1
|
Xu Y, Bei Z, Li M, Ye L, Chu B, Zhao Y, Qian Z. Biomedical application of materials for external auditory canal: History, challenges, and clinical prospects. Bioact Mater 2024; 39:317-335. [PMID: 38827173 PMCID: PMC11139775 DOI: 10.1016/j.bioactmat.2024.05.035] [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: 12/13/2023] [Revised: 05/14/2024] [Accepted: 05/19/2024] [Indexed: 06/04/2024] Open
Abstract
Biomaterials play an integral role in treatment of external auditory canal (EAC) diseases. Regarding the special anatomic structure and physiological characteristics of EAC, careful selection of applicable biomaterials was essential step towards effective management of EAC conditions. The bioactive materials can provide reasonable biocompatibility, reduce risk of host pro-inflammatory response and immune rejection, and promote the healing process. In therapeutic procedure, biomaterials were employed for covering or packing the wound, protection of the damaged tissue, and maintaining of normal structures and functions of the EAC. Therefore, understanding and application of biomaterials was key to obtaining great rehabilitation in therapy of EAC diseases. In clinical practice, biomaterials were recognized as an important part in the treatment of different EAC diseases. The choice of biomaterials was distinct according to the requirements of various diseases. As a result, awareness of property regarding different biomaterials was fundamental for appropriate selection of therapeutic substances in different EAC diseases. In this review, we firstly introduced the characteristics of EAC structures and physiology, and EAC pathologies were summarized secondarily. From the viewpoint of biomaterials, the different materials applied to individual diseases were outlined in categories. Besides, the underlying future of therapeutic EAC biomaterials was discussed.
Collapse
Affiliation(s)
- Yang Xu
- Department of Otorhinolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhongwu Bei
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mei Li
- Department of Otorhinolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lin Ye
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bingyang Chu
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu Zhao
- Department of Otorhinolaryngology-Head & Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhiyong Qian
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
2
|
Verboket RD, Henrich D, Janko M, Sommer K, Neijhoft J, Söhling N, Weber B, Frank J, Marzi I, Nau C. Human Acellular Collagen Matrices-Clinical Opportunities in Tissue Replacement. Int J Mol Sci 2024; 25:7088. [PMID: 39000200 PMCID: PMC11241445 DOI: 10.3390/ijms25137088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/19/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
The field of regenerative medicine is increasingly in need of effective and biocompatible materials for tissue engineering. Human acellular dermal matrix (hADM)-derived collagen matrices stand out as a particularly promising candidate. Their ability to preserve structural integrity, coupled with exceptional biocompatibility, positions them as a viable choice for tissue replacement. However, their clinical application has been largely confined to serving as scaffolds. This study aims to expand the horizon of clinical uses for collagen sheets by exploring the diverse cutting-edge clinical demands. This review illustrates the clinical utilizations of collagen sheets beyond traditional roles, such as covering skin defects or acting solely as scaffolds. In particular, the potential of Epiflex®, a commercially available and immediately clinically usable allogeneic membrane, will be evaluated. Collagen sheets have demonstrated efficacy in bone reconstruction, where they can substitute the induced Masquelet membrane in a single-stage procedure, proving to be clinically effective and safe. The application of these membranes allow the reconstruction of substantial tissue defects, without requiring extensive plastic reconstructive surgery. Additionally, they are found to be apt for addressing osteochondritis dissecans lesions and for ligament reconstruction in the carpus. The compelling clinical examples showcased in this study affirm that the applications of human ADM extend significantly beyond its initial use for skin defect treatments. hADM has proven to be highly successful and well-tolerated in managing various etiologies of bone and soft tissue defects, enhancing patient care outcomes. In particular, the application from the shelf reduces the need for additional surgery or donor site defects.
Collapse
Affiliation(s)
- René D. Verboket
- Department of Trauma Surgery and Orthopaedics, University Hospital, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (D.H.); (M.J.); (K.S.); (J.N.); (N.S.); (B.W.); (J.F.); (I.M.); (C.N.)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Makkawi KW, Beaineh PT, Habr NT, Ibrahim AE. Use of Dermal Substitute Matrices for Coverage of Exposed Limb Vascular Repairs: A Literature Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5855. [PMID: 38841527 PMCID: PMC11150027 DOI: 10.1097/gox.0000000000005855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/12/2024] [Indexed: 06/07/2024]
Abstract
Background Prompt coverage of vascular repairs in the extremities is needed to protect from desiccation and trauma. In the absence of local soft tissues to provide early coverage pending demarcation of the tissues and the zone of injury, there is no clear data in the literature on the ideal coverage method. This article is the first to review the use of dermal substitutes for temporary coverage of extremity vascular repairs pending definitive coverage. Methods We conducted a review of the literature to identify previous articles indexed in PubMed and Ovid using these search terms: [(skin) OR (artificial skin) OR (Integra) OR (dermal substitute) OR (dermal substitute matrix) OR (dermal regeneration) OR (dermal regeneration matrix) OR (dermal regeneration template)] AND [(bypass) OR (graft) OR (vascular surgery) OR (revascularization) OR (salvage) OR (limb salvage) OR (vascular repair) OR (artery repair) OR (arterial repair)] AND [(limb) OR (extremity) OR (leg) OR (arm) OR (vascular injury) OR (amputation)]. Results Of the 32 articles retrieved for initial review, five case reports with six patients of dermal substitute use for direct coverage of extremity repairs were identified. In all cases, the dermal substitute was able to provide stable coverage pending definitive coverage or was allowed to heal secondarily. Conclusions Dermal substitute matrices are a potential means of temporary coverage of exposed extremity vascular repairs when there is a paucity of local soft tissues pending more definitive coverage.
Collapse
Affiliation(s)
- Kareem W. Makkawi
- From the Division of Plastic and Reconstructive Surgery, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Paul T. Beaineh
- From the Division of Plastic and Reconstructive Surgery, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Natasha T. Habr
- From the Division of Plastic and Reconstructive Surgery, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Amir E. Ibrahim
- From the Division of Plastic and Reconstructive Surgery, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
4
|
Lee YJ, Han HJ, Shim HS. Treatment of hard-to-heal wounds in ischaemic lower extremities with a novel fish skin-derived matrix. J Wound Care 2024; 33:348-356. [PMID: 38683780 DOI: 10.12968/jowc.2024.33.5.348] [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: 05/02/2024]
Abstract
OBJECTIVE To evaluate the efficacy of treatment of hard-to-heal wounds of patients with ischaemia of the lower extremities, and compare an omega-3 wound matrix product (Kerecis, Iceland) with a standard dressing. METHOD A single-centre, prospective, randomised, controlled clinical trial of patients with hard-to-heal wounds following three weeks of standard care was undertaken. The ischaemic condition of the wound was confirmed as a decreased transcutaneous oxygen pressure (TcPO2) of <40mmHg. After randomising patients into either a case (omega-3 dressing) or a control group (standard dressing), the weekly decrease in wound area over 12 weeks and the number of patients that achieved complete wound closure were compared between the two groups. Patients with a TcPO2 of ≤32mmHg were taken for further analysis of their wound in a severe ischaemic context. RESULTS A total of 28 patients were assigned to the case group and 22 patients to the control group. Over the course of 12 weeks, the wound area decreased more rapidly in the case group than the control group. Complete wound healing occurred in 82% of patients in the case group and 45% in the control group. Even in patients with a severe ischaemic wound with a TcPO2 value of <32 mmHg, wound area decreased more rapidly in the case group than the control group. The proportions of re-epithelialised area in the case and control groups were 80.24% and 57.44%, respectively. CONCLUSION Considering the more rapid decrease in wound area and complete healing ratio in the case group, application of a fish skin-derived matrix for treating lower-extremity hard-to-heal wounds, especially with impaired vascularity, would appear to be a good treatment option.
Collapse
Affiliation(s)
- Yeon Ji Lee
- Department of Plastic and Reconstructive Surgery, St. Vincent Hospital, The Catholic University of Korea, South Korea
| | - Hye Ju Han
- Department of Plastic and Reconstructive Surgery, St. Vincent Hospital, The Catholic University of Korea, South Korea
| | - Hyung Sup Shim
- Department of Plastic and Reconstructive Surgery, St. Vincent Hospital, The Catholic University of Korea, South Korea
| |
Collapse
|
5
|
Sagheb K, Noelken R, Schröger SV, Walter C, Graef JJ, Schumann S. Biomechanical analysis of the human derived soft tissue graft Epiflex for use in oral soft tissue augmentation. Int J Implant Dent 2024; 10:16. [PMID: 38517552 PMCID: PMC10959861 DOI: 10.1186/s40729-024-00534-1] [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: 11/20/2023] [Accepted: 03/05/2024] [Indexed: 03/24/2024] Open
Abstract
PURPOSE This study aimed to investigate the biomechanical properties, cell migration, and revascularization of the acellular dermal matrix Epiflex. As a decellularized, freeze-dried human skin graft, Epiflex has broad applications in medical fields, particularly in implantology and dentistry. Understanding its biomechanical characteristics is crucial for its clinical adoption as a novel soft tissue graft option. METHODS Epiflex (n = 3) was evaluated in comparison to palatal tissue from body donors (n = 3). Key metrics, such as elongation and tear resistance, were quantified. Both graft types underwent histological analysis and scanning electron microscopy. Additionally, the healing properties of Epiflex were assessed using a Chorioallantoic Membrane (CAM) Assay. RESULTS Biomechanically, Epiflex (mean = 116.01 N) demonstrated the ability to withstand greater forces (p = 0.013) than human palatal tissue (mean = 12.58 N). When comparing the elongation, no significant difference was measured (ASG mean = 9.93 mm, EF mean = 9.7 mm). Histologically, Epiflex exhibited a loosely connected network of collagen fibers with a dense upper layer. The CAM Assay indicated efficient revascularization. CONCLUSION Epiflex appears to be a viable option for soft tissue augmentation, particularly appealing to patient groups who avoid all or specific animal-derived products due to ethical or religious reasons.
Collapse
Affiliation(s)
- Keyvan Sagheb
- Department of Oral and Maxillofacial Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, 55131, Mainz, Germany
| | - Robert Noelken
- Department of Oral and Maxillofacial Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, 55131, Mainz, Germany
- Private Practice for Oral Surgery, Lindau/Lake Constance, Germany
| | - Saskia-Vanessa Schröger
- Department of Oral and Maxillofacial Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, 55131, Mainz, Germany
| | - Christian Walter
- Department of Oral and Maxillofacial Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, 55131, Mainz, Germany
- Oral- and Maxillofacial Surgery-Facial Plastic Surgery, Mediplus Clinic, Haifa-Allee 20, 55128, Mainz, Germany
| | - Julian Jakob Graef
- Department of Oral and Maxillofacial Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, 55131, Mainz, Germany.
- Institute of Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, 55131, Mainz, Germany.
| | - Sven Schumann
- Institute of Anatomy, University Medical Center of the Johannes Gutenberg-University Mainz, 55131, Mainz, Germany
| |
Collapse
|
6
|
Alba B, Weinstein B, Arnold SH, Jacobs KM, Schechter L. The Use of Acellular Tissue Matrices in Gender-Affirming Surgery: Review of the Literature and Institutional Experience. Adv Biol (Weinh) 2023:e2300507. [PMID: 38053238 DOI: 10.1002/adbi.202300507] [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: 09/21/2023] [Revised: 11/14/2023] [Indexed: 12/07/2023]
Abstract
Wound healing complications are not uncommon after genital gender-affirming surgery and can pose significant challenges for the reconstructive surgeon. Acellular tissue matrices are products that contain extracellular matrix compounds without living cells and are used to expedite and improve wound healing. Some of these products have been described for a variety of different indications in gender-affirming surgery. In this paper, the authors present a review of the current literature on the use of acellular tissue matrices in gender-affirming surgery as well as the authors' institutional experience in using these products.
