Raoul-Batany, 92141 Clamart cedex, France
| | - T Leclerc
- Centre de traitement des brûlés, hôpital d'instruction des armées Percy, rue du Lieutenant-Raoul-Batany, 92141 Clamart cedex, France
| | - M Trouillas
- Unité de thérapie cellulaire et tissulaire et traumatologie de guerre, département soutien médical chirurgical des forces, CTS des armées/institut de recherche biomédicale des armées, BP 410, 92141 Clamart cedex, France
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24
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Abstract
Transplantation of cultured epidermal cell sheets (CES) has long been used to treat patients with burns, chronic wounds, and stable vitiligo. In patients with large area burns this can be a life-saving procedure. The ultimate goal, however, is to restore all normal functions of the skin and prevent scar formation. Increased focus on the incorporation of epidermal stem cells (EpiSCs) within CES transplants may ultimately prove to be key to achieving this. Transplanted EpiSCs contribute to restoring the complete epidermis and provide long-term renewal.Maintenance of the regenerative potential of EpiSCs is anchorage-dependent. The extracellular matrix (ECM) provides physical cues that are interpreted by EpiSCs and reciprocal signaling between cells and ECM are integrated to determine cell fate. Thus, the carrier scaffold chosen for culture and transplant influences maintenance of EpiSC phenotype and may enhance or detract from regenerative healing following transfer.Long-term effectiveness and safety of genetically modified EpiSCs to correct the severe skin blistering disease epidermolysis bullosa has been shown clinically. Furthermore, skin is gaining interest as an easily accessible source of adult epithelial stem cells potentially useful for restoration of other types of epithelia. This review highlights the role of EpiSCs in the current treatment of skin injury and disease, as well as their potential in novel regenerative medicine applications involving other epithelia.
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Affiliation(s)
- Catherine J Jackson
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway. .,Department of Plastic Surgery, Oslo University Hospital, Oslo, Norway. .,Institute of Oral biology, Faculty of Dentistry, University of Oslo, Oslo, Norway.
| | - Kim Alexander Tønseth
- Department of Plastic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tor Paaske Utheim
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,Department of Plastic Surgery, Oslo University Hospital, Oslo, Norway.,Institute of Oral biology, Faculty of Dentistry, University of Oslo, Oslo, Norway.,Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
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25
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Yoon C, Lee J, Jeong H, Lee S, Sohn T, Chung S. Rapid preparation of a noncultured skin cell suspension that promotes wound healing. Cell Tissue Bank 2017; 18:131-141. [DOI: 10.1007/s10561-017-9615-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/23/2017] [Indexed: 10/20/2022]
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26
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Shizhao J, Yongjun Z, Lisen Z, pengfei L, Xiaopeng Z, Guangyi W, Shihui Z, Xiaoyan H, Shichu X, Zhaofan X. Short- and long-term outcomes of small auto- and cryopreserved allograft skin grafting in those with >60%TBSA deep burn wounds. Burns 2017; 43:206-214. [DOI: 10.1016/j.burns.2016.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 04/07/2016] [Accepted: 07/19/2016] [Indexed: 10/21/2022]
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27
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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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Esteban-Vives R, Choi MS, Young MT, Over P, Ziembicki J, Corcos A, Gerlach JC. Second-degree burns with six etiologies treated with autologous noncultured cell-spray grafting. Burns 2016; 42:e99-e106. [DOI: 10.1016/j.burns.2016.02.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/11/2016] [Accepted: 02/18/2016] [Indexed: 10/21/2022]
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29
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Xiao Y, Ahadian S, Radisic M. Biochemical and Biophysical Cues in Matrix Design for Chronic and Diabetic Wound Treatment. TISSUE ENGINEERING PART B-REVIEWS 2016; 23:9-26. [PMID: 27405960 DOI: 10.1089/ten.teb.2016.0200] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Progress in biomaterial science and engineering and increasing knowledge in cell biology have enabled us to develop functional biomaterials providing appropriate biochemical and biophysical cues for tissue regeneration applications. Tissue regeneration is particularly important to treat chronic wounds of people with diabetes. Understanding and controlling the cellular microenvironment of the wound tissue are important to improve the wound healing process. In this study, we review different biochemical (e.g., growth factors, peptides, DNA, and RNA) and biophysical (e.g., topographical guidance, pressure, electrical stimulation, and pulsed electromagnetic field) cues providing a functional and instructive acellular matrix to heal diabetic chronic wounds. The biochemical and biophysical signals generally regulate cell-matrix interactions and cell behavior and function inducing the tissue regeneration for chronic wounds. Some technologies and devices have already been developed and used in the clinic employing biochemical and biophysical cues for wound healing applications. These technologies can be integrated with smart biomaterials to deliver therapeutic agents to the wound tissue in a precise and controllable manner. This review provides useful guidance in understanding molecular mechanisms and signals in the healing of diabetic chronic wounds and in designing instructive biomaterials to treat them.
