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Miyanaga T, Yoshitomi Y, Miyanaga A. Perifascial areolar tissue graft promotes angiogenesis and wound healing in an exposed ischemic component rabbit model. PLoS One 2024; 19:e0298971. [PMID: 38377120 PMCID: PMC10878522 DOI: 10.1371/journal.pone.0298971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/01/2024] [Indexed: 02/22/2024] Open
Abstract
Multiple studies have reported the use of perifascial areolar tissue (PAT) grafts to treat wounds involving exposed ischemic tissues, avascular structures, and defective membrane structures. Our objective was to assess the quantitative effects of PAT grafts and their suitability for wounds with ischemic tissue exposure and to qualitatively determine the factors through which PAT promotes wound healing and repair. We conducted histological, immunohistochemical, and mass spectrometric analyses of the PAT grafts. PAT grafts contain numerous CD34+ progenitor/stem cells, extracellular matrix, growth factors, and cytokines that promote wound healing and angiogenesis. Furthermore, we established a male rabbit model to compare the efficacy of PAT grafting with that of an occlusive dressing treatment (control) for wounds with cartilage exposure. PAT grafts could cover ischemic components with granulation tissue and promote angiogenesis. Macroscopic and histological observations of the PAT graft on postoperative day seven revealed capillaries bridging the ischemic tissue (vascular bridging). Additionally, the PAT graft suppressed wound contraction and alpha smooth muscle actin (αSMA) levels and promoted epithelialization. These findings suggested that PAT can serve as a platform to enhance wound healing and promote angiogenesis. This is the first study to quantify the therapeutic efficacy of PAT grafts, revealing their high value for the treatment of wounds involving exposed ischemic structures. The effectiveness of PAT grafts can be attributed to two primary factors: vascular bridging and the provision of three essential elements (progenitor/stem cells, extracellular matrix molecules, and growth factors/cytokines). Moreover, PAT grafts may be used as transplant materials to mitigate excessive wound contraction and the development of hypertrophic scarring.
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Affiliation(s)
- Toru Miyanaga
- Department of Plastic Surgery, Kanazawa Medical University, Kahoku, Ishikawa, Japan
| | - Yasuo Yoshitomi
- Department of Biochemistry, Kanazawa Medical University, Kahoku, Ishikawa, Japan
| | - Aiko Miyanaga
- Department of Nursing, Kanazawa Medical University, Kahoku, Ishikawa, Japan
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Garcia N, Lau LDW, Lo CH, Cleland H, Akbarzadeh S. Understanding the mechanisms of spontaneous and skin-grafted wound repair: the path to engineered skin grafts. J Wound Care 2023; 32:55-62. [PMID: 36630112 DOI: 10.12968/jowc.2023.32.1.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Spontaneous wound repair is a complex process that involves overlapping phases of inflammation, proliferation and remodelling, co-ordinated by growth factors and proteases. In extensive wounds such as burns, the repair process would not be achieved in a timely fashion unless grafted. Although spontaneous wound repair has been extensively described, the processes by which wound repair mechanisms mediate graft take are yet to be fully explored. This review describes engraftment stages and summarises current understanding of molecular mechanisms which regulate autologous skin graft healing, with the goal of directing innovation in permanent wound closure with skin substitutes. Graftability and vascularisation of various skin substitutes that are either in the market or in development phase are discussed. In doing so, we cast a spotlight on the paucity of scientific information available as to how skin grafts (both autologous and engineered) heal a wound bed. Better understanding of these processes may assist in developing novel methods of wound management and treatments.