Collapse
Affiliation(s)
- Brandon Alba
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Brielle Weinstein
- Department of Plastic Surgery, University of South Florida, Tampa, FL, 33606, USA
| | - Sydney H Arnold
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Kristin M Jacobs
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Loren Schechter
- Division of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, 60612, USA
| |
Collapse
|
7
|
Carolo A, Melotti L, Zivelonghi G, Sacchetto R, Akyürek EE, Martinello T, Venerando A, Iacopetti I, Sugni M, Martinelli G, Roncoroni M, Marzorati S, Barbon S, Contran M, Incendi D, Perozzo F, Porzionato A, Vindigni V, Patruno M. Mutable Collagenous Tissue Isolated from Echinoderms Leads to the Production of a Dermal Template That Is Biocompatible and Effective for Wound Healing in Rats. Mar Drugs 2023; 21:506. [PMID: 37888441 PMCID: PMC10608188 DOI: 10.3390/md21100506] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/28/2023] Open
Abstract
The mutable collagenous tissue (MCT) of echinoderms possesses biological peculiarities that facilitate native collagen extraction and employment for biomedical applications such as regenerative purposes for the treatment of skin wounds. Strategies for skin regeneration have been developed and dermal substitutes have been used to cover the lesion to facilitate cell proliferation, although very little is known about the application of novel matrix obtained from marine collagen. From food waste we isolated eco-friendly collagen, naturally enriched with glycosaminoglycans, to produce an innovative marine-derived biomaterial assembled as a novel bi-layered skin substitute (Marine Collagen Dermal Template or MCDT). The present work carried out a preliminary experimental in vivo comparative analysis between the MCDT and Integra, one of the most widely used dermal templates for wound management, in a rat model of full-thickness skin wounds. Clinical, histological, and molecular evaluations showed that the MCDT might be a valuable tool in promoting and supporting skin wound healing: it is biocompatible, as no adverse reactions were observed, along with stimulating angiogenesis and the deposition of mature collagen. Therefore, the two dermal templates used in this study displayed similar biocompatibility and outcome with focus on full-thickness skin wounds, although a peculiar cellular behavior involving the angiogenesis process was observed for the MCDT.
Collapse
Affiliation(s)
- Anna Carolo
- Department of Comparative Biomedicine and Food Science, University of Padua, 35020 Legnaro, Italy; (A.C.); (G.Z.); (R.S.); (E.E.A.)
| | - Luca Melotti
- Department of Comparative Biomedicine and Food Science, University of Padua, 35020 Legnaro, Italy; (A.C.); (G.Z.); (R.S.); (E.E.A.)
| | - Giulia Zivelonghi
- Department of Comparative Biomedicine and Food Science, University of Padua, 35020 Legnaro, Italy; (A.C.); (G.Z.); (R.S.); (E.E.A.)
| | - Roberta Sacchetto
- Department of Comparative Biomedicine and Food Science, University of Padua, 35020 Legnaro, Italy; (A.C.); (G.Z.); (R.S.); (E.E.A.)
| | - Eylem Emek Akyürek
- Department of Comparative Biomedicine and Food Science, University of Padua, 35020 Legnaro, Italy; (A.C.); (G.Z.); (R.S.); (E.E.A.)
| | - Tiziana Martinello
- Department of Veterinary Medicine, University of Bari, 70010 Valenzano, Italy;
| | - Andrea Venerando
- Department of Agricultural, Food, Environmental and Animal Sciences, University of Udine, 33100 Udine, Italy;
| | - Ilaria Iacopetti
- Department of Animal Medicine, Production and Health, University of Padova, 35020 Legnaro, Italy;
| | - Michela Sugni
- Department of Environmental Science and Policy, University of Milan, 20133 Milan, Italy; (M.S.); (G.M.); (M.R.); (S.M.)
| | - Giordana Martinelli
- Department of Environmental Science and Policy, University of Milan, 20133 Milan, Italy; (M.S.); (G.M.); (M.R.); (S.M.)
| | - Margherita Roncoroni
- Department of Environmental Science and Policy, University of Milan, 20133 Milan, Italy; (M.S.); (G.M.); (M.R.); (S.M.)
| | - Stefania Marzorati
- Department of Environmental Science and Policy, University of Milan, 20133 Milan, Italy; (M.S.); (G.M.); (M.R.); (S.M.)
| | - Silvia Barbon
- Department of Neuroscience, University of Padua, 35121 Padova, Italy; (S.B.); (M.C.); (D.I.); (A.P.); (V.V.)
| | - Martina Contran
- Department of Neuroscience, University of Padua, 35121 Padova, Italy; (S.B.); (M.C.); (D.I.); (A.P.); (V.V.)
| | - Damiana Incendi
- Department of Neuroscience, University of Padua, 35121 Padova, Italy; (S.B.); (M.C.); (D.I.); (A.P.); (V.V.)
| | - Filippo Perozzo
- Plastic and Reconstructive Surgery Unit, Padova University Hospital, 35128 Padova, Italy;
| | - Andrea Porzionato
- Department of Neuroscience, University of Padua, 35121 Padova, Italy; (S.B.); (M.C.); (D.I.); (A.P.); (V.V.)
| | - Vincenzo Vindigni
- Department of Neuroscience, University of Padua, 35121 Padova, Italy; (S.B.); (M.C.); (D.I.); (A.P.); (V.V.)
| | - Marco Patruno
- Department of Comparative Biomedicine and Food Science, University of Padua, 35020 Legnaro, Italy; (A.C.); (G.Z.); (R.S.); (E.E.A.)
| |
Collapse
|
8
|
Błażyńska-Spychalska A, Kur M, Brzeski T, Zając W, Pankiewicz T, Bielecki S, Woliński J, Jankau J. Potential of Bacterial Cellulose in Reconstructive Surgery of Body Integumentary System: Preliminary Studies in Animals. J Funct Biomater 2023; 14:397. [PMID: 37623642 PMCID: PMC10455510 DOI: 10.3390/jfb14080397] [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: 05/30/2023] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 08/26/2023] Open
Abstract
The aim of the study is to present the preliminary results of the in vivo application of Komagataeibacter xylinum E25 bacterial cellulose (BC) as a replacement material for produced defects during operations. Three pigs (sus scrofa domestica) had the same defects in the ear cartilage (4 × 4 cm) and in the rectus abdominis muscle (6 × 10 cm) with BC membranes implanted into them. The time of observation of the condition of the animals was 3 months. Implantation sites did not show clinical signs of complications in the form of inflammation or necrosis. Histologically, a normal scar was produced as a result of the material healing into the host's body. In one case, no residual implant material was found at the site of implantation, and the remodeled scar confirmed healing. No systemic inflammatory reaction was observed in any of the animals. The host organism's reaction to the bacterial cellulose allows us to believe that it meets the expectations as a material that can be widely used in reconstructive surgery. Nevertheless, this requires further research on a larger group and also using other foreign bodies. The next step would be an experiment on a group consisting of people.
Collapse
Affiliation(s)
| | - Martyna Kur
- Department of Plastic Surgery, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (A.B.-S.); (M.K.)
| | | | - Wacław Zając
- Independent Researcher, 75-671 Koszalin, Poland;
| | - Teresa Pankiewicz
- Institute of Molecular and Industrial Biotechnology, University of Technology of Łódź, 90-924 Łódź, Poland; (T.P.); (S.B.)
| | - Stanisław Bielecki
- Institute of Molecular and Industrial Biotechnology, University of Technology of Łódź, 90-924 Łódź, Poland; (T.P.); (S.B.)
| | - Jarosław Woliński
- The Kielanowski Institute of Animal Physiology and Nutrition, Polish Science Academy, 05-110 Jabłonna, Poland;
| | - Jerzy Jankau
- Department of Plastic Surgery, Medical University of Gdańsk, 80-210 Gdańsk, Poland; (A.B.-S.); (M.K.)
| |
Collapse
|
9
|
Ivanova Y, Gramatiuk S, Kryvoruchko I, Tymchenko M, Goltsev K, Sargsyan K. Investigating the joint application of negative pressure wound treatment and tissue therapy for chronic wounds in patients with diabetes. J Med Life 2023; 16:1098-1104. [PMID: 37900068 PMCID: PMC10600680 DOI: 10.25122/jml-2023-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/19/2023] [Indexed: 10/31/2023] Open
Abstract
This study aimed to investigate the effectiveness of combined negative pressure wound therapy (NPWT) and human amniotic membrane in patients with chronic wounds associated with diabetes. A total of five patients with type 2 diabetes, including ischemic and mixed forms of diabetic foot syndrome, presenting with ischemic wounds of the lower extremities were included in this study. Patients with uncorrected limb ischemia were excluded. The treatment protocol included diabetes compensation (treatment with fractional insulin therapy), anticoagulant, metabolic therapy and angiotropic therapy, physical treatment methods, osteoporosis therapy with calcium preparations, and wound-specific interventions. The primary treatment approach involved the application of a vacuum bandage to the transplanted human amniotic membrane, which improved the adaptation of the flap to the wound surface, allowed the removal of excess wound exudate, and stimulated angiogenesis and reparative properties. The combined approach of NPWT and biotherapy was a safe and effective cure for diabetic wounds, promoting faster wound healing, reducing the need for autodermoplasty, and possibly reducing the necessity for high-level amputations.
Collapse
Affiliation(s)
- Yulia Ivanova
- Institute of Bio-Stem Cell Rehabilitation, Ukraine Association of Biobank, Kharkiv, Ukraine
- Surgery Department, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Svitlana Gramatiuk
- Institute of Bio-Stem Cell Rehabilitation, Ukraine Association of Biobank, Kharkiv, Ukraine
- International Biobanking and Education, Medical University of Graz, Graz, Austria
| | - Igor Kryvoruchko
- Surgery Department, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Mykhailo Tymchenko
- Surgery Department, Kharkiv National Medical University, Kharkiv, Ukraine
- Zaytsev V.T. Institute of General and Urgent Surgery, National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
| | - Kyrylo Goltsev
- Surgery Department, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Karine Sargsyan
- International Biobanking and Education, Medical University of Graz, Graz, Austria
| |
Collapse
|
10
|
Mohammadyari F, Parvin S, Khorvash M, Amini A, Behzadi A, HajEbrahimi R, Kasaei F, Olangian-Tehrani S. Acellular dermal matrix in reconstructive surgery: Applications, benefits, and cost. FRONTIERS IN TRANSPLANTATION 2023; 2:1133806. [PMID: 38993878 PMCID: PMC11235262 DOI: 10.3389/frtra.2023.1133806] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/13/2023] [Indexed: 07/13/2024]
Abstract
Modern tissue engineering has made substantial advancements that have revolutionized plastic surgery. Acellular dermal matrix (ADM) is an example that has gained considerable attention recently. ADM can be made from humans, bovines, or porcine tissues. ADM acts as a scaffold that incorporates into the recipient tissue. It is gradually infiltrated by fibroblasts and vascularized. Fortunately, many techniques have been used to remove cellular and antigenic components from ADM to minimize immune system rejection. ADM is made of collagen, fibronectin, elastin, laminin, glycosaminoglycans, and hyaluronic acid. It is used in critical wounds (e.g., diabetic wounds) to protect soft tissue and accelerate wound healing. It is also used in implant-based breast reconstruction surgery to improve aesthetic outcomes and reduce capsule contracture risk. ADM has also gained attention in abdominal and chest wall defects. Some studies have shown that ADM is associated with less erosion and infection in abdominal hernias than synthetic meshes. However, its higher cost prevents it from being commonly used in hernia repair. Also, using ADM in tendon repair (e.g., Achilles tendon) has been associated with increased stability and reduced rejection rate. Despite its advantages, ADM might result in complications such as hematoma, seroma, necrosis, and infection. Moreover, ADM is expensive, making it an unsuitable option for many patients. Finally, the literature on ADM is insufficient, and more research on the results of ADM usage in surgeries is needed. This article aims to review the literature regarding the application, Benefits, and costs of ADM in reconstructive surgery.
