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Nuutila K, Mistry R, Broomhead M, Eriksson E. Split-Thickness Skin and Dermal Pixel Grafts Can Be Expanded up to 500 Times to Re-Epithelialize a Full-Thickness Burn Wound. Adv Wound Care (New Rochelle) 2024; 13:176-186. [PMID: 37905500 DOI: 10.1089/wound.2023.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Objective: Autologous skin transplantation is limited by donor site availability for patients with extensive burns. The objective of this study was to demonstrate the feasibility and efficacy of split-thickness skin (STS) and dermal pixel grafts (PG) in the treatment of burns. Approach: The study was divided into three arms of validation, expansion, and combination that all followed the same study design. Sixteen deep partial-thickness burns were created on the dorsum of anesthetized pigs. Three days postinjury the burns were debrided and grafted with STS and dermal PGs. The PGs were prepared by harvesting two skin grafts (split-thickness skin graft [STSG] and dermal graft) from the same donor site going down in depth. The grafts were minced to 0.3 × 0.3 × 0.3 mm PGs and suspended in a small volume of hydrogel. Healing was monitored for 6, 10, 14, or 28 days. In the validation study the PGs at 1:2 expansion ratio were transplanted and compared with STSG and untreated controls. The expansion study investigated the maximum expansion potential of the PGs and the combination of the benefits of transplanting STS and dermal PGs together. Results: The validation study showed that when STS and dermal PGs were transplanted in a 1:2 ratio they fully re-epithelialized the wounds in 14 days. The expansion study demonstrated that using expansion ratios up to 1:500 the wounds were re-epithelialized by day 28. The combination study showed that there was no additional benefit to use STS and dermal PGs together. Innovation: Pixel grafting provides expansion ratios greater than conventional STSG. The possibility to harvest both STS and dermal PGs from the same donor area further reduces the need for healthy skin. Conclusion: STSG and dermal grafts can be minced to PGs with preserved viability and expanded up to 500 times to re-epithelialize a wound.
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Affiliation(s)
- Kristo Nuutila
- Department of Combat Wound Care, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Riyam Mistry
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Elof Eriksson
- Applied Tissue Technologies LLC, Hingham, Massachusetts, USA
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Sanches‐Pinto DC, Eriksson E, Gomez DS, Nunes MPT, Gemperli R, Soriano FG. Minced skin grafts for chronic wounds compared to conventional mesh grafts. Health Sci Rep 2023; 6:e1353. [PMID: 37359407 PMCID: PMC10285033 DOI: 10.1002/hsr2.1353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
Background and Aims Skin grafting is the single most effective method to close a chronic wound. The current standard of care is to use meshed split thickness skin grafts. This entails the use of surgical instruments that need to be autoclaved and to have a power source, which usually requires an OR facility. The minced skin technique uses single use, presterilized instruments and the procedure can be done under local anesthesia, by a wound care practitioner, in a wound clinic, a physician's office or even at the bedside. The current study was designed to determine if the results from micrografting were non inferior to conventional mesh grafting. Methods In a prospective non inferiority study, 26 chronic ulcers were treated with micrografting (MSG) and 24 with conventional mesh grafts 1:3 (control group-CG) in a total of 21 patients, 10 male and 11 female. The donor site areas in the MSG group were predetermined to 2.5 × 5 cm and the mesh grafts expansion was set at 1:3. Results In the first weeks postoperatively, micrograft healing initially lagged behind the conventional mesh grafts but at 60 days after grafting, all MSG wounds were healed. The MSG wounds had better pigmentation, less itching, and less scarring. The micrografting procedure was easy to learn and expeditious to perform. The MSG mean expansion was 9.1 compared to three times (CG). Conclusion The MSG procedure is not inferior to conventional mesh grafting, requires smaller donor sites, and can be done with single use instruments, under local anesthesia, with early discharge.