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Affiliation(s)
- Nicole Garcia
- Skin Bioengineering Laboratory, Victorian Adult Burns Service, Alfred Health, 89 Commercial Road, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, 99 Commercial Road, Melbourne, Victoria, Australia
| | - Lachlan Dat Wah Lau
- Department of Surgery, Monash University, 99 Commercial Road, Melbourne, Victoria, Australia
| | - Cheng Hean Lo
- Department of Surgery, Monash University, 99 Commercial Road, Melbourne, Victoria, Australia
| | - Heather Cleland
- Skin Bioengineering Laboratory, Victorian Adult Burns Service, Alfred Health, 89 Commercial Road, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, 99 Commercial Road, Melbourne, Victoria, Australia
| | - Shiva Akbarzadeh
- Skin Bioengineering Laboratory, Victorian Adult Burns Service, Alfred Health, 89 Commercial Road, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, 99 Commercial Road, Melbourne, Victoria, Australia
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Abdelhakim M, Dohi T, Yamato M, Takada H, Sakai A, Suzuki H, Ema M, Fukuhara S, Ogawa R. A New Model for Specific Visualization of Skin Graft Neoangiogenesis Using Flt1-tdsRed BAC Transgenic Mice. Plast Reconstr Surg 2021; 148:89-99. [PMID: 34014859 DOI: 10.1097/prs.0000000000008039] [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: 11/25/2022]
Abstract
BACKGROUND Neovascularization plays a critical role in skin graft survival. Up to date, the lack of specificity to solely track the newly sprouting blood vessels has remained a limiting factor in skin graft transplantation models. Therefore, the authors developed a new model by using Flt1-tdsRed BAC transgenic mice. Flt1 is a vascular endothelial growth factor receptor expressed by sprouting endothelial cells mediating neoangiogenesis. The authors determined whether this model reliably visualizes neovascularization by quantifying tdsRed fluorescence in the graft over 14 days. METHODS Cross-transplantation of two full-thickness 1 × 1-cm dorsal skin grafts was performed between 6- to 8-week-old male Flt1 mice and KSN/Slc nude mice (n = 5). The percentage of graft area occupied by tdsRed fluorescence in the central and lateral areas of the graft on days 3, 5, 9, and 14 was determined using confocal-laser scanning microscopy. RESULTS Flt1+ endothelial cells migrating from the transgenic wound bed into the nude graft were first visible in the reticular dermis of the graft center on day 3 (0.5 ± 0.1; p < 0.05). Peak neovascularization was observed on day 9 in the lateral and central parts, increasing by 2- to 4-fold (4.6 ± 0.8 and 4.2 ± 0.9; p < 0.001). Notably, some limited neoangiogenesis was displayed within the Flt grafts on nude mice, particularly in the center. No neovascularization was observed from the wound margins. CONCLUSION The ability of the Flt1-tdsRed transgenic mouse model to efficiently identify the origin of the skin-graft vasculature and visualize graft neovascularization over time suggests its potential utility for developing techniques that promote graft neovascularization.
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Affiliation(s)
- Mohamed Abdelhakim
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, the Department of Pharmacology, and the Department of Molecular Pathophysiology, Institute of Advanced Medical Sciences, Nippon Medical School; and the Department of Stem Cells & Human Disease Models, Shiga University of Medical Science
| | - Teruyuki Dohi
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, the Department of Pharmacology, and the Department of Molecular Pathophysiology, Institute of Advanced Medical Sciences, Nippon Medical School; and the Department of Stem Cells & Human Disease Models, Shiga University of Medical Science
| | - Mizuho Yamato
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, the Department of Pharmacology, and the Department of Molecular Pathophysiology, Institute of Advanced Medical Sciences, Nippon Medical School; and the Department of Stem Cells & Human Disease Models, Shiga University of Medical Science
| | - Hiroya Takada
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, the Department of Pharmacology, and the Department of Molecular Pathophysiology, Institute of Advanced Medical Sciences, Nippon Medical School; and the Department of Stem Cells & Human Disease Models, Shiga University of Medical Science
| | - Atsushi Sakai
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, the Department of Pharmacology, and the Department of Molecular Pathophysiology, Institute of Advanced Medical Sciences, Nippon Medical School; and the Department of Stem Cells & Human Disease Models, Shiga University of Medical Science