Collapse
Affiliation(s)
| | - Sadaf Parvin
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Khorvash
- School of Medicine, Islamic Azad University of Medical Sciences, Tehran, Iran
| | - Amirhasan Amini
- School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | | | - Fatemeh Kasaei
- School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Sepehr Olangian-Tehrani
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Avicennet, Tehran, Iran
| |
Collapse
|
11
|
Simpson AM, Barrow BE, Corey SL, Kachare MD, Choo JH, Wilhelmi BJ. Red Breast Syndrome: Complete Resolution Following Replacement of Acellular Dermal Matrices With Acellular Collagen Matrices. EPLASTY 2022; 22:QA1. [PMID: 36330504 PMCID: PMC9615911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
What is red breast syndrome (RBS)?What causes RBS?How often do patients present with RBS?What are effective treatments for RBS?
Collapse
Affiliation(s)
| | | | - Samuel L Corey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
| | - Milind D Kachare
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
| | - Joshua H Choo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
| | - Bradon J Wilhelmi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Louisville, Louisville, KY
| |
Collapse
|
12
|
Zhang B, Zhang Y, Wang Y, Yang F, Sheng S, Wang Z, Chang X, Wei J, Guo J, Sun S. Acellular Dermal Matrix Prevents Esophageal Stricture After Full Circumferential Endoscopic Submucosal Dissection in a Porcine Model. Front Bioeng Biotechnol 2022; 10:884502. [PMID: 35586551 PMCID: PMC9108161 DOI: 10.3389/fbioe.2022.884502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 04/14/2022] [Indexed: 11/17/2022] Open
Abstract
Esophageal stricture is a common complication after endoscopic submucosal dissection (ESD), especially in full circumferential ESD. This study investigated fully covered self-expanding metal stent (FCSEMS) placement with an acellular dermal matrix (ADM) for preventing post-ESD esophageal stricture. Twelve Bama minipigs were randomly divided into two groups, which underwent full circumferential ESD in the distal esophagus. In group A, an FCSEMS with ADM was placed at the mucosal defect, whereas group B underwent standard FCSEMS placement. The stent was removed during gastroscopy 2 weeks after the ESD procedure. At the fourth week, gastroscopy was repeated to evaluate local healing and stenosis. The animals were sacrificed, esophageal specimens were obtained for macroscopic and histological evaluation, and serum C-reactive protein (CRP) levels were quantified. Four weeks post ESD, dysphagia occurrence was lesser in group A than in group B. Group A demonstrated lesser esophageal stricture on macroscopic evaluation (21.02 ± 16.65% vs. 57.41 ± 8.48%, p = 0.001) in the form of enhanced re-epithelization (99.13 ± 0.98% vs. 96.63 ± 1.64%, p = 0.009), diminished submucosal fibrosis (1117.53 ± 188.83 um vs. 1834.69 ± 421.99 um, p = 0.003), and attenuated inflammatory infiltration (121.00 ± 30.66 vs. 188.17 ± 64.92, p = 0.045). The increase in the serum CRP level was lower in group A than in group B at 4 weeks post-ESD. FCSEMS combined with ADM can enhance re-epithelization in the process of wound healing and significantly reduce the degree of esophageal stenosis after circumferential ESD. This study provided important preclinical findings for subsequent clinical trials.
Collapse
Affiliation(s)
- Baozhen Zhang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yue Zhang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yidan Wang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fan Yang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shiyun Sheng
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhe Wang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaoying Chang
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jianyu Wei
- Medical Transformation Department, Micro-Tech (Nanjing) Co. Ltd., Nanjing, China
| | - Jintao Guo
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Jintao Guo, ; Siyu Sun,
| | - Siyu Sun
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Jintao Guo, ; Siyu Sun,
| |
Collapse
|
13
|
Vernice NA, Berri N, Bender RJ, Dong X, Spector JA. Production of a Low-Cost, Off-the-Shelf, Decellularized Cartilage Xenograft for Tissue Regeneration. Ann Plast Surg 2022; 88:S296-S301. [PMID: 35513335 PMCID: PMC9097345 DOI: 10.1097/sap.0000000000003185] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND Reconstruction of cartilaginous deformities is a well-established surgical challenge with high levels of unpredictability and complication. Because of the morbidity associated with autologous cartilage grafting, combined with its limited supply and the significant expense of commercially decellularized allografts, increasing efforts have sought to produce an acellular, nonimmunogenic cartilage xenograft. We have developed and validated a novel protocol for high throughput decellularization of ovine costal cartilage with immediate translational potential for preclinical investigation of novel strategies for cartilaginous reconstruction. METHODS Floating ribs were isolated from freshly slaughtered rack of lamb and after cleaning, the ribs were either minced into 2-mm cubes or zested into 1-mm flakes. Tissue was then decellularized via a protocol consisting of 4 freeze/thaw cycles, digestion with trypsin, incubation in hyperosmolar and hypoosmolar salt solutions, with incubation in 1% Tween following both the hyperosmolar and hypoosmolar steps, a 48-hour incubation in nucleases, DNA elution via EDTA, and 2 terminal sterilization steps. Protocol success was evaluated via histologic analysis with hematoxylin and eosin, DAPI, and safranin-O staining, as well as DNA quantification. RESULTS Histologic analysis of the decellularized tissue revealed a significant reduction in nuclei as evidenced by hematoxylin and eosin and DAPI staining (P < 0.01). Safranin-O staining demonstrated a depletion of glycosaminoglycan content in the decellularized cartilage but with preservation of tissue architecture. Unprocessed lamb cartilage contained 421 ± 60 ng DNA/mg of lyophilized tissue, whereas decellularized zested and minced costal cartilage contained 27 ± 2 ng DNA/mg lyophilized tissue (P < 0.0001) and 24 ± 2.3 ng DNA/mg lyophilized tissue (p < 0.0001), respectively, well below the threshold of 50 ng accepted as evidence of suitable decellularization. In comparison, commercial allograft cartilage contained 17 ± 5 ng DNA/mg of lyophilized tissue. CONCLUSIONS We have developed a novel protocol for the decellularization of xenogeneic cartilage graft. This structurally stable, low immunogenicity decellularized cartilage can be produced at low cost in large quantities for use in preclinical investigation.
Collapse
Affiliation(s)
- Nicholas A. Vernice
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medicine, New York, NY
| | - Nabih Berri
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medicine, New York, NY
| | - Ryan J. Bender
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medicine, New York, NY
| | - Xue Dong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medicine, New York, NY
| | - Jason A. Spector
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Weill Cornell Medicine, New York, NY
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY
| |
Collapse
|
14
|
Dibbs RP, Depani M, Thornton JF. Technical Refinements with the Use of Biologic Healing Agents. Semin Plast Surg 2022; 36:8-16. [PMID: 35706558 PMCID: PMC9192159 DOI: 10.1055/s-0042-1742749] [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: 10/19/2022]
Abstract
Soft tissue defects resulting from trauma, vascular disease, burns, and postoncologic resections require reconstructive surgery for appropriate wound coverage and support. Dermal substitutes have been applied to a vast array of reconstructive settings across nearly all anatomical areas with demonstrable success. However, they require meticulous handling and operative technical expertise to optimize management of these soft tissue defects. In this review, we will address three dermal substitutes, their operative techniques, and their surgical applications.
Collapse
Affiliation(s)
- Rami P. Dibbs
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas,Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Monal Depani
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - James F. Thornton
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas,Address for correspondence James F. Thornton, MD Department of Plastic Surgery, University of Texas Southwestern Medical Center1801 Inwood Road, Dallas, TX 75390
| |
Collapse
|
15
|
Marongiu F, Bertozzi N, Sibilio A, Tognali D, Mingozzi M, Curcio A. The First Use of Human-Derived ADM in Prepectoral Direct-to-Implant Breast Reconstruction after Skin-Reducing Mastectomy. Aesthetic Plast Surg 2021; 45:2048-2057. [PMID: 33782725 DOI: 10.1007/s00266-021-02231-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Large and ptotic breasts always represented a great reconstructive challenge for plastic surgeons. In order to deal with these patients, we started performing Wise-pattern skin-reducing mastectomies (SRM) followed by direct-to-implant breast reconstructions (DTI-BR) in the prepectoral space where the implants were covered with the autologous adipo-dermal flap and a human acellular dermal matrix called MODA. MATERIALS AND METHOD We retrospectively reviewed all patients that underwent Wise-pattern SRM followed by MODA-assisted, prepectoral, DTI-BR between January 2017 and November 2019 at our Institution. Inclusion criteria were large ptotic breast and pinch test >2cm, while exclusion criteria were smoking >10 cigarettes/day, history of prior radiotherapy, patients supposedly requiring breast implants bigger than 550cc or post-mastectomy radiotherapy. Patients' data were collected through their electronic medical records. Both short- and long-term outcomes were reported. RESULTS Seventeen patients underwent Wise-pattern SRM followed by MODA-assisted, prepectoral, DTI-BR for a total of twenty-one breast reconstruction and fourteen matching procedures. Mean follow-up was 13.4 months (SD= ±3.67). No major complication was reported. Three (14.3%) reconstructed breasts had minor complications: 2 (9.5%) minimal (<1cm2) wound dehiscence and 1 (4.8%) de-epithelization of the skin at the T junction that were treated conservatively. Drainages gave mean output of 410.59 ml (SD= ±214.83) and were kept in place on average for 8.59 days (SD= ±3.45). CONCLUSION Few are the reports in the literature regarding DTI-BR following SRM and even fewer are those where BR was performed in the prepectoral space. Our work demonstrated the safety of prepectoral DTI-BR following SRM in selected patients in accordance with the "conservative reconstruction" principles. Furthermore, we confirmed the reliability of MODA in accordance with previously published works. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
|
16
|
Comparison of porcine and human acellular dermal matrix outcomes in wound healing: a deep dive into the evidence. Arch Plast Surg 2021; 48:433-439. [PMID: 34352957 PMCID: PMC8342249 DOI: 10.5999/aps.2020.02306] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/28/2021] [Indexed: 01/09/2023] Open
Abstract
Acellular dermal matrices (ADM) are a novel graft. The goal of this systematic review is to evaluate the evidence behind differences in human and porcine ADM, irrelevant of manufacturing method, and to determine if there is enough of an evidence base to change clinical practice. An extensive literature search was performed through MEDLINE and Embase with search terms defining a population, intervention and outcome. Title and abstract exclusion were performed with other exclusion criteria. In 191 articles were found after exclusion of duplicates, with only 29 remaining following exclusions. Ten studies were found to have level I and II evidence (I=3, II=8), of which two were histopathological, one was an animal model, one was a systematic review, and six were clinical. The remaining studies were reviewed and considered for discussion, but did not hold high enough standards for medical evidence. Strong clinical evidence already exists for the use of human ADM, but questions of access, cost, and ethics require consideration of a xenograft. Histopathologically, evidence suggests minimal long-term differences between human and porcine ADM, although there is a short acute immune response with porcine ADM. Clinically, there is limited difference in outcomes, with a small range in effect of different ADM preparations. Considering the effectiveness of ADM in wound healing, more high-level research with appropriate statistical analysis to facilitate a future meta-analysis is recommended to justify a transition from human to porcine ADM.