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Affiliation(s)
- Yun Xiao
- 1 Department of Chemical Engineering and Applied Chemistry, University of Toronto , Toronto, Ontario, Canada .,2 Institute of Biomaterials and Biomedical Engineering, University of Toronto , Toronto, Ontario, Canada
| | - Samad Ahadian
- 2 Institute of Biomaterials and Biomedical Engineering, University of Toronto , Toronto, Ontario, Canada
| | - Milica Radisic
- 1 Department of Chemical Engineering and Applied Chemistry, University of Toronto , Toronto, Ontario, Canada .,2 Institute of Biomaterials and Biomedical Engineering, University of Toronto , Toronto, Ontario, Canada
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30
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Abstract
The quest for skin expansion is not restricted to cover a large area alone, but to produce acceptable uniform surfaces, robust engraftment to withstand mechanical shear and infection, with a minimal donor morbidity. Ease of the technique, shorter healing period and reproducible results are essential parameters to adopt novel techniques. Significant advances seen in four fronts of autologous grafting are: (1) Dermal-epidermal graft expansion techniques, (2) epidermal graft harvests technique, (3) melanocyte-rich basal cell therapy for vitiligo and (4) robust and faster autologous cell cultures. Meek's original concept that the sum of perimeter of smaller grafts is larger than the harvested graft, and smaller the graft size, the greater is the potential for regeneration is witnessed in newer modification. Further, as graft size becomes smaller or minced, these micrografts can survive on the wound bed exudate irrespective of their dermal orientation. Expansion produced by 4 mm × 4 mm sized Meek micrografts is 10-folds, similarly 0.8 mm × 0.8 mm size micrografts produce 100-fold expansion, which becomes 700-fold with pixel grafts of 0.3 mm × 0.3 mm size. Fractional skin harvest is another new technique with 700 μ size full thickness graft. These provide instant autologous non-cultured graft to cover extensive areas with similar quality of engraftment surface as split skin grafts. Newer tools for epidermal blister graft harvest quickly, with uniform size to produce 7-fold expansions with reproducible results. In addition, donor area heals faster with minimal scar. Melanocyte-rich cell suspension is utilised in vitiligo surgery tapping the potential of hair root melanocytes. Further advances in the cell culture to reduce the cultivation time and provide stronger epidermal sheets with dermal carrier are seen in trials.