| | - Hidenori Suzuki
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, the Department of Pharmacology, and the Department of Molecular Pathophysiology, Institute of Advanced Medical Sciences, Nippon Medical School; and the Department of Stem Cells & Human Disease Models, Shiga University of Medical Science
| | - Masatsugu Ema
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, the Department of Pharmacology, and the Department of Molecular Pathophysiology, Institute of Advanced Medical Sciences, Nippon Medical School; and the Department of Stem Cells & Human Disease Models, Shiga University of Medical Science
| | - Shigetomo Fukuhara
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, the Department of Pharmacology, and the Department of Molecular Pathophysiology, Institute of Advanced Medical Sciences, Nippon Medical School; and the Department of Stem Cells & Human Disease Models, Shiga University of Medical Science
| | - Rei Ogawa
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, the Department of Pharmacology, and the Department of Molecular Pathophysiology, Institute of Advanced Medical Sciences, Nippon Medical School; and the Department of Stem Cells & Human Disease Models, Shiga University of Medical Science
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4
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Banakh I, Cheshire P, Rahman M, Carmichael I, Jagadeesan P, Cameron NR, Cleland H, Akbarzadeh S. A Comparative Study of Engineered Dermal Templates for Skin Wound Repair in a Mouse Model. Int J Mol Sci 2020; 21:ijms21124508. [PMID: 32630398 PMCID: PMC7350005 DOI: 10.3390/ijms21124508] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 02/07/2023] Open
Abstract
Engineered dermal templates have revolutionised the repair and reconstruction of skin defects. Their interaction with the wound microenvironment and linked molecular mediators of wound repair is still not clear. This study investigated the wound bed and acellular "off the shelf" dermal template interaction in a mouse model. Full-thickness wounds in nude mice were grafted with allogenic skin, and either collagen-based or fully synthetic dermal templates. Changes in the wound bed showed significantly higher vascularisation and fibroblast infiltration in synthetic grafts when compared to collagen-based grafts (P ≤ 0.05). Greater tissue growth was associated with higher prostaglandin-endoperoxide synthase 2 (Ptgs2) RNA and cyclooxygenase-2 (COX-2) protein levels in fully synthetic grafts. Collagen-based grafts had higher levels of collagen III and matrix metallopeptidase 2. To compare the capacity to form a double layer skin substitute, both templates were seeded with human fibroblasts and keratinocytes (so-called human skin equivalent or HSE). Mice were grafted with HSEs to test permanent wound closure with no further treatment required. We found the synthetic dermal template to have a significantly greater capacity to support human epidermal cells. In conclusion, the synthetic template showed advantages over the collagen-based template in a short-term mouse model of wound repair.
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Affiliation(s)
- Ilia Banakh
- Skin Bioengineering Laboratory, Victorian Adult Burns Service, Alfred Health, 89 Commercial Road, Melbourne VIC 3004, Australia; (I.B.); (P.C.); (M.R.); (H.C.)
- Department of Surgery, Monash University, 99 Commercial Road, Melbourne VIC 3004, Australia
| | - Perdita Cheshire
- Skin Bioengineering Laboratory, Victorian Adult Burns Service, Alfred Health, 89 Commercial Road, Melbourne VIC 3004, Australia; (I.B.); (P.C.); (M.R.); (H.C.)
- Department of Surgery, Monash University, 99 Commercial Road, Melbourne VIC 3004, Australia
| | - Mostafizur Rahman
- Skin Bioengineering Laboratory, Victorian Adult Burns Service, Alfred Health, 89 Commercial Road, Melbourne VIC 3004, Australia; (I.B.); (P.C.); (M.R.); (H.C.)
- Department of Surgery, Monash University, 99 Commercial Road, Melbourne VIC 3004, Australia
| | - Irena Carmichael
- Monash Micro Imaging, Monash University, 99 Commercial Road, Melbourne VIC 3004, Australia;
| | - Premlatha Jagadeesan
- Material Materials Science and Engineering, Monash University, 22 Alliance Lane, Clayton VIC 3800, Australia; (P.J.); (N.R.C.)
| | - Neil R. Cameron
- Material Materials Science and Engineering, Monash University, 22 Alliance Lane, Clayton VIC 3800, Australia; (P.J.); (N.R.C.)
| | - Heather Cleland
- Skin Bioengineering Laboratory, Victorian Adult Burns Service, Alfred Health, 89 Commercial Road, Melbourne VIC 3004, Australia; (I.B.); (P.C.); (M.R.); (H.C.)