Collapse
|
17
|
Xu S, Sun X, Yang N, Yan A. Human-derived acellular dermal matrix may be an alternative to autologous grafts in tympanic membrane reconstruction: systematic review and meta-analysis. J Otolaryngol Head Neck Surg 2021; 50:43. [PMID: 34229763 PMCID: PMC8261972 DOI: 10.1186/s40463-021-00518-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 05/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Human-derived acellular dermal matrix (ADM) has been widely used as an effective alternative to autologous grafts in tympanoplasty. However, evidence of ADM as an alternative to autologous grafts in the repair of tympanic membrane (TM) perforation still lacks adequate empirical evidence. Objectives To determine the clinical safety and efficacy of human-derived ADM as TM graft material for tympanoplasty. Data sources The PubMed, EMBASE, Cochrane Library, EBSCO, Ovid, Scopus, and Web of Science databases and reference lists of the retrieved articles were searched, with no language restriction. Selection criteria All randomized controlled trials and retrospective cohort studies that compared the use of human-derived ADM and autologous grafts in tympanoplasty for TM perforation were included. Data collection and analysis Two review authors independently assessed risk of bias in the included studies and extracted data. The pooled results for continuous data were reported as a mean difference (MD) and 95% confidence intervals (CI). For dichotomous data, odds risk (OR) with 95% CI was used. ChI2 statistic and Galbraith plots were used to assess the heterogeneity. Publication bias was assessed with a funnel plot and Egger’s test. Main results Five retrospective cohort studies and four randomized controlled studies with a total of 610 participants were included in the meta-analysis. No significant differences in graft success (OR: 0.71 [0.39, 1.29], p = 0.26), air-bone gap (ABG) reduction (MD: − 0.59 [− 3.81, 1.19], p = 0.51), or complications (OR: 1.23 [0.07, 20.64], p = 0.89) were found between the ADM group and autologous graft group. The use of ADM significantly shortened tympanoplasty surgery time (MD: − 16.14 [− 21.22, − 11.07], p < 0.00001) and reduced postoperative pain (MD: − 2.57 [− 3.57, − 1.58], p < 0.00001) compared with the autologous graft group. Conclusion Human-derived ADM might be an effective alternative to autologous grafts for tympanoplasty. However, some of the studies that were included in the present meta-analysis had rather low methodological quality, and more adequately designed clinical trials should be performed in the future. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40463-021-00518-w.
Collapse
Affiliation(s)
- Shan Xu
- Department of Otolaryngology, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, People's Republic of China
| | - Xia Sun
- Department of Otolaryngology, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, People's Republic of China
| | - Ning Yang
- Department of Otolaryngology, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, People's Republic of China
| | - Aihui Yan
- Department of Otolaryngology, The First Hospital of China Medical University, Shenyang, Liaoning, 110001, People's Republic of China.
| |
Collapse
|
18
|
Tognetti L, Pianigiani E, Ierardi F, Lorenzini G, Casella D, Liso FG, De Pascalis A, Cinotti E, Rubegni P. The use of human acellular dermal matrices in advanced wound healing and surgical procedures: State of the art. Dermatol Ther 2021; 34:e14987. [PMID: 33993627 DOI: 10.1111/dth.14987] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/12/2021] [Indexed: 12/26/2022]
Abstract
Wound closure after post-traumatic injuries and/or localized at peculiar body sites (head-and-neck, oral cavity, legs) are particularly challenging and can often be delayed due to local and systemic factors. In case of deep wounds and/or hard-to-heal wounds, grafting of dermal acellular matrices (ADM) is often needed. Though a great variety of synthetic and semisynthetic dermal and skin equivalents are available, viable human dermis, is still considered the most physiological alternative to replace the loss of autologous dermis, by acting as a physiological scaffold that add structural support to soft tissues. To date, human ADMs (hADMs) have been employed in the reconstruction of skin defects affecting almost all body sites, ranging from visceral sites to the skin and subcutaneous tissues. This review aims to investigate the use of hADM at different body sites and their peculiar advantages. A literature search was using the search terms "acellular dermal matrices", "dermal regeneration", "advances wound healing", "human acellular dermal matrices surgery". A total of 50 out of 150 papers was included. Based on the current body if evidence, hADMs appear to bring several advantages, such as: protection of deep structures (eg, tendons, bones, cartilage and nerves); stimulation of a functional new dermis (rather than a scar); reduction of wound closure time; control of pain and exudate. Finally, hADMs may represent the best treatment option for hard-to-heal wound not only in terms of efficacy and patient satisfaction bout also in terms of sanitary costs, especially across Europe, where hADMs cannot be commercialized as medical devices.
Collapse
Affiliation(s)
- Linda Tognetti
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - Elisa Pianigiani
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - Francesca Ierardi
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - Guido Lorenzini
- Department of Odontostomatologic and Ophthalmologic Sciences, University of Siena, Siena, Italy
| | - Donato Casella
- Department of Breast Cancer Surgery, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Flavio Giulio Liso
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - Andrea De Pascalis
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - Elisa Cinotti
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - Pietro Rubegni
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| |
Collapse
|
19
|
Decellularized dermis extracellular matrix alloderm mechanically strengthens biological engineered tunica adventitia-based blood vessels. Sci Rep 2021; 11:11384. [PMID: 34059745 PMCID: PMC8166942 DOI: 10.1038/s41598-021-91005-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/20/2021] [Indexed: 11/29/2022] Open
Abstract
The ideal engineered vascular graft would utilize human-derived materials to minimize foreign body response and tissue rejection. Current biological engineered blood vessels (BEBVs) inherently lack the structure required for implantation. We hypothesized that an ECM material would provide the structure needed. Skin dermis ECM is commonly used in reconstructive surgeries, is commercially available and FDA-approved. We evaluated the commercially-available decellularized skin dermis ECM Alloderm for efficacy in providing structure to BEBVs. Alloderm was incorporated into our lab’s unique protocol for generating BEBVs, using fibroblasts to establish the adventitia. To assess structure, tissue mechanics were analyzed. Standard BEBVs without Alloderm exhibited a tensile strength of 67.9 ± 9.78 kPa, whereas Alloderm integrated BEBVs showed a significant increase in strength to 1500 ± 334 kPa. In comparison, native vessel strength is 1430 ± 604 kPa. Burst pressure reached 51.3 ± 2.19 mmHg. Total collagen and fiber maturity were significantly increased due to the presence of the Alloderm material. Vessels cultured for 4 weeks maintained mechanical and structural integrity. Low probability of thrombogenicity was confirmed with a negative platelet adhesion test. Vessels were able to be endothelialized. These results demonstrate the success of Alloderm to provide structure to BEBVs in an effective way.
Collapse
|
20
|
Melotti L, Martinello T, Perazzi A, Iacopetti I, Ferrario C, Sugni M, Sacchetto R, Patruno M. A Prototype Skin Substitute, Made of Recycled Marine Collagen, Improves the Skin Regeneration of Sheep. Animals (Basel) 2021; 11:ani11051219. [PMID: 33922557 PMCID: PMC8145883 DOI: 10.3390/ani11051219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Marine ecosystems are a huge source of unexplored “blue” materials for different applications. The edible part of sea urchin is limited, and the vast majority of the product ends up as waste. Our studies intend to fully recycle wastes from the food industry and reconvert them in high added-value products, as innovative biocompatible skin substitutes for tissue regeneration. The aim of the present work is to apply the pioneering skin substitute in in vivo experimental wounds to test its regenerative potential and compare it, in a future study, to the available commercial membranes produced with collagen of bovine, porcine, and equine origin. Results are encouraging since the skin substitute made with marine collagen reduced inflammation, promoted the deposition of granulation tissue, and enhanced a proper re-epithelialization with the adequate development of skin appendages. In summary, our findings might be of great interest for processing industries and biotech companies which transform waste materials in high-valuable and innovative products for Veterinary advanced applications. Abstract Skin wound healing is a complex and dynamic process that aims to restore lesioned tissues. Collagen-based skin substitutes are a promising treatment to promote wound healing by mimicking the native skin structure. Recently, collagen from marine organisms has gained interest as a source for producing biomaterials for skin regenerative strategies. This preliminary study aimed to describe the application of a collagen-based skin-like scaffold (CBSS), manufactured with collagen extracted from sea urchin food waste, to treat experimental skin wounds in a large animal. The wound-healing process was assessed over different time points by the means of clinical, histopathological, and molecular analysis. The CBSS treatment improved wound re-epithelialization along with cell proliferation, gene expression of growth factors (VEGF-A), and development of skin adnexa throughout the healing process. Furthermore, it regulated the gene expression of collagen type I and III, thus enhancing the maturation of the granulation tissue into a mature dermis without any signs of scarring as observed in untreated wounds. The observed results (reduced inflammation, better re-epithelialization, proper development of mature dermis and skin adnexa) suggest that sea urchin-derived CBSS is a promising biomaterial for skin wound healing in a “blue biotechnologies” perspective for animals of Veterinary interest.
Collapse
Affiliation(s)
- Luca Melotti
- Department of Comparative Biomedicine and Food Science, University of Padova, Viale dell’Università 16, Legnaro, 35020 Padova, Italy; (L.M.); (R.S.)
| | - Tiziana Martinello
- Department of Veterinary Medicine, University of Bari, SP. Casamassima Km.3, Valenzano, 70010 Bari, Italy;
| | - Anna Perazzi
- Department of Animal Medicine, Production and Health, University of Padova, Viale dell’Università 16, Legnaro, 35020 Padova, Italy;
| | - Ilaria Iacopetti
- Department of Animal Medicine, Production and Health, University of Padova, Viale dell’Università 16, Legnaro, 35020 Padova, Italy;
- Correspondence: (I.I.); (M.S.); (M.P.)
| | - Cinzia Ferrario
- Department of Environmental Science and Policy, University of Milan, Via Celoria, 2, 20133 Milan, Italy;
- Center for Complexity and Biosystems, Department of Physics, University of Milan, Via Celoria, 16, 20133 Milan, Italy
| | - Michela Sugni
- Department of Environmental Science and Policy, University of Milan, Via Celoria, 2, 20133 Milan, Italy;
- Center for Complexity and Biosystems, Department of Physics, University of Milan, Via Celoria, 16, 20133 Milan, Italy
- Correspondence: (I.I.); (M.S.); (M.P.)
| | - Roberta Sacchetto
- Department of Comparative Biomedicine and Food Science, University of Padova, Viale dell’Università 16, Legnaro, 35020 Padova, Italy; (L.M.); (R.S.)
| | - Marco Patruno
- Department of Comparative Biomedicine and Food Science, University of Padova, Viale dell’Università 16, Legnaro, 35020 Padova, Italy; (L.M.); (R.S.)
- Correspondence: (I.I.); (M.S.); (M.P.)
| |
Collapse
|
21
|
Mantelakis A, Kostantinos A, D'Souza A, Joshi A. Use of Novel Decellularized Cadaveric Dermis (DCELL) in Single-Stage Resection and Reconstruction of Nonmelanomatous Skin Cancer of the Head and Neck. Facial Plast Surg 2021; 37:599-605. [PMID: 33648014 DOI: 10.1055/s-0041-1725163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Reconstructive options in nonmelanomatous skin tumors of the head and neck region are limited in the frail, elderly patient group, where split skin thickness or full thickness grafts may not be a viable option. This study examines the use decellularized cadaveric dermis (DCELL), an acellular dermis product produced in the United Kingdom for the reconstruction of these skin defects. This was a single-center, prospective study of patients undergoing single stage wide local excision of nonmelanomatous skin cancer and reconstruction with decellularized dermis. Our inclusion criteria included any patient that required a curative excision but had risk factors where conventional local flap or free tissue transfer could have a potential adverse outcome. Thirty-seven wounds were treated with DCELL in 31 patients. Mean age was 81.6 years (range 61-94 years) and at the time of operation, 25 patients (80.7%) were ASA 3 or above. The scalp was the most common anatomical area operated on (n = 28, 75.7%). The overall proportion of wounds with complete closure was 89.2% (33 out of 37 wounds), with a failure rate of 10.8% (four complete graft failures). Device-related complications included one episode of crusting over the graft which resolved with topical antibiotics, and a hypertrophic scar over the wound edges. Cosmesis was satisfactory in all cases. DCELL demonstrated a very good take rate with equally satisfactory cosmetic outcomes in patients where standard reconstructive approaches may have adverse outcomes. Further research is needed to better define its role in the management of these skin cancers.
