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Schlottmann F, Strauß S, Ziesing S, Reineke C, Ipaktchi R, Weyand B, Krezdorn N, Vogt PM, Bucan V. Organization of Hannover Skin Bank: Sterile culture and procurement protocols for viable cryopreserved allogeneic skin grafts of living donors. Int Wound J 2024; 21:e14374. [PMID: 37675770 PMCID: PMC10784195 DOI: 10.1111/iwj.14374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023] Open
Abstract
Preserved allogeneic donor skin still represents one of the gold standard therapies in temporary wound coverage in severely burned patients or chronic wounds. Allogeneic skin grafts are currently commercially available as cryo- or glycerol-preserved allografts through skin tissue banks all over the world. Most of the skin tissue banks rely on human cadaveric skin donations. Due to the chronic shortage of human allogeneic transplants, such as skin, and increasing costs in the procurement of allografts from other skin tissue banks, Hannover Medical School has been building up its own skin tissue bank based on allogeneic skin grafts from living donors who underwent surgical treatment (i.e., body-contouring procedures, such as abdominioplasties). This article presents procedures and protocols for the procurement and processing of allogeneic skin grafts according to national legislation and European regulations and guidelines. Beside protocols, initial microbiological data regarding the sterility of the harvested grafts are presented. The results currently form the basis for further investigations as well as clinical applications. In summary, a microbiological testing and acceptance procedure is presented that ensures adequate patient safety and skin viability.
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Affiliation(s)
- Frederik Schlottmann
- Department of Plastic, Aesthetic, Hand and Reconstructive SurgeryHannover Medical SchoolHannoverGermany
| | - Sarah Strauß
- Department of Plastic, Aesthetic, Hand and Reconstructive SurgeryHannover Medical SchoolHannoverGermany
| | - Stefan Ziesing
- Department of MicrobiologyHannover Medical SchoolHannoverGermany
| | | | - Ramin Ipaktchi
- Department of Plastic, Aesthetic, Hand and Reconstructive SurgeryHannover Medical SchoolHannoverGermany
- Department of Plastic and Hand Surgery, InselspitalUniversity Hospital BernBernSwitzerland
| | - Birgit Weyand
- Department of Plastic, Aesthetic, Hand and Reconstructive SurgeryHannover Medical SchoolHannoverGermany
| | - Nicco Krezdorn
- Department of Plastic, Aesthetic, Hand and Reconstructive SurgeryHannover Medical SchoolHannoverGermany
| | - Peter Maria Vogt
- Department of Plastic, Aesthetic, Hand and Reconstructive SurgeryHannover Medical SchoolHannoverGermany
| | - Vesna Bucan
- Department of Plastic, Aesthetic, Hand and Reconstructive SurgeryHannover Medical SchoolHannoverGermany
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Rivas E, Foster J, Crandall CG, Finnerty CC, Suman-Vejas OE. Key Exercise Concepts in the Rehabilitation from Severe Burns. Phys Med Rehabil Clin N Am 2023; 34:811-824. [PMID: 37806699 PMCID: PMC10731385 DOI: 10.1016/j.pmr.2023.05.003] [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: 10/10/2023]
Abstract
This article presents information on the benefits of exercise in counteracting the detrimental effects of bed rest, and/or severe burns. Exercise is key for maintaining physical function, lean body mass, metabolic recovery, and psychosocial health after major burn injuries. The details of an exercise training program conducted in severely burned persons are presented, as well as information on the importance of proper regulation of body temperature during exercise or physical activity. The sections on exercise and thermoregulation are followed by a section on the role of exercise in scarring and contractures. Finally, gaps in the current knowledge of exercise, thermoregulation, and contractures are presented.
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Affiliation(s)
- Eric Rivas
- Microgravity Research, In-Space Solutions, Axiom Space Headquarters, 1290 Hercules Avenue, Houston, TX 77058, USA
| | - Josh Foster
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Institute for Exercise and Environmental Medicine (IEEM), Texas Health Presbyterian Hospital Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Craig G Crandall
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Institute for Exercise and Environmental Medicine (IEEM), Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Suite 435, Dallas, TX 75231, USA
| | - Celeste C Finnerty
- Department of Surgery, Division of Surgical Sciences, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-1220, USA
| | - Oscar E Suman-Vejas
- Department of Surgery, Division of Surgical Sciences, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-1220, USA.