- Department of Surgery, Monash University, 99 Commercial Road, Melbourne VIC 3004, Australia
| | - Shiva Akbarzadeh
- Skin Bioengineering Laboratory, Victorian Adult Burns Service, Alfred Health, 89 Commercial Road, Melbourne VIC 3004, Australia; (I.B.); (P.C.); (M.R.); (H.C.)
- Department of Surgery, Monash University, 99 Commercial Road, Melbourne VIC 3004, Australia
- Correspondence: ; Tel.: +61-3-9903-0616
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Photobiomodulation (PBM) promotes angiogenesis in-vitro and in chick embryo chorioallantoic membrane model. Sci Rep 2018; 8:17080. [PMID: 30459437 PMCID: PMC6244005 DOI: 10.1038/s41598-018-35474-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 11/02/2018] [Indexed: 12/22/2022] Open
Abstract
The application of light in various therapeutic settings known as Photobiomodulation (PBM) is well established. Indications are the improvement of wound healing and tissue regeneration, scarring, and perfusion as well as pain therapy. Tissue perfusion is mandatory for successful wound healing. Nevertheless, there is a lack of mechanistic studies. We investigate the potential effect of PBM from light emitting diodes (LED) at 635 nm, 80 mW/cm2, 24 J/cm2 on angiogenesis in a two-part study: 1.) Investigation of the effect of PBM on the proliferation of endothelial cells and on vasculogenesis in a co-culture model of endothelial cells and stem cells. 2.) Investigation of the influence of PBM at chick egg chorioallantoic membrane (CAM) assays with fresh human skin xenografts. In both study phases, we observed a stimulating effect of PBM at 635 nm; in part 1: for proliferation of HUVEC (human umbilical vein endothelial cells) (25833 ± 12859 versus 63002 ± 35760 cells/well, p < 0.05, for cellular network formation (2.1 ± 2.1 versus 4.6 ± 3.5, p < 0.05) and for less cell compactness p = 0.01; in part 2: for the increase of number of vessel junctions per ROI (region of interest) (15.9 ± 2.6 versus 20.8 ± 5.4, p < 0.05). Our results suggest significant promotion of angiogenesis by PBM at 635 nm in vitro and in vivo.
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6
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Prevascularization of dermal substitutes with adipose tissue-derived microvascular fragments enhances early skin grafting. Sci Rep 2018; 8:10977. [PMID: 30030486 PMCID: PMC6054621 DOI: 10.1038/s41598-018-29252-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 07/09/2018] [Indexed: 02/07/2023] Open
Abstract
Split-thickness skin grafts (STSG) are still the gold standard for the treatment of most skin defects. Hence, there is an ongoing need to improve this procedure. For this purpose, we herein analyzed dermal matrices seeded with adipose tissue-derived microvascular fragments (ad-MVF) in a bradythrophic wound model. In additional experiments, the matrices were covered with autologous STSG 10 days after implantation. Green fluorescence protein (GFP)+ ad-MVF were isolated from C57BL/6-Tg(CAG-EGFP)1Osb/J mice and seeded onto collagen-glycosaminoglycan matrices. Non-seeded and prevascularized matrices were implanted into full-thickness skin defects on the skull of CD1 nu/nu mice for 21 days. Vascularization, lymphangiogenesis and incorporation of the matrices were analyzed using photo-acoustic imaging, trans-illumination stereomicroscopy, histology, and immunohistochemistry. The survival rate of STSG was assessed by planimetry. After 21 days, the density of microvascular and lymphatic networks was significantly higher in prevascularized matrices when compared to controls. This was associated with an improved implant integration. Moreover, prevascularization with ad-MVF allowed successful autologous skin grafting already at day 10, while coverage of non-seeded controls at day 10 resulted in STSG necrosis. In conclusion, ad-MVF represent powerful vascularization units. Seeded on dermal substitutes, they accelerate and enhance the healing of full-thickness skin defects and allow early coverage with STSG.