Collapse
Affiliation(s)
- Angelos Mantelakis
- Department of Otolaryngology, Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Argiris Kostantinos
- Deparmnet of ENT and Facial Plastic and Reconstructive Surgery, Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Alwyn D'Souza
- Department of ENT and Facial Plastic Surgery, Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Anil Joshi
- Deparmnet of ENT and Facial Plastic and Reconstructive Surgery, Lewisham and Greenwich NHS Trust, London, United Kingdom
| |
Collapse
|
22
|
Samson DJ, Gachabayov M, Latifi R. Biologic Mesh in Surgery: A Comprehensive Review and Meta-Analysis of Selected Outcomes in 51 Studies and 6079 Patients. World J Surg 2021; 45:3524-3540. [PMID: 33416939 DOI: 10.1007/s00268-020-05887-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND In recent decades, biologic mesh (BM) has become an important adjunct to surgical practice. Recent evidence-based clinical applications of BM include but are not limited to: reconstruction of abdominal wall defects; breast reconstruction; face, head and neck surgery; periodontal surgery; other hernia repairs (diaphragmatic, hiatal/paraesophageal, inguinal and perineal); hand surgery; and shoulder arthroplasty. Prior systematic reviews of BM in complex abdominal wall hernia repair had several shortcomings that our comprehensive review seeks to address, including exclusion of laparoscopic repair, assessment of risk of bias, use of an acceptable meta-analytic method and review of risk factors identified in multivariable regression analyses. MATERIALS AND METHODS We sought articles of BM for open ventral hernia repair reporting on early complications, late complications or recurrences and included minimum of 50. We used the quality in prognostic studies risk of bias assessment tool. Random effects meta-analysis was applied. RESULTS This comprehensive review selected 62 articles from 51 studies that included 6,079 patients. Meta-analytic pooling found that early complications are present in about 50%, surgical site occurrences (SSOs) in 37%, surgical site infections (SSIs) in 18%, reoperation in 7%, readmission in 20% and mortality in 3%. Meta-analytic estimates of late outcomes included overall complications (42%), SSOs (40%) and SSIs (22%). Specific SSOs included seroma (14%), hematoma (4%), abscess (10%), necrosis (5%), dehiscence (8%) and fistula formation (5%). Reoperation occurred in about 17%, mesh explantation in 9% and recurrence in 36%. CONCLUSION Estimates of nearly all outcomes from individual studies were highly heterogeneous and sensitivity analyses and meta-regressions generally failed to explain this heterogeneity. Recurrence is the only outcome for which there are consistent findings for risk factors. Bridge placement of BM is associated with higher risk of recurrence. Prior hernia repair, history of reintervention and history of mesh removal were also risk factors for increased recurrence.
Collapse
Affiliation(s)
- David J Samson
- Department of Surgery, Westchester Medical Center, 100 Woods Road, Taylor Pavilion, Suite D-353, Valhalla, NY, 10595, USA
| | - Mahir Gachabayov
- Department of Surgery, New York Medical College, School of Medicine, Valhalla, NY, 10595, USA
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center, 100 Woods Road, Taylor Pavilion, Suite D-353, Valhalla, NY, 10595, USA. .,Department of Surgery, New York Medical College, School of Medicine, Valhalla, NY, 10595, USA.
| |
Collapse
|
23
|
Beccia E, Carbone A, Cecchino LR, Pedicillo MC, Annacontini L, Lembo F, Di Gioia S, Parisi D, Angiolillo A, Pannone G, Portincasa A, Conese M. Adipose Stem Cells and Platelet-Rich Plasma Induce Vascular-Like Structures in a Dermal Regeneration Template. Tissue Eng Part A 2020; 27:631-641. [PMID: 32907520 DOI: 10.1089/ten.tea.2020.0175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In the context of biointeractive dressings used for enhancing wound healing, the use of stromal vascular fraction (SVF) or adipose-derived stem cells (ASCs) hereof derived has not been fully exploited yet. Noncultured SVF, a heterogeneous mesenchymal population of cells, is attractive in the field of dermal regeneration because it can be instantaneously obtained, avoids genomic alterations, and is comparatively safer than cultured ASCs. Integra® Dermal Regeneration Template (DRT) was sprinkled with ASCs in complete medium supplemented with 10% fetal bovine serum (FBS), or SVF, obtained from emulsified or nonemulsified fat, in medium supplemented with 2% platelet-rich plasma (PRP). The presence and differentiation of cells were evaluated by standard histochemistry and immunohistochemistry, whereas conditioned media were analyzed for vascular endothelial growth factors (VEGF) by ELISA. In vitro experiments were conducted to analyze ASC proliferation in the presence of either FBS or PRP. Deposition of ASCs in medium supplemented with FBS caused their integration into Integra DRT as early as 1 h. ASCs were found as aggregates until 6-10 days without forming organized structures. When seeded onto Integra DRT, SVF cells in medium supplemented with PRP formed aggregates at early times, which at 7 and 10 days organized into vascular-like structures, lined by CD31+ and smooth muscle actin-positive cells. With nonemulsified fat, the lacunar structures did not show an organized distribution of SVF cells. PRP induced ASC proliferation although at lower level than FBS. VEGF secretion was enhanced when fat emulsification was introduced into the protocol. In conclusion, the combination of SVF cells obtained from emulsified fat, PRP, and Integra DRT exhibit synergistic effect on the formation of vessel-like structures indicating a step forward aimed at regenerative surgery for chronic wound healing.
Collapse
Affiliation(s)
- Elisa Beccia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.,Department of Medicine and Health Sciences "V. Tiberio," University of Molise, Campobasso, Italy
| | - Annalucia Carbone
- Division of Internal Medicine and Chronobiology Unit, IRCCS "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Foggia, Italy
| | | | | | - Luigi Annacontini
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Fedele Lembo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Sante Di Gioia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Domenico Parisi
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Antonella Angiolillo
- Department of Medicine and Health Sciences "V. Tiberio," University of Molise, Campobasso, Italy
| | - Giuseppe Pannone
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Aurelio Portincasa
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Massimo Conese
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| |
Collapse
|
24
|
Palmer LS, Palmer JS. The use of Alloderm® for correction of severe chordee in children: An initial experience. J Pediatr Urol 2020; 16:446.e1-446.e5. [PMID: 32622738 DOI: 10.1016/j.jpurol.2020.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/26/2020] [Accepted: 06/08/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Correction of chordee remains a prerequisite prior to urethroplasty in children with severe hypospadias. The use of an interposition graft is indicated when significant chordee (>300) persists after division of the urethral plate. The use of free dermis or tunica vaginalis are most often used, but the use of a pre-packaged graft material is attractive with regards to efficiency. The success with small intestine submucosa (SIS) has been variable and experience with Alloderm® has not been published. OBJECTIVE To determine if Alloderm®, an acellular dermal matrix with regenerative properties, can effectively, safely, and efficiently be used for corporal grafting in cases of severe chordee in children associated with hypospadias or intersex STUDY DESIGN: All boys underwent planned staged repair of severe hypospadias (penoscrotal or more proximal). If artificial erection (AE) demonstrated chordee >450 after penile degloving and removal of fibrotic tissue, and again after urethral plate division, the ventral tunica albuginea was incised 1800 transversely and the oval defect measured in both axes. Alloderm® was trimmed to size and sewn into the defect. AE confirmed chordee correction. At the second stage repair (>6 months later), AE was performed to confirm continued absence of chordee. CONCLUSION Alloderm®is safe, effective and simple to use graft material for correcting severe chordee. The benefits include performance efficiency without need for separate harvesting and donor site closure, and redundancy of material, if needed. Additional series and longer follow up must confirm these results and better assess durability.
Collapse
Affiliation(s)
- Lane S Palmer
- Division Pediatric Urology, Cohen Children's Medical Center of New York, Zucker School of Medicine at Hofstra/Northwell, Long Island, NY, USA.
| | - Jeffrey S Palmer
- Division Pediatric Urology, Cohen Children's Medical Center of New York, Zucker School of Medicine at Hofstra/Northwell, Long Island, NY, USA
| |
Collapse
|
25
|
Zhang Y, Dai J, Yan L, Sun Y. Intra-articular injection of decellularized extracellular matrices in the treatment of osteoarthritis in rabbits. PeerJ 2020; 8:e8972. [PMID: 32351784 PMCID: PMC7183306 DOI: 10.7717/peerj.8972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 03/24/2020] [Indexed: 11/20/2022] Open
Abstract
Background We investigated the role of decellularized cartilage matrix in osteoarthritis to seek a new treatment for this disease. Methods Knee cartilage from rabbits was decellularized and the degree of decellularization was assessed. A grinder was used to turn acellular cartilage into particles, which were then used in a suspension. Thirty New Zealand white rabbits were subjected to an operation on their anterior cruciate ligament for the osteoarthritis model. The success of the animal model of osteoarthritis was evaluated using results from six rabbits. The remaining 24 rabbits were randomly divided into four groups (groups A, B, C, and D). Rabbits in groups A, B, C, and D were injected with 200 µl of normal saline, 200 µl of 10% (w/v) cartilage decellularized suspension, 200 µl of 20% (w/v) cartilage decellularized suspension, and 200 µl of 40% (w/v) cartilage decellularized suspension into the knee joints, respectively. Macroscopic and microscopic assessments were performed three months after surgery to assess the degree of osteoarthritic changes. Results Histological and biochemical analysis revealed that the cartilage decellularized matrix removed cells after decellularization but retained components of collagen and glycosaminoglycan. Group A exhibited the most significant changes from osteophyte and cartilage erosion, which was macroscopically observable on the surface of the femoral cartilage. HE staining in group A revealed damage to the cartilage surface, disorganized chondrocytes, and spontaneous fibrocartilage formation. Safranin O-fast green staining revealed a cavity formed at the osteochondral junction in group A that did not appear in other groups. Conclusion Our study shows that decellularized cartilage matrix has a certain therapeutic effect on osteoarthritis and provides new insights in the treatment of osteoarthritis.
Collapse
Affiliation(s)
| | - Jihang Dai
- Dalian Medical University, Dalian, China
| | - Lianqi Yan
- Northern Jiangsu People's Hospital, Yangzhou, China
| | - Yu Sun
- Northern Jiangsu People's Hospital, Yangzhou, China
| |
Collapse
|
26
|
Marin L, Bedoschi G, Kawahara T, Oktay KH. History, Evolution and Current State of Ovarian Tissue Auto-Transplantation with Cryopreserved Tissue: a Successful Translational Research Journey from 1999 to 2020. Reprod Sci 2020; 27:955-962. [PMID: 32046442 PMCID: PMC7148200 DOI: 10.1007/s43032-019-00066-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/27/2019] [Indexed: 12/24/2022]
Abstract
The loss of fertility and early menopause are common after gonadotoxic therapies and radical pelvic surgery. The strategy of ovarian tissue cryopreservation and auto-transplantation was introduced to prevent this significant quality of health issue. Ovarian transplantation with cryopreserved tissue has gone through remarkable evolution in the last 20 years. In this review, we detail the history and evolution of ovarian transplantation with cryopreserved tissue from its origins to the present. Ovarian cryopreservation and transplantation approach was first tested with animal models. The approach was then validated in human ovarian xenografting models before being applied to patients in pioneering clinical studies. The first orthotopic and heterotopic approaches to ovarian transplantation was developed by Oktay et al. who reported the first successful restoration of ovarian function with these approaches beginning in 2000 with first embryo development in 2004. Controversy remains on when the first live birth occurred after orthotopic ovarian transplantation with cryopreserved tissue as the patient was ovulating with elevated progesterone levels in the case reported in 2004; first live birth is likely to be the one reported by Meirow et al. in 2005. Nevertheless, the technique has evolved to reach a level where most recent live birth rates are exceeding 35% and the procedure is no longer considered experimental by many.