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Affiliation(s)
- Dinesh Kadam
- Department of Plastic and Reconstructive Surgery, A.J. Institute of Medical Sciences and A.J. Hospital and Research Centre, Mangalore, Karnataka, India
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31
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Osada A, Sekine H, Soejima K, Sakurai H, Shimizu T. Harvesting epithelial keratinocyte sheets from temperature-responsive dishes preserves basement membrane proteins and improves cell survival in a skin defect model. J Tissue Eng Regen Med 2016; 11:2516-2524. [PMID: 27061496 DOI: 10.1002/term.2149] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 11/10/2022]
Abstract
Cultured epithelial autograft (CEA) therapy has been used in clinical applications since the 1980s. However, there are some issues related to this treatment that still remain unsolved. Enzymatic treatment is typically used in the collection of epithelial keratinocyte sheets, but it tends to break the adhesion and basement membrane proteins. It is thought that the loss of proteins after enzymatic treatment is responsible for the poor survival of transplanted cell sheets. Our laboratory has developed a temperature-responsive culture dish that does not require enzymatic treatment to harvest the cells. In this study, we compare morphological and survival results from rat epithelial keratinocyte cell sheets harvested by temperature-reducing treatment (TT sheets) against cell sheets harvested by enzymatic (dispase) treatment (DT sheets). TT sheets preserve keratin structure in better conditions and express higher levels of collagen IV and laminin 5 than DT sheets. In order to evaluate cell sheet survival after transplantation, we created an in vivo transplant model. Keratinocyte sheets obtained from GFP-positive animals were transplanted into athymic rats. The survival rate 7 days after transplantation of TT sheet was higher than that of DT sheets. Collagen IV and Laminin 5 expression was observed in the TT sheet transplantation group. These results indicate that the remaining basement membrane proteins are important for initial attachment and cell survival. We believe that the cell sheet harvesting method using temperature-responsive culture dishes provides superior cell survival and can solve one of the roadblocks in CEA therapy. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- A Osada
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University (TWIns), Japan.,Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Japan
| | - H Sekine
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University (TWIns), Japan
| | - K Soejima
- Department of Plastic and Reconstructive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - H Sakurai
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Japan
| | - T Shimizu
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University (TWIns), Japan
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Challenging the Conventional Therapy: Emerging Skin Graft Techniques for Wound Healing. Plast Reconstr Surg 2016; 136:524e-530e. [PMID: 26397272 DOI: 10.1097/prs.0000000000001634] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Split-thickness skin grafting is the current gold standard for treatment of major traumatic skin loss. However, split-thickness skin grafting is limited by donor-skin availability, especially in large burns. In addition, the donor-site wound is associated with pain and scarring. Multiple techniques have been developed in the past to overcome these limitations but have been unable to achieve clinical relevance. In this study, the authors examine the novel emerging skin grafting techniques, aiming to improve the utility of split-thickness skin grafting. METHODS An extensive literature review was conducted on PubMed, MEDLINE, and Google Scholar to look for new skin grafting techniques. Special focus was given to techniques with potential for large expansion ratio and decreased donor-site pain. RESULTS The new modalities of modified skin grafting technique, discussed in this article, include (1) Xpansion Micrografting System, (2) fractional skin harvesting, (3) epidermal suction blister grafting, and (4) ReCell technology. These techniques are able to achieve significantly increased expansion ratios compared with conventional split-thickness skin grafting and also have decreased donor-site morbidity. CONCLUSIONS These techniques can be used separately or in conjunction with split-thickness skin grafting to overcome the associated pitfalls. Further studies and clinical trials are needed to define the utility of these procedures and where they fit into routine clinical practice.
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Maver T, Maver U, Kleinschek KS, Raščan IM, Smrke DM. Advanced therapies of skin injuries. Wien Klin Wochenschr 2015; 127 Suppl 5:S187-98. [PMID: 26404739 DOI: 10.1007/s00508-015-0859-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 08/21/2015] [Indexed: 11/24/2022]
Abstract
The loss of tissue is still one of the most challenging problems in healthcare. Efficient laboratory expansion of skin tissue to reproduce the skins barrier function can make the difference between life and death for patients with extensive full-thickness burns, chronic wounds, or genetic disorders such as bullous conditions. This engineering has been initiated based on the acute need in the 1980s and today, tissue-engineered skin is the reality. The human skin equivalents are available not only as models for permeation and toxicity screening, but are frequently applied in vivo as clinical skin substitutes. This review aims to introduce the most important recent development in the extensive field of tissue engineering and to describe already approved, commercially available skin substitutes in clinical use.