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7
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Pi J, Cheng Y, Sun H, Chen X, Zhuang T, Liu J, Li Y, Chang H, Zhang L, Zhang Y, Tao T. Apln-CreERT:mT/mG reporter mice as a tool for sprouting angiogenesis study. BMC Ophthalmol 2017; 17:163. [PMID: 28865439 PMCID: PMC5581477 DOI: 10.1186/s12886-017-0556-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 08/24/2017] [Indexed: 01/23/2023] Open
Abstract
Background Angiogenesis is defined as a new blood vessel sprouting from pre-existing vessels, and the sprouting angiogenesis is the start phase of angiogenesis, which is critical for both physiological and pathological processes, such as embryonic development, organ growth, wound healing, tumor growth, diabetic retinopathy and age-related macular degeneration. Better understanding of the mechanisms of sprout angiogenesis will provide a rationale for the treatments of these angiogenesis related diseases. Methods mT/mG tool mice are crossed with Apln-CreERT mice to generate Apln-CreERT: mT/mG mice, then we used neonatal retinal angiogenesis model to observe the angiogenic pattern of Apln-CreERT:mT/mG mice compared with Cdh5-CreERT:mT/mG mice. FACS analysis was used to sort eGFP and tdTomato endothelial cells (ECs) for measuring Apelin and Cdh5 expression. Retinal sprouting angiogenesis pattern was also observed at different neonatal time when induced by tamoxifen and at hypoxia condition, as well as in vivo tumor in real-time angiogenesis in a dorsal skinfold window chamber in Apln-CreERT:mT/mG mice. Results Apln-CreERT:mT/mG mice exhibited eGFP signal only in the sprouting angiogenesis, with less eGFP expression in the retinal “optic nerve” area than in that of Cdh5-CreERT: mT/mG mice, which might be due to relative mature vessels in the “optic nerve” area. The ECs sorted by FACS confirmed that the Apelin expression level was higher in eGFP ECs than tdTomato ECs of “optic nerve” area. Further we found that GFP-labeled sprouting angiogenesis decreased gradually following tamoxifen administration from P5-P7, but increased significantly during hypoxia in Apln-CreERT:mT/mG mice. At last, using Apln-CreERT:mT/mG mice we found tumor sprouting angiogenesis in dorsal skinfold, but not in the normal skinfold tissue. Conclusions Apln-CreERT:mT/mG mouse line is a useful tool to differentiate sprouting angiogenesis from whole blood vessels in the investigation of retinal and tumor sprouting angiogenesis in vivo.
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Affiliation(s)
- Jingjiang Pi
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Yu Cheng
- Department of Ophthalmology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, 197 Ruijin Er Rd, Huangpu District, Shanghai, 200025, China
| | - Huimin Sun
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Xiaoli Chen
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Tao Zhuang
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Jie Liu
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Yixi Li
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China.,Dalian Medical University, Liaoning, 116044, China
| | - Huan Chang
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China.,Dalian Medical University, Liaoning, 116044, China
| | - Lin Zhang
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - YuZhen Zhang
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China
| | - Ting Tao
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, 197 Ruijin Er Rd, Huangpu District, Shanghai, 200025, China.