Collapse
Affiliation(s)
- Loris Marin
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT USA
| | - Giuliano Bedoschi
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT USA
| | - Tai Kawahara
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT USA
| | - Kutluk H Oktay
- Department of Obstetrics and Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT USA
| |
Collapse
|
27
|
Bassetto F, Pandis L. Clinical experience with Surgimend in breast reconstruction: an overview. Br J Hosp Med (Lond) 2020; 81:1-18. [PMID: 32240008 DOI: 10.12968/hmed.2018.0428c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the field of breast reconstruction, products and techniques are continuing to evolve to ensure good clinical and quality outcomes. This article reviews the published literature regarding the use of fetal bovine-derived acellular dermal matrix (SurgiMend, SurgiMend PRS and SurgiMend PRS meshed), focusing on safety, clinical outcomes and surgical techniques.
Collapse
Affiliation(s)
- F Bassetto
- Plastic Surgery Department, Padova University, Italy
| | - L Pandis
- Plastic Surgery Department, Padova University, Italy
| |
Collapse
|
28
|
Zang J, Feng S, Yang H, Guo X. Comparison of xenogeneic acellular dermal matrix and skin grafts in reconstruction of postoperative defects of hypopharyngeal cancer: A retrospective cohort study. Medicine (Baltimore) 2020; 99:e19361. [PMID: 32118779 PMCID: PMC7478681 DOI: 10.1097/md.0000000000019361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Successful reconstruction after tumor resection facilitates rapid recovery and retention of good quality of life, and this is important for a successful operation. This study aimed to analyze and compare the application and efficacy of xenogeneic acellular dermal matrix (xeno-ADM) and abdominal skin graft in hypopharynx reconstruction.This is a retrospective cohort study that included 25 patients with posterior hypopharyngeal wall cancer who underwent partial hypopharyngectomy with laryngeal preservation. The patients were divided into 2 groups according to the repair materials used. Eleven patients were treated with xeno-ADM, and 14 patients with abdominal skin grafts for repairing hypopharyngeal mucosal defects. The intraoperative data, postoperative recovery time of eating function, graft contraction, infection and pharyngeal fistula rate, and 1-year survival rate of the 2 groups were analyzed and compared.Compared with skin grafts group (23.1 ± 5.8 days), the recovery time of eating function in xeno-ADM group was shorter (17.3 ± 6.4 days), (P = .026). Also the number of postoperative hospitalization days were less in the xeno-ADM group (18.5 ± 6.7 days) than in the skin grafts group (24.1 ± 5.6 days) (P = .035). Besides, no significant differences were observed in other comparisons between the 2 groups. Also no obvious rejection and severe graft contraction were observed in both the groups. All patients were successfully decannulated.Both xeno-ADM and abdominal skin grafts demonstrated good effects in the reconstruction of hypopharynx, but the recovery time of eating function in patients with xeno-ADM was faster, which may be due to rapid epithelialization. In addition, it avoids trauma of donor sites.
Collapse
|
29
|
Zang J, Yang B, Feng S, Jiang X. Repair effect of xenogeneic acellular dermal matrix during external auditory canal reconstruction after canal wall down mastoidectomy. Acta Otolaryngol 2020; 140:110-115. [PMID: 31859578 DOI: 10.1080/00016489.2019.1701705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: In some cases, there is insufficient external auditory canal (EAC) skin to cover the reconstructed canal wall after canal wall down (CWD) mastoidectomy. Acellular dermal matrix (ADM) can help to repair the skin, mucosa and other epidermal tissue defects.Aims: To investigate the repair effect of xenogeneic ADM (xeno-ADM) for EAC skin defects.Material and Methods: We retrospectively analyzed 28 patients who underwent open mastoidectomy combined with canal wall reconstruction and mastoid obliteration in our hospital. The xeno-ADM was used to repair the EAC skin defect. The epithelialization time, dressing change times, complications and hearing improvement post-operation were summarized and analyzed.Results: Reasons for using xeno-ADM included: 11 (39.3%) cases suffered from extensive middle ear cholesteatoma, three (10.7%) cases suffered from advanced EAC cholesteatoma, eight (28.6%) cases to solve the cavity-related problems, and six (21.4%) patients had a narrow EAC. The postoperative epithelialization time was 5.8 ± 1.6 weeks, and the number of dressing changes was 4.8 ± 1.6 times. There was no xeno-ADM rejection and related complications, the postoperative hearing improvement was statistically significant (p = .013).Conclusions and Significance: Xeno-ADM could be a safe, effective and simple method for repairing skin defect in the reconstruction of EAC after CWD mastoidectomy.
Collapse
Affiliation(s)
- Jian Zang
- Department of Otolaryngology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Bo Yang
- Department of Otolaryngology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Shuai Feng
- Department of Otolaryngology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xuejun Jiang
- Department of Otolaryngology, The First Affiliated Hospital of China Medical University, Shenyang, China
| |
Collapse
|
30
|
The Role of Adipose-Derived Stem Cells, Dermal Regenerative Templates, and Platelet-Rich Plasma in Tissue Engineering-Based Treatments of Chronic Skin Wounds. Stem Cells Int 2020; 2020:7056261. [PMID: 32399048 PMCID: PMC7199611 DOI: 10.1155/2020/7056261] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/29/2019] [Indexed: 12/12/2022] Open
Abstract
The continuous improvements in the field of both regenerative medicine and tissue engineering have allowed the design of new and more efficacious strategies for the treatment of chronic or hard-to-heal skin wounds, which represent heavy burden, from a medical and economic point of view. These novel approaches are based on the usage of three key methodologies: stem cells, growth factors, and biomimetic scaffolds. These days, the adipose tissue can be considered the main source of multipotent mesenchymal stem cells, especially adipose-derived stem cells (ASCs). ASCs are easily accessible from various fat depots and show an intrinsic plasticity in giving rise to cell types involved in wound healing and angiogenesis. ASCs can be found in fat grafts, historically used in the treatment of chronic wounds, and have been evaluated as such in both animal models and human trials, to exploit their capability of accelerating wound closure and inducing a correct remodeling of the newly formed fibrovascular tissue. Since survival and fitness of ASCs need to be improved, they are now employed in conjunction with advanced wound dressings, together with dermal regenerative templates and platelet-rich plasma (as a source of growth and healing factors). In this work, we provide an overview of the current knowledge on the topic, based on existing studies and on our own experience.
Collapse
|
31
|
Boyce S, Chang P, Warner P. Burn Dressings and Skin Substitutes. Biomater Sci 2020. [DOI: 10.1016/b978-0-12-816137-1.00074-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
32
|
Tork S, Jefferson RC, Janis JE. Acellular Dermal Matrices: Applications in Plastic Surgery. Semin Plast Surg 2019; 33:173-184. [PMID: 31384233 DOI: 10.1055/s-0039-1693019] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Modern advances in tissue engineering have transformed the plastic surgeon's management strategies across a wide variety of applications. Comprehension of the fundamentals of biologic constructs is critical to navigating the available armamentarium. It is essential that plastic surgeons become familiar with some of the existing methods for utilizing biologics as well as the advantages and limitations to their use. In this article, the authors describe the basic science of biologics with a focus on acellular dermal matrices (ADMs), and review the recent evidence behind their use for a variety of reconstructive and aesthetic purposes. The review is organized by system and examines the common indications, techniques, and outcomes pertaining to the application of ADMs in select anatomic areas. The final section briefly considers possible future directions for using biologics in plastic and reconstructive surgery.
Collapse
Affiliation(s)
- Shahryar Tork
- Department of Plastic and Reconstructive Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Ryan C Jefferson
- Department of Plastic and Reconstructive Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Jeffrey E Janis
- Department of Plastic Surgery, University Hospitals, Wexner Medical Center, Ohio State University, Columbus, Ohio
| |
Collapse
|
33
|
Li XY, Wu J, Cao J, Yang W, Wu B, Xie C. [Clinical analysis of acellular dermal matrix and acellular bone matrix in oro-antral fistula repair]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2019; 36:633-637. [PMID: 30593109 DOI: 10.7518/hxkq.2018.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aimed to investigate the application of acellular dermal matrix and acellular bone matrix in the management of oro-antral fistula. METHODS Nine patients with oro-antral fistula (with defect greater than 5 mm×5 mm) after maxillary cyst resection or maxillary molar extraction were selected. The defects were repaired by the simultaneous implantation of acellular dermal matrix and acellular bone matrix. RESULTS The incisions of nine patients were all primary healing. After 6 months of follow-up, the oro-antral communication healed well, and no symptom such as nasal congestion or runny nose was observed. The clinical and CT examinations confirmed wound healing. CONCLUSIONS The usage of acellular dermal matrix and acellular bone matrix is a reliable repairing method for ora-antral fistula.
Collapse
Affiliation(s)
- Xiao-Yu Li
- Dept. of Stomatology, The People's Hospital of Longhua Shenzhen, Shenzhen 518109, China
| | - Jing Wu
- Dept. of Stomatology, The People's Hospital of Longhua Shenzhen, Shenzhen 518109, China
| | - Jun Cao
- Dept. of Stomatology, The People's Hospital of Longhua Shenzhen, Shenzhen 518109, China
| | - Wei Yang
- Dept. of Stomatology, The People's Hospital of Longhua Shenzhen, Shenzhen 518109, China
| | - Bin Wu
- Dept. of Stomatology, The People's Hospital of Longhua Shenzhen, Shenzhen 518109, China
| | - Chun Xie
- Dept. of Stomatology, The People's Hospital of Longhua Shenzhen, Shenzhen 518109, China
| |
Collapse
|
34
|
Robot-assisted orthotopic and heterotopic ovarian tissue transplantation techniques: surgical advances since our first success in 2000. Fertil Steril 2019; 111:604-606. [DOI: 10.1016/j.fertnstert.2018.11.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 01/21/2023]
|
35
|
Hamilton NJ, Hynds RE, Gowers KH, Tait A, Butler CR, Hopper C, Burns AJ, Birchall MA, Lowdell M, Janes SM. Using a Three-Dimensional Collagen Matrix to Deliver Respiratory Progenitor Cells to Decellularized Trachea In Vivo. Tissue Eng Part C Methods 2019; 25:93-102. [PMID: 30648458 PMCID: PMC6389769 DOI: 10.1089/ten.tec.2018.0241] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/14/2019] [Indexed: 10/27/2022] Open
Abstract
IMPACT STATEMENT This article describes a method for engrafting epithelial progenitor cells to a revascularized scaffold in a protective and supportive collagen-rich environment. This method has the potential to overcome two key limitations of existing grafting techniques as epithelial cells are protected from mechanical shear and the relatively hypoxic phase that occurs while grafts revascularize, offering the opportunity to provide epithelial cells to decellularized allografts at the point of implantation. Advances in this area will improve the safety and efficacy of bioengineered organ transplantation.