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Affiliation(s)
- Tina Maver
- Faculty of Mechanical Engineering, Laboratory for Characterisation and Processing of Polymers, University of Maribor, Smetanova 17, 2000, Maribor, Slovenia
| | - Uroš Maver
- Faculty of Medicine, Department of Pharmacology and Experimental Toxicology, University of Maribor, Taborska ulica 8, 2000, Maribor, Slovenia.
| | - Karin Stana Kleinschek
- Faculty of Mechanical Engineering, Laboratory for Characterisation and Processing of Polymers, University of Maribor, Smetanova 17, 2000, Maribor, Slovenia
| | - Irena Mlinarič Raščan
- Faculty of Pharmacy, University of Ljubljana, Aškerčeva 7, 1000, Ljubljana, Slovenia
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Kym D, Yim H, Yoon J, Yang HT, Cho YS, Hur J, Chun W, Kim JH. The application of cultured epithelial autografts improves survival in burns. Wound Repair Regen 2015; 23:340-4. [PMID: 25758428 DOI: 10.1111/wrr.12279] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 03/02/2015] [Indexed: 11/26/2022]
Abstract
This prospective observational study was performed to analyze the clinical outcomes of patients with massive burns treated using cultured epithelial autografts (CEAs) and to determine the association of this treatment with survival outcomes. During 2006-2013, total 177 massive-burns subjects treated with (96 subjects) or without (81 subjects) CEAs. Data were analyzed using the independent t test or chi-square test. Multivariate logistic regression, Kaplan-Meier survival, and Cox regression analyses were performed to evaluate the factors that influenced mortality. Age, percentage of total body surface area burned, incidence of inhalation injury, allograft-application rate, Abbreviated Burn Severity Index score, length of hospital stay, and mortality significantly differed between the CEA and noncultured epithelial autograft groups. Mortality and other clinical parameters did not differ between the sheet-type and spray-type CEA groups. Allograft application (odds ratio, 4.44; p < 0.01) significantly influenced CEA application. The CEA group showed significantly higher survival rates (p = 0.05). Cultured epithelial autografting had a hazard ratio of 0.55 (p = 0.02) and 0.59 (p = 0.05) according to the uni- and multivariate Cox regression analysis, respectively. In conclusion, early and aggressive allograft application is required to facilitate CEA application. Furthermore, the use of CEAs was associated with a lower mortality, but this result should be interpreted with caution as the groups were not randomized.
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Affiliation(s)
- Dohern Kym
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Haejun Yim
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Jaechul Yoon
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Hyeong-Tae Yang
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Yong Suk Cho
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Jun Hur
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Wook Chun
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Jong-Hyun Kim
- Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea
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Clinical application of cultured epithelial autografts on acellular dermal matrices in the treatment of extended burn injuries. Ann Plast Surg 2015; 73:509-15. [PMID: 24322642 DOI: 10.1097/sap.0b013e3182840883] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Achieving permanent replacement of skin in extensive full-thickness and deep partial-thickness burn injuries and chronic wounds remains one of the fundamental surgical problems. Presently, split-thickness skin grafts are still considered the best material for surgical repair of an excised burn wound. However, in burns that affect greater than 50% of total body surface area, the patient has insufficient areas of unaffected skin from which split-thickness skin grafts can be harvested. The use of cultured epithelial (or epidermal) autografts (CEAs) has achieved satisfactory results. But the take rate of CEAs is poor in full-thickness bed or in chronically infected area. Providing temporary cover with allograft skin, or a more permanent allodermis, may increase clinical take. This review aims to (1) describe the use of CEAs in the regeneration of the epidermis, (2) introduce the application of the acellular dermal matrices (ADMs) in the clinics, and (3) enhance understanding of the CEAs applied with ADM as an appropriate strategy to treat the extended burn injuries. The current evidence regarding the cultured epithelial cell or keratinocyte autograft and dermal grafts applied in the treatment of burn injuries was investigated with an extensive electronic and manual search (MEDLINE and EMBASE). The included literature (N=136 publications) was critically evaluated focusing on the efficacy and safety of this technique in improving the healing of the deep dermal and full-thickness burn injuries. This review concluded that the use of ADM with CEAs is becoming increasingly routine, particularly as a life-saving tool after acute thermal trauma.