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Langer S, Beescho C, Ring A, Dorfmann O, Steinau HU, Spindler N. A new in vivo model using a dorsal skinfold chamber to investigate microcirculation and angiogenesis in diabetic wounds. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2016; 5:Doc09. [PMID: 26955508 PMCID: PMC4764794 DOI: 10.3205/iprs000088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction: Diabetes mellitus describes a dysregulation of glucose metabolism due to improper insulin secretion, reduced insulin efficacy or both. It is a well-known fact that diabetic patients are likely to suffer from impaired wound healing, as diabetes strongly affects tissue angiogenesis. Until now, no satisfying in vivo murine model has been established to analyze the dynamics of angiogenesis during diabetic wound healing. To help understand the pathophysiology of diabetes and its effect on angiogenesis, a novel in vivo murine model was established using the skinfold chamber in mice. Materials and Methods: Mutant diabetic mice (db; BKS.Cg-m+/+Leprdb/J), wildtype mice (dock7Leprdb+/+m) and laboratory BALB/c mice were examined. They were kept in single cages with access to laboratory chow with an 12/12 hour day/night circle. Lesions of the panniculus muscle (Ø 2 mm) were created in the center of the transparent window chamber and the subsequent muscular wound healing was then observed for a period of 22 days. Important analytic parameters included vessel diameter, red blood cell velocity, vascular permeability, and leakage of muscle capillaries and post capillary venules. The key parameters were functional capillary density (FCD) and angiogenesis positive area (APA). Results: We established a model which allows high resolution in vivo imaging of functional angiogenesis in diabetic wounds. As expected, db mice showed impaired wound closure (day 22) compared to wounds of BALB/c or WT mice (day 15). FCD was lower in diabetic mice compared to WT and BALB/c during the entire observation period. The dynamics of angiogenesis also decreased in db mice, as reflected by the lowest APA levels. Significant variations in the skin buildup were observed, with the greatest skin depth in db mice. Furthermore, in db mice, the dermis:subcutaneous ratio was highly shifted towards the subcutaneous layers as opposed to WT or BALB/c mice. Conclusion: Using this new in vivo model of the skinfold chamber, it was possible to analyze and quantify microangiopathical changes which are essential for a better understanding of the pathophysiology of disturbed wound healing. Research in microcirculation is important to display perfusion in wounds versus healthy tissue. Using our model, we were able to compare wound healing in diabetic and healthy mice. We were also able to objectively analyze perfusion in wound edges and compare microcirculatory parameters. This model may be well suited to augment different therapeutic options.
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Affiliation(s)
- Stefan Langer
- Department of Plastic, Esthetic and Special Hand Surgery, University Hospital Leipzig, Germany
| | - Christian Beescho
- Department of Plastic, Esthetic and Special Hand Surgery, University Hospital Leipzig, Germany
| | - Andrej Ring
- Department of Plastic Surgery and Severe Burns, University Hospital Bergmannsheil, Ruhr University Bochum, Germany
| | - Olivia Dorfmann
- Department of Plastic, Esthetic and Special Hand Surgery, University Hospital Leipzig, Germany
| | | | - Nick Spindler
- Department of Plastic, Esthetic and Special Hand Surgery, University Hospital Leipzig, Germany
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9
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Augustine R, Kalarikkal N, Thomas S. Advancement of wound care from grafts to bioengineered smart skin substitutes. Prog Biomater 2014; 3:103-113. [PMID: 29470769 PMCID: PMC5299852 DOI: 10.1007/s40204-014-0030-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 10/31/2014] [Indexed: 11/04/2022] Open
Abstract
This review gives a brief description on the skin and its essential functions, damages or injury which are common to the skin and the role of skin substitute to replace the functions of the skin soon after an injury. Skin substitutes have crucial role in the management of deep dermal and full thickness wounds. At present, there is no skin substitute in the market that can replace all the functions of skin 'and the research is still continuing for a better alternative. This review is an attempt to recollect and report the past efforts including skin grafting and recent trends like use of bioengineered smart skin substitutes in wound care. Incorporation functional moieties like antimicrobials and wound healing agents are also described.
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Affiliation(s)
- Robin Augustine
- International and Interuniversity Centre for Nanoscience and Nanotechnology, Mahatma Gandhi University, Priyadarshini Hills P. O., Kottayam, 686 560, Kerala, India
| | - Nandakumar Kalarikkal
- International and Interuniversity Centre for Nanoscience and Nanotechnology, Mahatma Gandhi University, Priyadarshini Hills P. O., Kottayam, 686 560, Kerala, India.
- School of Pure and Applied Physics, Mahatma Gandhi University, Priyadarshini Hills P. O., Kottayam, 686 560, Kerala, India.
| | - Sabu Thomas
- International and Interuniversity Centre for Nanoscience and Nanotechnology, Mahatma Gandhi University, Priyadarshini Hills P. O., Kottayam, 686 560, Kerala, India.