Collapse
Affiliation(s)
- Nick J.I. Hamilton
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
- UCL Ear Institute, The Royal National Throat Nose and Ear Hospital, London, United Kingdom
| | - Robert E. Hynds
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Kate H.C. Gowers
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Angela Tait
- Department of Biochemical Engineering, University College London, London, United Kingdom
| | - Colin R. Butler
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| | - Colin Hopper
- Maxillofacial Surgery, Eastman Dental Institute, London, United Kingdom
| | - Alan J. Burns
- Stem Cell and Regenerative Medicine, Birth Defects Research Centre, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Martin A. Birchall
- UCL Ear Institute, The Royal National Throat Nose and Ear Hospital, London, United Kingdom
| | - Mark Lowdell
- Institute of Immunity and Transplantation, Centre for Cell, Gene and Tissue Therapeutics, Royal Free Hospital, London, United Kingdom
| | - Sam M. Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, United Kingdom
| |
Collapse
|
36
|
Giatsidis G, Succar J, Haddad A, Lago G, Schaffer C, Wang X, Schilling B, Chnari E, Matsumine H, Orgill DP. Preclinical Optimization of a Shelf-Ready, Injectable, Human-Derived, Decellularized Allograft Adipose Matrix. Tissue Eng Part A 2018; 25:271-287. [PMID: 30084731 DOI: 10.1089/ten.tea.2018.0052] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
IMPACT STATEMENT Trauma, disease, surgery, or congentital defects can cause soft tissue losses in patients, leading to disfigurement, functional impairment, and a low quality of life. In the lack of available effective methods to reconstruct these defects, acellular adipose matrices could provide a novel therapeutic solution to such challenge.
Collapse
Affiliation(s)
- Giorgio Giatsidis
- 1 Tissue Engineering and Wound Healing Laboratory, Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Julien Succar
- 1 Tissue Engineering and Wound Healing Laboratory, Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anthony Haddad
- 1 Tissue Engineering and Wound Healing Laboratory, Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gianluigi Lago
- 1 Tissue Engineering and Wound Healing Laboratory, Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Clara Schaffer
- 1 Tissue Engineering and Wound Healing Laboratory, Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Xingang Wang
- 1 Tissue Engineering and Wound Healing Laboratory, Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,2 Department of Burns and Wound Care Center, Second Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China
| | - Benjamin Schilling
- 3 Department of Bioengineering, School of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Hajime Matsumine
- 1 Tissue Engineering and Wound Healing Laboratory, Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dennis Paul Orgill
- 1 Tissue Engineering and Wound Healing Laboratory, Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
37
|
Giatsidis G, Guyette JP, Ott HC, Orgill DP. Development of a large-volume human-derived adipose acellular allogenic flap by perfusion decellularization. Wound Repair Regen 2018; 26:245-250. [DOI: 10.1111/wrr.12631] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 03/26/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Giorgio Giatsidis
- Tissue Engineering and Wound Healing Laboratory, Department of Surgery, Division of Plastic Surgery; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts
| | - Jacques P. Guyette
- Laboratory for Organ Engineering and Regeneration; Harvard Medical School-Harvard Stem Cell Institute; Boston Massachusetts
| | - Harald C. Ott
- Laboratory for Organ Engineering and Regeneration; Harvard Medical School-Harvard Stem Cell Institute; Boston Massachusetts
| | - Dennis P. Orgill
- Tissue Engineering and Wound Healing Laboratory, Department of Surgery, Division of Plastic Surgery; Brigham and Women's Hospital and Harvard Medical School; Boston Massachusetts
| |
Collapse
|
38
|
Khoo R, Jansen S. Slow to heel: a literature review on the management of diabetic calcaneal ulceration. Int Wound J 2018; 15:205-211. [PMID: 29431291 PMCID: PMC7949754 DOI: 10.1111/iwj.12839] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 09/08/2017] [Indexed: 12/19/2022] Open
Abstract
The diabetic heel ulcer (DHU) represents a reconstructive challenge to clinicians and the multidisciplinary team alike. It is traditionally viewed as a condition that is inherently difficult to treat due to the intrinsic anatomical vulnerabilities of the heel. In addition to this, several factors are associated with poorer end outcomes - namely, that of major amputation. These include peripheral vascular disease, infection/osteomyelitis and the size of the ulcer itself. In light of the significant morbidity, economic burden and mortality seen in this cohort of patients, this review aims to explore current treatment modalities that have been undertaken. Literature in this field has mostly been confined to a handful of small case studies, some of which reflect novel, multimodal approaches, and promising results. Management with osteotomy, flap reconstruction and acellular dermal matrices, amongst other options, is covered within this review.
Collapse
Affiliation(s)
- Rachel Khoo
- Department of Plastic and Reconstructive SurgeryFiona Stanley HospitalPerthWAAustralia
| | - Shirley Jansen
- Department of Vascular and Endovascular SurgerySir Charles Gairdner HospitalPerthWAAustralia
- Centre for Population Health ResearchCurtin UniversityPerthWAAustralia
- Faculty of Health and Medical SciencesUniversity of Western AustraliaPerthWAAustralia
- Heart Research InstituteHarry Perkins Institute of Medical ResearchPerthWAAustralia
| |
Collapse
|
39
|
Udelsman B, Mathisen DJ, Ott HC. Bioprosthetics and repair of complex aerodigestive defects. Ann Cardiothorac Surg 2018; 7:284-292. [PMID: 29707507 DOI: 10.21037/acs.2018.01.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Aerodigestive defects involving the trachea, bronchi and esophagus are a result of prolonged intubation, operative complications, congenital defects, trauma, radiation and neoplastic disease. The vast majority of these defects may be repaired primarily. Rarely, due the size of the defect, underlying complexity, or unfavorable patient characteristics, primary repair is not possible. One alternative to primary repair is bioprosthetic repair. Materials such as acellular dermal matrix and aortic homograft have been used in a variety of applications, including closure of tracheal, bronchial and esophageal defects. Herein, we review the use of bioprosthetics in the repair of aerodigestive defects, along with the unique advantages and disadvantages of these repairs.
Collapse
Affiliation(s)
- Brooks Udelsman
- Division of General Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Douglas J Mathisen
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Harald C Ott
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
40
|
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.
Collapse
|
41
|
Boyce ST, Lalley AL. Tissue engineering of skin and regenerative medicine for wound care. BURNS & TRAUMA 2018; 6:4. [PMID: 30009192 PMCID: PMC6040609 DOI: 10.1186/s41038-017-0103-y] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/12/2017] [Indexed: 12/11/2022]
Abstract
Engineering of biologic skin substitutes has progressed over time from individual applications of skin cells, or biopolymer scaffolds, to combinations of cells and scaffolds for treatment, healing, and closure of acute and chronic skin wounds. Skin substitutes may be categorized into three groups: acellular scaffolds, temporary substitutes containing allogeneic skin cells, and permanent substitutes containing autologous skin cells. Combined use of acellular dermal substitutes with permanent skin substitutes containing autologous cells has been shown to provide definitive wound closure in burns involving greater than 90% of the total body surface area. These advances have contributed to reduced morbidity and mortality from both acute and chronic wounds but, to date, have failed to replace all of the structures and functions of the skin. Among the remaining deficiencies in cellular or biologic skin substitutes are hypopigmentation, absence of stable vascular and lymphatic networks, absence of hair follicles, sebaceous and sweat glands, and incomplete innervation. Correction of these deficiencies depends on regulation of biologic pathways of embryonic and fetal development to restore the full anatomy and physiology of uninjured skin. Elucidation and integration of developmental biology into future models of biologic skin substitutes promises to restore complete anatomy and physiology, and further reduce morbidity from skin wounds and scar. This article offers a review of recent advances in skin cell thrapies and discusses the future prospects in cutaneous regeneration.
Collapse
Affiliation(s)
- Steven T Boyce
- 1Department of Surgery, University of Cincinnati, P.O. Box 670558, Cincinnati, Ohio 45267-0558 USA.,2Research Department, Shriners Hospitals for Children, Cincinnati, Ohio USA
| | - Andrea L Lalley
- 2Research Department, Shriners Hospitals for Children, Cincinnati, Ohio USA
| |
Collapse
|
42
|
What’s New in Acellular Dermal Matrix and Soft-Tissue Support for Prosthetic Breast Reconstruction. Plast Reconstr Surg 2017; 140:30S-43S. [DOI: 10.1097/prs.0000000000003950] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
43
|
James J, Corrigan B, Saunders C. Pre-hydrated sterile acellular dermal matrix allograft in breast reconstruction: review of a single unit's experience. ANZ J Surg 2017; 88:369-373. [PMID: 28727237 DOI: 10.1111/ans.13857] [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: 06/24/2016] [Revised: 10/24/2016] [Accepted: 10/25/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The acellular dermal matrix (Flex HD) (FHD) became available for use in Western Australia in 2014 to aid prosthetic breast reconstruction and this descriptive study aims to review and discuss a single institution's experience since its introduction. METHODS By retrospective case note, review data were collected for all patients who underwent prosthetic breast reconstruction with the aid of FHD between January 2014 and August 2015 in our institution. Data on basic demographic parameters, risk factors, surgery-related factors, post-operative factors and follow-up information were collected. All complications were recorded and described in detail. RESULTS FHD was used in 42 breast reconstructions in 26 patients. Procedure-related complications were seen in 26% (n = 11) of cases. A major complication requiring return to theatre was seen in 11% (n = 5) of cases. Cellulitis of the reconstructed breast (red breast syndrome) was seen in 16.67% (n = 7) cases. Overall implant loss was 2.4% (n = 1). Of the six possible risk factors for any complication, only current smoking was found to increase the risk of complications (odds ratio = 9.667, 95% confidence interval = 1.429-65.377). CONCLUSION FHD is associated with a relatively high overall complication rate. Use of this optional expensive material has to be carefully selected balancing its perceived advantages against this possible risk. The red breast syndrome merits further studies considering its frequent occurrence with FHD use.
Collapse
Affiliation(s)
- Justin James
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Brigid Corrigan
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.,Department of Plastic and Reconstructive Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Christobel Saunders
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.,School of Surgery, The University of Western Australia, Harry Perkins Institute of Medical Research, Fiona Stanley Hospital, Perth, Western Australia, Australia
| |
Collapse
|
44
|
Łabuś W, Glik J, Klama-Baryła A, Kitala D, Kraut M, Maj M, Nowak M, Misiuga M, Marcinkowski A, Trzebicka B, Poloczek R, Kawecki M. Atomic force microscopy in the production of a biovital skin graft based on human acellular dermal matrix produced in-house and in vitro cultured human fibroblasts. J Biomed Mater Res B Appl Biomater 2017; 106:726-733. [PMID: 28323389 DOI: 10.1002/jbm.b.33883] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 02/08/2017] [Accepted: 02/28/2017] [Indexed: 12/18/2022]
Abstract
The most efficient method in III° burn treatment is the use of the autologous split thickness skin grafts that were donated from undamaged body area. The main limitation of this method is lack of suitable donor sites. Tissue engineering is a useful tool to solve this problem. The goal of this study was to find the most efficient way of producing biovital skin substitute based on in house produced acellular dermal matrix ADM and in vitro cultured fibroblasts. Sixty samples of sterilized human allogeneic skin (that came from 10 different donors) were used to examine the influence of decellularizing substances on extracellular matrix and clinical usefulness of the test samples of allogeneic human dermis. Six groups of acellular dermal matrix were studied: ADM-1 control group, ADM-2 research group (24 h incubation in 0.05% trypsin/EDTA solution), ADM-3 research group (24 h incubation in 0.025% trypsin/EDTA solution), ADM-4 research group (24 h incubation in 0.05% trypsin/EDTA solution and 4 h incubation in 0,1% SDS), ADM-5 research group (24 h incubation in 0.025% trypsin/EDTA solution and 4 h incubation in 0,1% SDS), and ADM-6 research group (24 h incubation in 0,1% SDS). Obtained ADMs were examined histochemically and by atomic force microscopy (AFM). ADMs were settled by human fibroblasts. The number of cultured cells and their vitality were measured. The obtained results indicated that the optimal method for production of living skin substitutes is colonization of autologous fibroblasts on the scaffold prepared by the incubation of human allogeneic dermis in 0.05% trypsin/EDTA. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 726-733, 2018.