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Affiliation(s)
- Débora C. Sanches‐Pinto
- Divisão de Cirurgia Plástica e Queimaduras. Clinicas Hospital ‐ School of MedicineUniversity of São PauloSão PauloBrazil
| | | | - David S. Gomez
- Divisão de Cirurgia Plástica e Queimaduras. Clinicas Hospital ‐ School of MedicineUniversity of São PauloSão PauloBrazil
| | - Maria P. T. Nunes
- Department of Internal Medicine, School of MedicineUniversity of São PauloSão PauloBrazil
| | - Rolf Gemperli
- Divisão de Cirurgia Plástica e Queimaduras. Clinicas Hospital ‐ School of MedicineUniversity of São PauloSão PauloBrazil
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Yan X, Wang C, Ma Y, Wang Y, Song F, Zhong J, Wu X. Development of air-assisted atomization device for the delivery of cells in viscous biological ink prepared with sodium alginate. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2023; 94:044101. [PMID: 38081259 DOI: 10.1063/5.0102035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 03/19/2023] [Indexed: 12/18/2023]
Abstract
Skin wounds, especially large-area skin trauma, would bring great pain and even fatal risk to patients. In recent years, local autologous cell transplantation has shown great potential for wound healing and re-epithelialization. However, when the cell suspension prepared with normal saline is delivered to the wound, due to its low viscosity, it is easy to form big drops in the deposition and lose them from the wound bed, resulting in cell loss and uneven coverage. Here, we developed a novel air-assisted atomization device (AAAD). Under proper atomization parameters, 1% (w/v) sodium alginate (SA) solution carrier could be sprayed uniformly. Compared with normal saline, the run-off of the SA on the surface of porcine skin was greatly reduced. In theory, the spray height of AAAD could be set to achieve the adjustment of a large spray area of 1-12 cm2. In the measurement of droplet velocity and HaCaT cell viability, the spray height of AAAD would affect the droplet settling velocity and then the cell delivery survival rate (CSR). Compared with the spray height of 50 mm, the CSR of 100 mm was significantly higher and could reach 91.09% ± 1.82% (92.82% ± 2.15% in control). For bio-ink prepared with 1% (w/v) SA, the viability remained the same during the 72-h incubation. Overall, the novel AAAD uniformly atomized bio-ink with high viscosity and maintained the viability and proliferation rate during the delivery of living cells. Therefore, AAAD has great potential in cell transplantation therapy, especially for large-area or irregular skin wounds.
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Affiliation(s)
- Xintao Yan
- Academy for Engineering and Technology, Fudan University, Shanghai 200433, China
- CAS Key Lab of Bio-Medical Diagnostics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu 215163, China
| | - Ce Wang
- CAS Key Lab of Bio-Medical Diagnostics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu 215163, China
| | - Yuting Ma
- CAS Key Lab of Bio-Medical Diagnostics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu 215163, China
| | - Yao Wang
- CAS Key Lab of Bio-Medical Diagnostics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu 215163, China
| | - Feifei Song
- CAS Key Lab of Bio-Medical Diagnostics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu 215163, China
| | - Jinfeng Zhong
- CAS Key Lab of Bio-Medical Diagnostics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu 215163, China
| | - Xiaodong Wu
- Academy for Engineering and Technology, Fudan University, Shanghai 200433, China
- CAS Key Lab of Bio-Medical Diagnostics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu 215163, China
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4
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Eriksson E, Griffith GL, Nuutila K. Topical Drug Delivery in the Treatment of Skin Wounds and Ocular Trauma Using the Platform Wound Device. Pharmaceutics 2023; 15:pharmaceutics15041060. [PMID: 37111546 PMCID: PMC10145636 DOI: 10.3390/pharmaceutics15041060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/18/2023] [Accepted: 03/23/2023] [Indexed: 03/28/2023] Open
Abstract
Topical treatment of injuries such as skin wounds and ocular trauma is the favored route of administration. Local drug delivery systems can be applied directly to the injured area, and their properties for releasing therapeutics can be tailored. Topical treatment also reduces the risk of adverse systemic effects while providing very high therapeutic concentrations at the target site. This review article highlights the Platform Wound Device (PWD) (Applied Tissue Technologies LLC, Hingham, MA, USA) for topical drug delivery in the treatment of skin wounds and eye injuries. The PWD is a unique, single-component, impermeable, polyurethane dressing that can be applied immediately after injury to provide a protective dressing and a tool for precise topical delivery of drugs such as analgesics and antibiotics. The use of the PWD as a topical drug delivery platform has been extensively validated in the treatment of skin and eye injuries. The purpose of this article is to summarize the findings from these preclinical and clinical studies.