- School of Chemical Sciences, Mahatma Gandhi University, Priyadarshini Hills P. O., Kottayam, 686 560, Kerala, India.
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10
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Paradigm change in the treatment of non-melanoma skin cancer of the auricle: reconstruction with full thickness skin grafting instead of wedge excision. Eur Arch Otorhinolaryngol 2014; 272:1743-8. [PMID: 24871861 DOI: 10.1007/s00405-014-3092-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 05/06/2014] [Indexed: 10/25/2022]
Abstract
Non-melanoma skin cancer (NMSC) has become an epidemic disease and is predominantly located in the head and neck area. While historically auricular NMSCs are treated by means of a wedge excision, we describe a more elegant technique with excellent esthetical results. We conducted a retrospective cohort study of 43 consecutive patients with NMSC of the auricle who underwent reconstruction with a full thickness skin graft (FTSG). All grafts survived. Two patients (5%) showed crust formation, but fully recovered. One patient had an irradical resection for which he required a limited re-excision. All patients showed excellent esthetical results. When treating NMSC of the auricle, reconstruction with a FTSG demonstrates several important advantages. It is a relatively simple but oncological safe technique; it leads to excellent esthetical and functional outcomes, and shows high patient and surgeon satisfaction.
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Zuhr O, Bäumer D, Hürzeler M. The addition of soft tissue replacement grafts in plastic periodontal and implant surgery: critical elements in design and execution. J Clin Periodontol 2014; 41 Suppl 15:S123-42. [DOI: 10.1111/jcpe.12185] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/07/2013] [Accepted: 10/16/2013] [Indexed: 01/27/2023]
Affiliation(s)
- Otto Zuhr
- Private Practice Hürzeler/Zuhr; Munich Germany
- Department of Periodontology; Centre for Dental, Oral, and Maxillofacial Medicine (Carolinum); Johann Wolfgang Goethe-University Frankfurt/Main; Frankfurt Germany
| | | | - Markus Hürzeler
- Private Practice Hürzeler/Zuhr; Munich Germany
- Department of Operative Dentistry and Periodontology; University Dental School; University of Freiburg; Freiburg Germany
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12
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In Vivo Evaluation of Wound Bed Reaction and Graft Performance After Cold Skin Graft Storage. J Burn Care Res 2014; 35:e187-96. [DOI: 10.1097/bcr.0b013e3182a226df] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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13
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van Wingerden JJ, Lapid O, van der Horst CMAM. Bridging phenomenon - Simplifying complex ear reconstructions. Head Neck 2013; 36:735-8. [PMID: 23970464 DOI: 10.1002/hed.23458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 08/13/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Extirpation of noninvasive skin tumors of the anterior ear may create large defects. Various flaps, described to cover these defects, demand special knowledge without which a loss of the fine detail of the ear may result. METHODS Healthy, exposed cartilage is deliberately excised leaving a basic framework for support, thus preserving contours and a well-vascularized recipient bed for full-thickness skin grafting. The grafts heal by revascularization and "bridging," a phenomenon whereby grafts on avascular beds (such as denuded cartilage) are revascularized. RESULTS By marrying clinical experience gained during microtia reconstruction with insights regarding the bridging phenomenon derived from the laboratory, our 17 reconstructed ears healed without serious complications and kept their normal contours and shape, and there was no recurrence of the carcinoma. CONCLUSION Satisfactory patient-centered outcome can be obtained in reconstructing defects of one-third to two-thirds of the total anterior surface of the ear relying on the bridging phenomenon.