Collapse
Affiliation(s)
- Wojciech Łabuś
- Dr Stanislaw Sakiel Centre for Burn Treatment, Siemianowice, Śląskie, Poland
| | - Justyna Glik
- Dr Stanislaw Sakiel Centre for Burn Treatment, Siemianowice, Śląskie, Poland.,Department of Chronic Wounds Management Organization, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Diana Kitala
- Dr Stanislaw Sakiel Centre for Burn Treatment, Siemianowice, Śląskie, Poland
| | - Małgorzata Kraut
- Dr Stanislaw Sakiel Centre for Burn Treatment, Siemianowice, Śląskie, Poland
| | - Mariusz Maj
- Dr Stanislaw Sakiel Centre for Burn Treatment, Siemianowice, Śląskie, Poland
| | - Mariusz Nowak
- Dr Stanislaw Sakiel Centre for Burn Treatment, Siemianowice, Śląskie, Poland
| | - Marcelina Misiuga
- Dr Stanislaw Sakiel Centre for Burn Treatment, Siemianowice, Śląskie, Poland
| | - Andrzej Marcinkowski
- Centre of Polymer and Carbon Materials, Polish Academy of Sciences, M. Curie-Skłodowskiej 34 Str., 41-819, Zabrze, Poland
| | - Barbara Trzebicka
- Centre of Polymer and Carbon Materials, Polish Academy of Sciences, M. Curie-Skłodowskiej 34 Str., 41-819, Zabrze, Poland
| | - Ryszard Poloczek
- Laboratory for Microscopic Examination "Diagno-Med", Siemianowice Slaskie, Poland
| | - Marek Kawecki
- Dr Stanislaw Sakiel Centre for Burn Treatment, Siemianowice, Śląskie, Poland.,The Department of Health Sciences, Technical-Humanistic Academy, 43-309, Bielsko-Biała, Poland
| |
Collapse
|
45
|
Taylan E, Oktay KH. Robotics in reproduction, fertility preservation, and ovarian transplantation. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2017; 4:19-24. [PMID: 30697560 PMCID: PMC6193444 DOI: 10.2147/rsrr.s123703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Robotic technology is one of the most promising and rapidly developing advancements of the twenty-first century with a potential to make significant contributions to reproductive surgery and preservation of fertility. Along with the major advances in cancer therapy, the number of female cancer survivors of reproductive age has dramatically increased. As a consequence, fertility preservation has gained more emphasis in reproductive science in the last few decades. A broad range of surgical procedures such as tubal reanastomosis, ovarian transposition, radical trachelectomy, and ovarian transplantation has been introduced to restore or preserve fertility in selected patients. These procedures can be accomplished through various surgical routes, including open surgery and minimally invasive approaches. In this review, we aim to present the current applications, advantages, and disadvantages of robotic technology in the field of reproductive surgery with a special interest in ovarian transplantation for fertility preservation.
Collapse
Affiliation(s)
- Enes Taylan
- Department of Obstetrics and Gynecology, Laboratory of Molecular Reproduction and Fertility Preservation New York Medical College, Valhalla, NY, USA, .,Innovation Institute for Fertility Preservation and In Vitro Fertilization, NY, USA,
| | - Kutluk H Oktay
- Department of Obstetrics and Gynecology, Laboratory of Molecular Reproduction and Fertility Preservation New York Medical College, Valhalla, NY, USA, .,Innovation Institute for Fertility Preservation and In Vitro Fertilization, NY, USA,
| |
Collapse
|
46
|
Kawecki M, Łabuś W, Klama-Baryla A, Kitala D, Kraut M, Glik J, Misiuga M, Nowak M, Bielecki T, Kasperczyk A. A review of decellurization methods caused by an urgent need for quality control of cell-free extracellular matrix' scaffolds and their role in regenerative medicine. J Biomed Mater Res B Appl Biomater 2017; 106:909-923. [DOI: 10.1002/jbm.b.33865] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/12/2016] [Accepted: 01/26/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Marek Kawecki
- Dr Stanislaw Sakiel Centre for Burns Treatment in Siemianowice Slaskie; Poland
- University of Technology and Humanities in Bielsko-Biała; Department of Health Science in Bielsko-Biała; Poland
| | - Wojciech Łabuś
- Dr Stanislaw Sakiel Centre for Burns Treatment in Siemianowice Slaskie; Poland
| | | | - Diana Kitala
- Dr Stanislaw Sakiel Centre for Burns Treatment in Siemianowice Slaskie; Poland
| | - Malgorzata Kraut
- Dr Stanislaw Sakiel Centre for Burns Treatment in Siemianowice Slaskie; Poland
| | - Justyna Glik
- Dr Stanislaw Sakiel Centre for Burns Treatment in Siemianowice Slaskie; Poland
- The Medical University of Silesia in Katowice; Unit for Chronic Wound Treatment Organization, Nursery Division; School of Healthcare in Zabrze Poland
| | - Marcelina Misiuga
- Dr Stanislaw Sakiel Centre for Burns Treatment in Siemianowice Slaskie; Poland
| | - Mariusz Nowak
- Dr Stanislaw Sakiel Centre for Burns Treatment in Siemianowice Slaskie; Poland
| | - Tomasz Bielecki
- Saint Barbara's Clinical Hospital number 5 in Sosnowiec; Clinical Department of Orthopaedics, Trauma; Oncologic and Reconstructive Surgery Poland
| | - Aleksandra Kasperczyk
- Medical University of Silesia in Katowice; Department of Biochemistry, School of Medicine with the Division of Dentistry in Zabrze
| |
Collapse
|
47
|
Guo X, Mu D, Gao F. Efficacy and safety of acellular dermal matrix in diabetic foot ulcer treatment: A systematic review and meta-analysis. Int J Surg 2017; 40:1-7. [PMID: 28232031 DOI: 10.1016/j.ijsu.2017.02.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/05/2017] [Accepted: 02/08/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Diabetic foot ulcer(DFU) is a chronic, refractory disease in need of multidisciplinary endeavour, miscellaneous strategies have been adopted to address this annoying issue, including acellular dermal matrix(ADM)/negative pressure wound therapy/standard of care (SOC) etc. However, consensus has not been reached. As a promising procedure, the efficacy and safety of ADM remains controversial. We therefore performed a meta-analysis of randomized controlled trials (RCTs) to compare the efficacy and safety of acellular dermal matrix to standard of care in DFU. METHODS Databases, including Pubmed, Medline, Embase and Cochrane library were searched to identify RCTs comparing ADM to SOC in DFU patients. The outcomes mainly included complete wound healing, mean time to heal and adverse events. RESULTS A total of 632 DFU patients from 6 RCTs were subjected to meta-analysis. The results showed that compared with the merely SOC, the complete healing rate in ADM group was higher both at 12 weeks [risk ratio (RR) 2.31, 95% confidence interval (CI) 1.42 to 3.76] and 16 weeks [RR 1.57, 95% CI 1.28 to 1.93]. The mean time to complete wound healing was shorter in ADM group [MD = -2.98, 95% CI: -5.15 to -0.82]. The occurrence of adverse event in both groups showed no significant difference [RR 0.98, 95%CI 0.58 to 1.67]. CONCLUSION Compared with standard of care, acellular dermal matrix may accelerate the healing velocity of uninfected, non-ischemic, full-thickness diabetic foot ulcer. Acellular dermal matrix showed superiority compared with standard of care alone, while generating no more complications.
Collapse
Affiliation(s)
- Xiaoshuang Guo
- Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, and the Plastic Surgery Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, 33# Badachu Road, Shijingshan District, 100144, Beijing, People's Republic of China.
| | - Dali Mu
- Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, and the Plastic Surgery Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, 33# Badachu Road, Shijingshan District, 100144, Beijing, People's Republic of China.
| | - Fuqiang Gao
- Department of Orthopedic Surgery, China-Japan Friendship Hospital, 2# Yinghua Dongjie Road, Chaoyang District, 100029, Beijing, People's Republic of China.
| |
Collapse
|
48
|
Blythe JNS, Moffat C, Bakshi A, Brennan PA. Novel approach in the treatment of a persistent oroantral fistula using an acellular dermal graft tissue: technical note. Br J Oral Maxillofac Surg 2016; 54:700-1. [DOI: 10.1016/j.bjoms.2015.09.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 09/30/2015] [Indexed: 11/28/2022]
|
49
|
James J, Jackson L, Saunders C. Florid pustular dermatitis of breast: A case report on a unusual complication from acellular dermal matrix use. Int J Surg Case Rep 2016; 22:59-61. [PMID: 27058152 PMCID: PMC4832039 DOI: 10.1016/j.ijscr.2016.02.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/28/2016] [Accepted: 02/28/2016] [Indexed: 11/18/2022] Open
Abstract
Red Breast syndrome is a known complication with acellular dermal matrix use. Pustular dermatitis like presentation is previously unreported with the use of acellular dermal matrix. Like red breast syndrome, systemic signs are characteristically absent even in the presence of significant local symptoms. Surgical interventions and removal of implants may be avoided if this condition is considered as a possibility in fitting clinical cases.
Introduction Idiopathic erythematous reaction of the breast (Red breast syndrome) is a known complication following breast reconstruction with acellular dermal matrix. However pustular dermatitis like presentation is not previously known. Presentation of case We present a 42-year-old lady who developed bilateral pustular dermatitis like appearance following breast reconstruction with acellular dermal matrix slings. Though surgical washout was done, both expanders and flex HD could be preserved. Discussion Acellular dermal matrix use is the only possible explanation for such a presentation and this can be considered a variant of red breast syndrome. Conclusion Pustular dermatitis like presentation can be associated with acelluar dermal matrix use and should be considered in similar clinical presentations, since this can avoid unnecessary surgical procedures.
Collapse
Affiliation(s)
- Justin James
- Breast Surgery Unit, Fiona Stanley Hospital, 102-118 Murdoch Drive, Murdoch,WA 6150, Australia; Monash University, Faculty of Medicine, Nursing and Health Sciences, VIC 3800, Australia.
| | - Lee Jackson
- Breast Surgery Unit, Fiona Stanley Hospital, 102-118 Murdoch Drive, Murdoch,WA 6150, Australia.
| | - Christobel Saunders
- Breast Surgery Unit, Fiona Stanley Hospital, 102-118 Murdoch Drive, Murdoch,WA 6150, Australia; University of Western Australia, School of Surgery, Harry Perkins Institute of Medical Research, Fiona Stanley Hospital, Murdoch, WA 6150, Australia
| |
Collapse
|
50
|
Skovsted Yde S, Brunbjerg ME, Damsgaard TE. Acellular dermal matrices in breast reconstructions - a literature review. J Plast Surg Hand Surg 2016; 50:187-96. [PMID: 26881927 DOI: 10.3109/2000656x.2016.1140053] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
During the last two decades, acellular dermal matrices (ADM) have been more widely used in reconstructive procedures i.e. breast reconstructions. Several, both synthetic and biologic products derived from human, porcine and bovine tissue, have been introduced. Until this point postoperative complications for the acellular dermal matrices, as a group, have been the main focus. The purpose of this literature review is to summarize the current knowledge on the each biologic product used in breast reconstructions, including product specific complication frequencies. A systematic search of the literature was performed in the PubMed and EMBASE databases, identifying 55 relevant articles, mainly evidence level III. AlloDerm seems to be associated with severe complicating matters in the reconstructive process compared to other products. This could be due to the higher number of investigating studies relative to the others. The surgical area faces certain challenges comparing results, due to surgical variance, the data collection and follow-up. More well-defined guidelines and more high-evidence randomized studies could increase the overall level of evidence in this area.
Collapse
Affiliation(s)
- Simon Skovsted Yde
- a Plastic Surgical Research Unit, Department of Plastic Surgery , Aarhus University Hospital , Aarhus , Denmark
| | - Mette Eline Brunbjerg
- a Plastic Surgical Research Unit, Department of Plastic Surgery , Aarhus University Hospital , Aarhus , Denmark
| | - Tine Engberg Damsgaard
- a Plastic Surgical Research Unit, Department of Plastic Surgery , Aarhus University Hospital , Aarhus , Denmark
| |
Collapse
|