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Dogan S, Elmasry M, El-Serafi A, Sjöberg F, Vuola J, Kankuri E, Grigoriadi MP, Valtonen J, Abdelrahman I, Steinvall I, Karlsson M, Olofsson P, Lindford A. A prospective dual-centre intra-individual controlled study for the treatment of burns comparing dermis graft with split-thickness skin auto-graft. Sci Rep 2022; 12:21666. [PMID: 36522434 PMCID: PMC9755129 DOI: 10.1038/s41598-022-25346-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
To investigate if donor and recipient site morbidity (healing time and cosmesis) could be reduced by a novel, modified split-thickness skin grafting (STSG) technique using a dermal component in the STSG procedure (DG). The STSG technique has been used for 150 years in surgery with limited improvements. Its drawbacks are well known and relate to donor site morbidity and recipient site cosmetic shortcomings (especially mesh patterns, wound contracture, and scarring). The Dermal graft technique (DG) has emerged as an interesting alternative, which reduces donor site morbidity, increases graft yield, and has the potential to avoid the mesh procedure in the STSG procedure due to its elastic properties. A prospective, dual-centre, intra-individual controlled comparison study. Twenty-one patients received both an unmeshed dermis graft and a regular 1:1.5 meshed STSG. Aesthetic and scar assessments were done using The Patient and Observer Scar Assessment Scale (POSAS) and a Cutometer Dual MPA 580 on both donor and recipient sites. These were also examined histologically for remodelling and scar formation. Dermal graft donor sites and the STSG donor sites healed in 8 and 14 days, respectively (p < 0.005). Patient-reported POSAS showed better values for colour for all three measurements, i.e., 3, 6, and 12 months, and the observers rated both vascularity and pigmentation better on these occasions (p < 0.01). At the recipient site, (n = 21) the mesh patterns were avoided as the DG covered the donor site due to its elastic properties and rendered the meshing procedure unnecessary. Scar formation was seen at the dermal donor and recipient sites after 6 months as in the standard scar healing process. The dermis graft technique, besides potentially rendering a larger graft yield, reduced donor site morbidity, as it healed faster than the standard STSG. Due to its elastic properties, the DG procedure eliminated the meshing requirement (when compared to a 1:1.5 meshed STSG). This promising outcome presented for the DG technique needs to be further explored, especially regarding the elasticity of the dermal graft and its ability to reduce mesh patterns.Trial registration: ClinicalTrials.gov Identifier (NCT05189743) 12/01/2022.
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Affiliation(s)
- Sinan Dogan
- grid.5640.70000 0001 2162 9922Department of Hand Surgery, Plastic Surgery and Burns in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden ,grid.411384.b0000 0000 9309 6304Linköping University Hospital, 58185 Linköping, Sweden
| | - Moustafa Elmasry
- grid.5640.70000 0001 2162 9922Department of Hand Surgery, Plastic Surgery and Burns in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ahmed El-Serafi
- grid.5640.70000 0001 2162 9922Department of Hand Surgery, Plastic Surgery and Burns in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Folke Sjöberg
- grid.5640.70000 0001 2162 9922Department of Hand Surgery, Plastic Surgery and Burns in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Jyrki Vuola
- grid.7737.40000 0004 0410 2071Department of Plastic Surgery, Helsinki Burn Centre, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Esko Kankuri
- grid.7737.40000 0004 0410 2071Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Marina Perdiki Grigoriadi
- grid.5640.70000 0001 2162 9922Department of Clinical Pathology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Jussi Valtonen
- grid.7737.40000 0004 0410 2071Department of Plastic Surgery, Helsinki Burn Centre, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Islam Abdelrahman
- grid.5640.70000 0001 2162 9922Department of Hand Surgery, Plastic Surgery and Burns in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ingrid Steinvall
- grid.5640.70000 0001 2162 9922Department of Hand Surgery, Plastic Surgery and Burns in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Matilda Karlsson
- grid.5640.70000 0001 2162 9922Department of Hand Surgery, Plastic Surgery and Burns in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Pia Olofsson
- grid.5640.70000 0001 2162 9922Department of Hand Surgery, Plastic Surgery and Burns in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Andrew Lindford
- grid.7737.40000 0004 0410 2071Department of Plastic Surgery, Helsinki Burn Centre, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Cooley J, Obaidi N, Diaz V, Anselmo K, Eriksson E, Carlsson AH, Chan RK, Nuutila K. Delivery of topical gentamicin cream via platform wound device to reduce wound infection—A prospective, controlled, randomised, clinical study. Int Wound J 2022; 20:1426-1435. [PMID: 36307989 PMCID: PMC10088835 DOI: 10.1111/iwj.13998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/28/2022] Open
Abstract
The platform wound device (PWD) is a wound coverage system that is designed to decrease wound infection rates by allowing for direct delivery of topical antibiotics and antimicrobials while creating a sealed, protective barrier around the area of injury. This study evaluated the safety and efficacy of the PWD as a protective dressing and a delivery system for topical antibiotics compared to the current standard of care (SoC). This was a multi-center, prospective, randomised, controlled clinical trial. The wounds were treated with the PWD with gentamicin cream or SoC dressings. The wounds were evaluated before the start of treatment and after 48-96 hours via clinical assessment, photographs, and qualitative bacterial swabs for bacterial analysis. The delivery of gentamicin via the PWD was safe and did not cause any adverse effects. The treatment decreased both inflammation and bacterial growth during the study period. No significant differences in the SoC were observed. The PWD is a transparent and impermeable polyurethane chamber that encloses and protects the injured area. The delivery of topical gentamicin via the PWD was safe and effective. Clinical assessment for infection found the PWD to be non-inferior to the current SoC treatment options.