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Papuga AY, Lukash LL. Different types of biotechnological wound coverages created with the application of alive human cells. ACTA ACUST UNITED AC 2015. [DOI: 10.7124/bc.0008d1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- A. Ye. Papuga
- Institute of Molecular Biology and Genetics, NAS of Ukraine
| | - L. L. Lukash
- Institute of Molecular Biology and Genetics, NAS of Ukraine
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Gardien KLM, Middelkoop E, Ulrich MMW. Progress towards cell-based burn wound treatments. Regen Med 2015; 9:201-18. [PMID: 24750061 DOI: 10.2217/rme.13.97] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cell therapy as part of the concept of regenerative medicine represents an upcoming platform technology. Although cultured epidermal cells have been used in burn treatment for decades, new developments have renewed the interest in this type of treatment. Whereas early results were hampered by long culture times in order to produce confluent sheets of keratinocytes, undifferentiated proliferating cells can nowadays be applied on burns with different application techniques. The application of cells on carriers has improved early as well as long-term results in experimental settings. The results of several commercially available epidermal substitutes for burn wound treatment are reviewed in this article. These data clearly demonstrate a lack of randomized comparative trials and application of measurable outcome parameters. Experimental research in culture systems and animal models has demonstrated new developments and proof of concepts of further improvements in epidermal coverage. These include combinations of epidermal cells and mesenchymal stem cells, and the guidance of both material and cell interactions towards regeneration of skin appendages as well as vascular and nerve structures.
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Affiliation(s)
- Kim L M Gardien
- Department of Plastic Reconstructive & Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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39
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Sun BK, Siprashvili Z, Khavari PA. Advances in skin grafting and treatment of cutaneous wounds. Science 2014; 346:941-5. [PMID: 25414301 DOI: 10.1126/science.1253836] [Citation(s) in RCA: 481] [Impact Index Per Article: 48.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The ability of the skin to repair itself after injury is vital to human survival and is disrupted in a spectrum of disorders. The process of cutaneous wound healing is complex, requiring a coordinated response by immune cells, hematopoietic cells, and resident cells of the skin. We review the classic paradigms of wound healing and evaluate how recent discoveries have enriched our understanding of this process. We evaluate current and experimental approaches to treating cutaneous wounds, with an emphasis on cell-based therapies and skin transplantation.
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Affiliation(s)
- Bryan K Sun
- Program in Epithelial Biology, Stanford University, Stanford, CA 94305, USA
| | - Zurab Siprashvili
- Program in Epithelial Biology, Stanford University, Stanford, CA 94305, USA
| | - Paul A Khavari
- Program in Epithelial Biology, Stanford University, Stanford, CA 94305, USA. Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA 94304, USA.
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40
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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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Wood FM. Skin regeneration: the complexities of translation into clinical practise. Int J Biochem Cell Biol 2014; 56:133-40. [PMID: 25448410 DOI: 10.1016/j.biocel.2014.10.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/22/2014] [Accepted: 10/22/2014] [Indexed: 12/01/2022]
Abstract
The integration of engineering into biological science has resulted in the capacity to provide tissue engineered solutions for tissue damage. Skin regeneration remains the goal of skin repair to reduce the long term consequences of scarring to the individual. A scar is abnormal in its architecture, chemistry and cell phenotype, tissue engineering of scaffolds and cells opens up the potential of tissue regeneration into the future. Tissue engineering solutions have been applied to skin many decades despite technical success the clinical application has been modest. To realise the potential of the developing technologies needs alignment of not only the science and engineering but also the commercial upscaling of production in a safe and regulated framework for clinical use. In addition the education and training for the introduction of new technology within the health system is essential, bringing together the technology and systems for utilisation to optimise the patient outcome. This article is part of a Directed Issue entitled: Regenerative Medicine: The challenge of translation.
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Affiliation(s)
- Fiona M Wood
- Burns Service of Western Australia, Burn Injury Research Unit, University of Western Australia, Australia.