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Affiliation(s)
- Jan J van Wingerden
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Knapik A, Hegland N, Calcagni M, Althaus M, Vollmar B, Giovanoli P, Lindenblatt N. Metalloproteinases facilitate connection of wound bed vessels to pre-existing skin graft vasculature. Microvasc Res 2012; 84:16-23. [PMID: 22521453 DOI: 10.1016/j.mvr.2012.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 02/16/2012] [Accepted: 04/02/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite advances in tissue engineering of human skin, the exact revascularization processes remain unclear. Therefore it was the aim of this study to investigate the vascular transformations during engraftment and to identify associated proteolytic factors. METHODS The modified dorsal skinfold chamber with autologous skin grafting was prepared in C57BL/6J mice, and intravital microscopy was performed. The expression of proteases and vascular factors was quantified by immunohistochemistry. RESULTS Reperfusion of the skin graft after 72hours was followed by a temporary angiogenic response of the graft vessels. Wound bed bud formation appeared after 24 to 48hours representing starting points for capillary sprouting. In the reperfused skin graft larger buds developed over several days without transformation into angiogenic sprouts; instead pruning took place. MT1-MMP was detected at sprout tips of in-growing vessels. MMP-2 expression was located at the wound bed/graft connection sites. Pericytes were found to withdraw from the angiogenic vessel in order to facilitate sprouting. CONCLUSIONS Skin graft vasculature responded with temporary angiogenesis to reperfusion, which was pruned after several days and exhibited a different morphology than regular sprouting angiogenesis present within the wound bed. Furthermore we identified MT1-MMP as sprout-tip located protease indicating its potential role as sprout growth facilitator as well as potentially in lysing the existing graft capillaries in order to connect to them. The differences between the wound bed and skin graft angiogenesis may represent a relevant insight into the processes of vascular pruning and may help in the engineering of skin substitutes.
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Affiliation(s)
- Alicia Knapik
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zürich, Switzerland
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Schweizer R, Merz K, Schlosser S, Spanholtz T, Contaldo C, Stein J, Enzmann V, Giovanoli P, Erni D, Plock J. Morphology and Hemodynamics during Vascular Regeneration in Critically Ischemic Murine Skin Studied by Intravital Microscopy Techniques. Eur Surg Res 2011; 47:222-30. [DOI: 10.1159/000333088] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 07/20/2011] [Indexed: 12/28/2022]
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Calcagni M, Althaus MK, Knapik AD, Hegland N, Contaldo C, Giovanoli P, Lindenblatt N. In vivo visualization of the origination of skin graft vasculature in a wild-type/GFP crossover model. Microvasc Res 2011; 82:237-45. [PMID: 21784083 DOI: 10.1016/j.mvr.2011.07.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Revised: 07/06/2011] [Accepted: 07/08/2011] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Skin substitutes are increasingly produced in tissue engineering, but still the understanding of the physiological skin revascularization process is lacking. To study in vivo conditions we recently introduced a mouse model, in which we already characterized the angiogenic changes within the wound bed and the skin graft. The aim of this study was to identify the origination of the vasculature during skin graft revascularization in vivo and to track vessel development over time. METHODS We created a crossover wild-type/GFP skin transplantation model, in which each animal carried the graft from the other strain. The preparation of the modified dorsal skin fold chamber including cross-over skin grafting was performed in male C57BL/6J wild-type mice (n=5) and C57BL/6-Tg(ACTB-EGFP)1O sb/J mice (n=5). Intravital microscopy in 12 areas of wild-type and GFP skin grafts was performed daily over a time period of 10 days. RESULTS Graft reperfusion started after 48-72 h. After reperfusion GFP-positive structures from the wound bed were visible in the graft capillaries with the highest density in the center of the graft. Overall, we observed a replacement of existing graft capillaries with vessels from the wound bed in 68% of the vessels. Of note, vessel replacement occurred in almost 100% of graft vessels in the periphery. Additionally, vessels within the graft showed a temporary angiogenic response between days 3-8, which originated predominantly from the autochthonous graft vasculature, but also contained already grown-in vessels from the wound bed. CONCLUSIONS These in vivo data indicate an early in-growth of angiogenic bed vessels into the existing vascular channels of the graft and subsequent centripetal replacement. Additionally we observed a temporary angiogenic response of the autochthonous capillaries of the skin graft with contribution from bed vessels. These findings further support the theory that sprouting angiogenesis from the wound bed in combination with the replacement of existing graft vessels are the key factors in skin graft taking. Thus, manufacturing of skin substitutes should be aimed at providing pre-formed vascular channels within the construct to improve vascularization.
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Affiliation(s)
- Maurizio Calcagni
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospital Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
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