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Affiliation(s)
| | | | | | | | - Elof Eriksson
- Applied Tissue Technologies LLC Hingham Massachusetts USA
| | | | | | - Kristo Nuutila
- Applied Tissue Technologies LLC Hingham Massachusetts USA
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ATMP-classified, scalable, autologous cell spray for the treatment of skin wounds and assessment of its effects on wound healing clinically and on molecular level. Burns 2022:S0305-4179(22)00240-6. [DOI: 10.1016/j.burns.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022]
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Eriksson E, Liu PY, Schultz GS, Martins‐Green MM, Tanaka R, Weir D, Gould LJ, Armstrong DG, Gibbons GW, Wolcott R, Olutoye OO, Kirsner RS, Gurtner GC. Chronic wounds: Treatment consensus. Wound Repair Regen 2022; 30:156-171. [PMID: 35130362 PMCID: PMC9305950 DOI: 10.1111/wrr.12994] [Citation(s) in RCA: 79] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/23/2021] [Accepted: 01/09/2022] [Indexed: 12/17/2022]
Abstract
The Wound Healing Foundation (WHF) recognised a need for an unbiased consensus on the best treatment of chronic wounds. A panel of 13 experts were invited to a virtual meeting which took place on 27 March 2021. The proceedings were organised in the sub-sections diagnosis, debridement, infection control, dressings, grafting, pain management, oxygen treatment, outcomes and future needs. Eighty percent or better concurrence among the panellists was considered a consensus. A large number of critical questions were discussed and agreed upon. Important takeaways included that wound care needs to be simplified to a point that it can be delivered by the patient or the patient's family. Another one was that telemonitoring, which has proved very useful during the COVID-19 pandemic, can help reduce the frequency of interventions by a visiting nurse or a wound care center. Defining patient expectations is critical to designing a successful treatment. Patient outcomes might include wound specific outcomes such as time to heal, wound size reduction, as well as improvement in quality of life. For those patients with expectations of healing, an aggressive approach to achieve that goal is recommended. When healing is not an expectation, such as in patients receiving palliative wound care, outcomes might include pain reduction, exudate management, odour management and/or other quality of life benefits to wound care.