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42
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Leto Barone AA, Mastroianni M, Farkash EA, Mallard C, Albritton A, Torabi R, Leonard DA, Kurtz JM, Sachs DH, Cetrulo CL. Genetically modified porcine split-thickness skin grafts as an alternative to allograft for provision of temporary wound coverage: preliminary characterization. Burns 2014; 41:565-74. [PMID: 25406888 DOI: 10.1016/j.burns.2014.09.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 08/29/2014] [Accepted: 09/02/2014] [Indexed: 01/28/2023]
Abstract
Temporary coverage of severely burned patients with cadaver allograft skin represents an important component of burn care, but is limited by availability and cost. Porcine skin shares many physical properties with human skin, but is susceptible to hyperacute rejection due to preformed antibodies to α-1,3-galactose (Gal), a carbohydrate on all porcine cells. Our preliminary studies have suggested that skin grafts from α-1,3-galactosyltransferase knock out (GalT-KO) miniature swine might provide temporary wound coverage comparable to allografts, since GalT-KO swine lack this carbohydrate. To further evaluate this possibility, eight non-human primates received primary autologous, allogeneic, GalT-KO, and GalT+xenogeneic skin grafts. Additionally, secondary grafts were placed to assess whether sensitization would affect the rejection time course of identical-type grafts. We demonstrate that both GalT-KO xenografts and allografts provide temporary coverage of partial- and full-thickness wounds for up to 11 days. In contrast, GalT+xenografts displayed hyperacute rejection, with no signs of vascularization and rapid avulsion from wounds. Furthermore, secondary GalT-KO transplants failed to vascularize, demonstrating that primary graft rejection sensitizes the recipient. We conclude that GalT-KO xenografts may provide temporary coverage of wounds for a duration equivalent to allografts, and thus, could serve as a readily available alternative treatment of severe burns.
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Affiliation(s)
- Angelo A Leto Barone
- Transplant Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Melissa Mastroianni
- Transplant Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Evan A Farkash
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Christopher Mallard
- Transplant Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Alexander Albritton
- Transplant Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Radbeh Torabi
- Transplant Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - David A Leonard
- Transplant Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Josef M Kurtz
- Transplant Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Department of Biology, Emmanuel College, Boston, MA, United States
| | - David H Sachs
- Transplant Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Curtis L Cetrulo
- Transplant Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
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Epidermal healing in burns: autologous keratinocyte transplantation as a standard procedure: update and perspective. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2014; 2:e218. [PMID: 25426401 PMCID: PMC4229277 DOI: 10.1097/gox.0000000000000176] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 07/11/2014] [Indexed: 01/03/2023]
Abstract
Background: Treatment of burned patients is a tricky clinical problem not only because of the extent of the physiologic abnormalities but also because of the limited area of normal skin available. Methods: Literature indexed in the National Center (PubMed) has been reviewed using combinations of key words (burns, children, skin graft, tissue engineering, and keratinocyte grafts). Articles investigating the association between burns and graft therapeutic modalities have been considered. Further literature has been obtained by analysis of references listed in reviewed articles. Results: Severe burns are conventionally treated with split-thickness skin autografts. However, there are usually not enough skin donor sites. For years, the question of how covering the wound surface became one of the major challenges in clinical research area and several procedures were proposed. The microskin graft is one of the oldest methods to cover extensive burns. This technique of skin expansion is efficient, but results remain inconsistent. An alternative is to graft cultured human epidermal keratinocytes. However, because of several complications and labor-intensive process of preparing grafts, the initial optimism for cultured epithelial autograft has gradually declined. In an effort to solve these drawbacks, isolated epithelial cells from selecting donor site were introduced in skin transplantation. Conclusions: Cell suspensions transplanted directly to the wound is an attractive process, removing the need for attachment to a membrane before transfer and avoiding one potential source of inefficiency. Choosing an optimal donor site containing cells with high proliferative capacity is essential for graft success in burns.
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Abstract
A unique understanding of the components of mammalian skin has led to the development of numerous skin substitutes. These skin substitutes attempt to compensate for functional and physiologic deficits present in damaged tissue. Skin substitutes, when appropriately applied in optimized settings, offer a promising solution to difficult wound management. The body of literature on skin substitutes increases as the understanding of tissue engineering and molecular biology expands. Given the high cost of these products, future randomized large prospective studies are needed to guide the clinical applications of skin substitutes.