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Affiliation(s)
| | - Paul Y. Liu
- Department of Plastic Surgery, Rhode Island HospitalAlpert Medical School of Brown UniversityProvidenceRIUSA
| | - Gregory S. Schultz
- Department of Obstetrics and Gynecology and Institute for Wound ResearchUniversity of FloridaGainesvilleFAUSA
| | - Manuela M. Martins‐Green
- Department of Molecular, Cell and Systems BiologyLaboratory of Wound Healing Biology, University of CaliforniaRiversideCAUSA
| | - Rica Tanaka
- Juntendo University School of MedicineTokyoJapan
| | - Dot Weir
- Saratoga Hospital Center for Wound Healing and Hyperbaric MedicineSaratoga SpringsNew YorkUSA
| | - Lisa J. Gould
- Department of SurgerySouth Shore HospitalSouth WeymouthMassachusettsUSA
| | - David G. Armstrong
- Keck School of Medicine of University of Southern CaliforniaLos AngelesCAUSA
| | - Gary W. Gibbons
- Boston University School of Medicine, Center for Wound Healing South Shore HealthWeymouthMAUSA
| | | | - Oluyinka O. Olutoye
- Center for Regenerative MedicineAbigail Wexner Research Institute, Nationwide Children's HospitalColumbusOHUSA
- Department of SurgeryThe Ohio State UniversityColumbusOHUSA
| | - Robert S. Kirsner
- Dr Philip Frost Department of Dermatology and Cutaneous SurgeryUniversity of Miami Miller School of MedicineMiamiFAUSA
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Nuutila K, Samandari M, Endo Y, Zhang Y, Quint J, Schmidt TA, Tamayol A, Sinha I. In vivo printing of growth factor-eluting adhesive scaffolds improves wound healing. Bioact Mater 2022; 8:296-308. [PMID: 34541402 PMCID: PMC8427093 DOI: 10.1016/j.bioactmat.2021.06.030] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/16/2021] [Accepted: 06/24/2021] [Indexed: 12/25/2022] Open
Abstract
Acute and chronic wounds affect millions of people around the world, imposing a growing financial burden on patients and hospitals. Despite the application of current wound management strategies, the physiological healing process is disrupted in many cases, resulting in impaired wound healing. Therefore, more efficient and easy-to-use treatment modalities are needed. In this study, we demonstrate the benefit of in vivo printed, growth factor-eluting adhesive scaffolds for the treatment of full-thickness wounds in a porcine model. A custom-made handheld printer is implemented to finely print gelatin-methacryloyl (GelMA) hydrogel containing vascular endothelial growth factor (VEGF) into the wounds. In vitro and in vivo results show that the in situ GelMA crosslinking induces a strong scaffold adhesion and enables printing on curved surfaces of wet tissues, without the need for any sutures. The scaffold is further shown to offer a sustained release of VEGF, enhancing the migration of endothelial cells in vitro. Histological analyses demonstrate that the administration of the VEGF-eluting GelMA scaffolds that remain adherent to the wound bed significantly improves the quality of healing in porcine wounds. The introduced in vivo printing strategy for wound healing applications is translational and convenient to use in any place, such as an operating room, and does not require expensive bioprinters or imaging modalities.
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Affiliation(s)
- Kristo Nuutila
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Mohamadmahdi Samandari
- Department of Biomedical Engineering, University of Connecticut, Farmington, CT, 06030, USA
| | - Yori Endo
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Yuteng Zhang
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Jacob Quint
- Department of Biomedical Engineering, University of Connecticut, Farmington, CT, 06030, USA
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA
| | - Tannin A. Schmidt
- Department of Biomedical Engineering, University of Connecticut, Farmington, CT, 06030, USA
| | - Ali Tamayol
- Department of Biomedical Engineering, University of Connecticut, Farmington, CT, 06030, USA
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA
| | - Indranil Sinha
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
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Nuutila K, Eriksson E. Moist Wound Healing with Commonly Available Dressings. Adv Wound Care (New Rochelle) 2021; 10:685-698. [PMID: 32870777 DOI: 10.1089/wound.2020.1232] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Significance: A moist wound environment has several benefits that result in faster and better quality of healing. It facilitates autolytic debridement, reduces pain, reduces scarring, activates collagen synthesis, facilitates and promotes keratinocyte migration over the wound surface, and supports the presence and function of nutrients, growth factors, and other soluble mediators in the wound microenvironment. Recent Advances: Wound dressings can be utilized to create, maintain, and control a moist environment for healing. Moist wound dressings can be divided into films, foams, hydrocolloids, hydrogels, and alginates. We are also including negative pressure wound therapy systems in the moist dressings. Critical Issues: An optimal wound dressing should provide a moist environment and have an optimal water vapor transmission rate (WVTR) and absorptive capacity. It should also protect the wound against trauma and contamination and be easy to apply, painless to remove, and esthetically acceptable or even pleasing. Future Directions: Interventions, particularly dressing changes, by medical caregivers are labor intensive and expensive and there should be a continuous effort to reduce their number per week. Smart dressings with integrated microsensors and delivery capabilities that would allow wireless real-time monitoring and treatment of the wound would be very advantageous. This way the state of the wound as well as the wear time of the dressing could be assessed without dressing removal or visit to the wound care center. In addition, an ability to adjust the WVTRs to the exudate level of the wound (or having a large absorptive capacity without changing the WVTR) would be useful. This feature would guarantee an optimal level of hydration of the wound surface throughout the treatment.
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Affiliation(s)
- Kristo Nuutila
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elof Eriksson
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
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11
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Chavan V, Chittoria R, Elankumar S, Reddy KS, Aggarwal A, Gupta S, Reddy CL, Mohan PLB. Pixel Grafting: A Novel Skin Graft Expansion Technique. J Cutan Aesthet Surg 2021; 14:229-232. [PMID: 34566368 PMCID: PMC8423196 DOI: 10.4103/jcas.jcas_101_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Skin grafting is the transplantation of skin, a routinely performed procedure to cover the loss of skin. Skin is the largest organ of the body, which falls short of availability in extensive injuries, especially burns. In such a situation, pixel grafting, a novel expansion technique helps to cover a large area with less skin harvest. The objective of the study was to test fast, minimally invasive, easy to use minced split-thickness skin graft to cover large wounds and to reflect on the advantages of pixel graft. It is a pilot study of patients admitted with severe burns. We conclude that with this technique of pixel or minced grafting, large areas can be grafted with minimal donor-site requirement, and the techniques of preparation provide adequate size graft for pixel grafting.
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Affiliation(s)
- Vinayak Chavan
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Ravi Chittoria
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Subbarayan Elankumar
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Konda Sireesha Reddy
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Abhinav Aggarwal
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Saurabh Gupta
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Chira Likhitha Reddy
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Padma Lakshmi Bharathi Mohan
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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12
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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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Chen J, Wan Y, Lin Y, Jiang H. The application of platelet-rich plasma for skin graft enrichment: A meta-analysis. Int Wound J 2020; 17:1650-1658. [PMID: 32633467 DOI: 10.1111/iwj.13445] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/11/2020] [Accepted: 06/16/2020] [Indexed: 02/06/2023] Open
Abstract
Existing evidence demonstrated that the role of platelet-rich plasma (PRP) in skin graft enrichment is uncertain. The aim of this study was to evaluate the efficacy and safety of PRP for skin graft. PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for randomised controlled trials that compared outcomes of skin graft treated with PRP versus those treated with blank controls. The outcomes mainly included the rate of skin graft take, number of skin graft loss and haematoma formation, and complications. There were 11 studies involving a total of 910 cases of skin grafts. Compared with the control group, PRP group had a significantly higher rate of skin graft take (mean difference = 5.47%; 95% confidence interval [CI], 2.80%-8.14%; P < .0001), fewer number of skin graft loss (risk ratio [RR] = 0.26; 95% CI, 0.13-0.55; P = .0004) and fewer cases of haematoma formation (RR = 0.24; 95% CI, 0.11-0.54; P = .0006). There was no significant difference in the incidence of complications between two groups. This meta-analysis summarises current evidence and indicates that PRP is a safe and effective adjuvant for skin graft enrichment.
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Affiliation(s)
- Jianguo Chen
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yingying Wan
- Department of Internal Medicine, Xi Yuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yan Lin
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haiyue Jiang
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Miyanaga T, Kishibe M, Yamashita M, Kaneko T, Kinoshita F, Shimada K. Minced Skin Grafting for Promoting Wound Healing and Improving Donor-Site Appearance after Split-Thickness Skin Grafting. Plast Reconstr Surg 2019; 144:475-483. [DOI: 10.1097/prs.0000000000005868] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Muscle-Derived Stem Cell-Enriched Scaffolds Are Capable of Enhanced Healing of a Murine Volumetric Muscle Loss Defect. Plast Reconstr Surg 2019; 143:329e-339e. [PMID: 30531618 DOI: 10.1097/prs.0000000000005273] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Volumetric muscle loss secondary to traumatic or surgical causes can lead to functional and aesthetic impairments. The authors hypothesize that an implantable muscle-derived stem cell-enriched collagen scaffold could significantly augment muscle regeneration in a murine model of volumetric muscle loss. METHODS Murine muscle-derived stem cells were isolated using a modified preplating technique and seeded onto type 1 collagen scaffolds to create the muscle-derived stem cell-enriched collagen scaffolds. Murine rectus femoris defects of 5 mm were created and randomized to one of three conditions (n = 6 per group): untreated controls, collagen scaffold only, and muscle-derived stem cell-enriched collagen scaffolds. In vivo muscle healing was quantified using micro-computed tomography. Muscle explants were analyzed using standard histology and whole-mount immunofluorescence at 8 weeks. RESULTS In vivo experiments demonstrated significantly greater quadriceps cross-sectional area in the muscle-derived stem cell-enriched collagen scaffold group compared with controls on micro-computed tomography (0.74 ± 0.21 versus 0.55 ± 0.06 versus 0.49 ± 0.04 ratio of experimental to naive quadriceps cross-sectional area; p < 0.05). Muscle explants of the muscle-derived stem cell-enriched collagen scaffold group demonstrated significantly higher cellular density compared with controls (1185 ± 360 versus 359 ± 62 versus 197 ± 68 nuclei/high-power field; p < 0.01). Immunofluorescence for laminin and myosin heavy chain confirmed formation of organized muscle fibers within the defect of the muscle-derived stem cell-enriched collagen scaffold group only. However, appreciable confocal colocalization of myosin heavy chain with green fluorescent protein expression was low. CONCLUSIONS The results of this study indicate that muscle-derived stem cell-enriched scaffolds significantly improved skeletal muscle regeneration in a murine muscle defect model. Based on the low fluorescent colocalization, host progenitor cells appear to contribute significantly to intradefect myogenesis, suggesting that deployment of a viable muscle-derived stem cell-enriched scaffold stimulates a regenerative mitogen response in native tissues.