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Affiliation(s)
- Theodore T Nyame
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - H Abraham Chiang
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Dennis P Orgill
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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45
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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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Abstract
Bioengineered alternative tissues (BATs) are heterogeneous processed materials used to aid in wound closure of diabetic foot ulcers. There has been significant progress in the development and clinical use of BATs in the last decade. BATs may be derived from an autograft, allograft, or xenograft source. They may be a single-layer material and consist of only an epidermal or dermal component or they may be bilayer, consisting of both epidermal and dermal components. The holy grail of tissue replacement has yet to be discovered. Nevertheless, if researchers and bioengineers can flip the switch to return cells to their prenatal period, this can be a breakthrough in cellular regeneration.
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Affiliation(s)
- Emily A Cook
- Mount Auburn Hospital, Harvard Medical School, Cambridge, MA 02138, USA.
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47
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Ma B, Xie J, Jiang J, Wu J. Sandwich-type fiber scaffolds with square arrayed microwells and nanostructured cues as microskin grafts for skin regeneration. Biomaterials 2013; 35:630-41. [PMID: 24144904 DOI: 10.1016/j.biomaterials.2013.09.111] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 09/30/2013] [Indexed: 11/19/2022]
Abstract
The paper reports the fabrication of sandwich-type scaffolds consisting of radially-aligned nanofibers at the bottom, nanofiber membranes with square arrayed microwells and nanostructured cues at the top, and microskin tissues in between as microskin grafts for use in skin regeneration. This class of nanofiber scaffolds was able to confine the microskin tissues in the square arrayed wells and simultaneously present nanotopographic cues to the cultured NIH 3T3 fibroblasts and primary rat skin cells, guiding and facilitating their migration in vitro. More importantly, we demonstrated that the sandwich-type transplants exhibited an even distribution of microskin grafts, greatly improved the 'take' rate of microskin tissues, and promoted re-epithelialization on wound in vivo. In addition, the void area in the scaffolds was well suitable for exudate drainage in wound. The sandwich-type scaffolds show great potential as microskin grafts for repairing extensive burn injuries and may provide a good solution for the treatment of acute skin defects and chronic wounds including diabetic ulcer, pressure ulcer, and venous stasis ulcer.
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Affiliation(s)
- Bing Ma
- Marshall Institute for Interdisciplinary Research and Center for Diagnostic Nanosystems, Marshall University, WV 25755, USA
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48
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Delivery of epithelial autografts and cutaneous wound healing in burn patients. Burns 2013; 40:166-8. [PMID: 24054550 DOI: 10.1016/j.burns.2013.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 07/10/2013] [Indexed: 11/22/2022]
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49
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Experience of ReCell in Skin Cancer Reconstruction. Arch Plast Surg 2013; 40:627-9. [PMID: 24086821 PMCID: PMC3785601 DOI: 10.5999/aps.2013.40.5.627] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/10/2013] [Accepted: 05/24/2013] [Indexed: 11/13/2022] Open
Abstract
The ReCell system (Avita Medical) is a cell culture product that allows the immediate processing of a small split-thickness skin biopsy to produce a complete population of cells including keratinocytes, melanocytes, Langerhans cells and fibroblasts. This series is the first to highlight the reconstructive applications of ReCell following ablative skin cancer surgery. The ReCell system was utilized for three patients following skin cancer excision. In two cases, the cells were applied to forehead flap donor sites following nasal reconstruction. In one case, the cells were applied to the calvarial periosteum following wide local excision of a melanoma scar. Assessment of the treated area was performed using the patient and observer scar assessment scale after 1 year. The Patient and Observer Scar Assessment Scale (POSAS) scores for the 2 patients treated with ReCell following forehead flap surgery were 22 and 32. The score for the patient that underwent wide local excision of a melanoma scar was 45. The absence of a donor site, accelerated healing and the satisfactory aesthetic appearance of the mature scars in this series suggest that ReCell may play a useful role in reconstruction following skin cancer excision.
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50
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Kamel RA, Ong JF, Eriksson E, Junker JPE, Caterson EJ. Tissue engineering of skin. J Am Coll Surg 2013; 217:533-55. [PMID: 23816384 DOI: 10.1016/j.jamcollsurg.2013.03.027] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 03/15/2013] [Accepted: 03/18/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Rami A Kamel
- Division of Plastic Surgery, Brigham and Women's Surgery, Harvard Medical School, Boston, MA 02115, USA
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