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Kruse CR, Sakthivel D, Sinha I, Helm D, Sørensen JA, Eriksson E, Nuutila K. Evaluation of the efficacy of cell and micrograft transplantation for full-thickness wound healing. J Surg Res 2018; 227:35-43. [PMID: 29804860 DOI: 10.1016/j.jss.2018.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 11/09/2017] [Accepted: 02/07/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Skin grafting is the current standard of care in the treatment of full-thickness burns and other wounds. It is sometimes associated with substantial problems, such as poor quality of the healed skin, scarring, and lack of donor-site skin in large burns. To overcome these problems, alternative techniques that could provide larger expansion of a skin graft have been introduced over the years. Particularly, different cell therapies and methods to further expand skin grafts to minimize the need for donor skin have been attempted. The purpose of this study was to objectively evaluate the efficacy of cell and micrograft transplantation in the healing of full-thickness wounds. MATERIALS AND METHODS Allogeneic cultured keratinocytes and fibroblasts, separately and together, as well as autologous and allogeneic skin micrografts were transplanted to full-thickness rat wounds, and healing was studied over time. In addition, wound fluid was collected, and the level of various cytokines and growth factors in the wound after transplantation was measured. RESULTS Our results showed that both autologous and allogeneic micrografts were efficient treatment modalities for full-thickness wound healing. Allogeneic skin cell transplantation did not result in wound closure, and no viable cells were found in the wound 10 d after transplantation. CONCLUSIONS Our study demonstrated that allogeneic micrografting is a possible treatment modality for full-thickness wound healing. The allografts stayed viable in the wound and contributed to both re-epithelialization and formation of dermis, whereas allogeneic skin cell transplantation did not result in wound closure.
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Affiliation(s)
- Carla R Kruse
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Plastic and Reconstructive Surgery, Odense University Hospital, Denmark
| | - Dharaniya Sakthivel
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Indranil Sinha
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Douglas Helm
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jens A Sørensen
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, Denmark
| | | | - Kristo Nuutila
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Rettinger CL, Fletcher JL, Carlsson AH, Chan RK. Accelerated epithelialization and improved wound healing metrics in porcine full‐thickness wounds transplanted with full‐thickness skin micrografts. Wound Repair Regen 2017; 25:816-827. [DOI: 10.1111/wrr.12585] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 09/09/2017] [Indexed: 01/04/2023]
Affiliation(s)
- Christina L. Rettinger
- Dental and Craniofacial Trauma Research Directorate, United States Army Institute of Surgical ResearchFort Sam Houston Texas
| | - John L. Fletcher
- Dental and Craniofacial Trauma Research Directorate, United States Army Institute of Surgical ResearchFort Sam Houston Texas
| | - Anders H. Carlsson
- Dental and Craniofacial Trauma Research Directorate, United States Army Institute of Surgical ResearchFort Sam Houston Texas
| | - Rodney K. Chan
- Dental and Craniofacial Trauma Research Directorate, United States Army Institute of Surgical ResearchFort Sam Houston Texas
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Wound Healing from Dermal Grafts Containing CD34+ Cells Is Comparable to Wound Healing with Split-Thickness Skin Micrografts. Plast Reconstr Surg 2017; 140:306-314. [DOI: 10.1097/prs.0000000000003516] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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