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Schlottmann F, Bucan V, Vogt PM, Krezdorn N. A Short History of Skin Grafting in Burns: From the Gold Standard of Autologous Skin Grafting to the Possibilities of Allogeneic Skin Grafting with Immunomodulatory Approaches. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:225. [PMID: 33801228 PMCID: PMC7998351 DOI: 10.3390/medicina57030225] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/05/2021] [Accepted: 02/22/2021] [Indexed: 12/13/2022]
Abstract
Due to groundbreaking and pioneering developments in the last century, significant improvements in the care of burn patients have been achieved. In addition to the still valid therapeutic standard of autologous split-thickness skin grafting, various commercially available skin substitutes are currently available. Significant progress in the field of tissue engineering has led to the development of promising therapeutic approaches. However, scientific advances in the field of allografting and transplant immunology are of great importance. The achievement of various milestones over the past decades has provided thought-provoking impulses in the field of skin allotransplantation. Thus, biologically viable skin allotransplantation is still not a part of the clinical routine. The purpose of this article is to review the achievements in burn surgery with regards to skin allotransplantation in recent years.
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Affiliation(s)
- Frederik Schlottmann
- Department of Plastic, Aesthetic, Hand- and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany; (V.B.); (P.M.V.); (N.K.)
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Blears E, Sommerhalder C, Toliver-Kinsky T, Finnerty CC, Herndon DN. Current problems in burn immunology. Curr Probl Surg 2020; 57:100779. [PMID: 32507131 DOI: 10.1016/j.cpsurg.2020.100779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/22/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Elizabeth Blears
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | | | - Tracy Toliver-Kinsky
- Department of Anesthesiology, Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX.
| | - Celeste C Finnerty
- Department of Surgery, University of Texas Medical Branch, Galveston, TX; Shriners Hospitals for Children, Galveston, TX
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Schlottmann F, Strauss S, Hake K, Vogt PM, Bucan V. Down-Regulation of MHC Class I Expression in Human Keratinocytes Using Viral Vectors Containing US11 Gene of Human Cytomegalovirus and Cultivation on Bovine Collagen-Elastin Matrix (Matriderm ®): Potential Approach for an Immune-Privileged Skin Substitute. Int J Mol Sci 2019; 20:E2056. [PMID: 31027326 PMCID: PMC6540026 DOI: 10.3390/ijms20092056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 12/31/2022] Open
Abstract
Skin transplantation, especially in burn patients, is still challenging because surgeons are faced with limited disposability of autologous donor side material. The in vitro culture of keratinocytes has become an important reconstructive option. However, only non-immunogenic allogenic keratinocytes offer the opportunity to develop a skin graft that can overcome rejection. The purpose of the study was to develop targeted gene modification of keratinocytes in order to reduce immunogenicity for the use as allogenic transplantable skin graft by decreasing the expression of MHC class I. To reduce MHC class I expression, viral vectors containing the US11 gene of human cytomegalovirus were generated and tested on their functionality using Western blotting, indirect immunofluorescence staining, and flow cytometry. Transfected keratinocytes were seeded on commercially available bovine collagen-elastin matrices and further cultured for histological and cell survival assays. Results showed transient down-regulation of MHC class I after 24 h post-transfection, with recovery of MHC class I expression after 48 h. Histological assessments showed long-term cell survival as well as histological patterns comparable to epidermal layers of healthy human skin. The data postulates the potential application of US11 transfected keratinocytes as an approach towards an immune-privileged skin substitute. Nevertheless, further studies and data are needed.
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Affiliation(s)
- Frederik Schlottmann
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
| | - Sarah Strauss
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
| | - Kevin Hake
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
| | - Peter M Vogt
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
| | - Vesna Bucan
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
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Čapek KD, Culnan DM, Desai MH, Herndon DN. Fifty Years of Burn Care at Shriners Hospitals for Children, Galveston. Ann Plast Surg 2018; 80:S90-S94. [PMID: 29461291 PMCID: PMC5825277 DOI: 10.1097/sap.0000000000001376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
More than 50 years ago, Shriners Hospitals for Children expanded their philanthropy to include care for burned children. In so doing, the effects of their work weightily expanded from rehabilitation and quality of life outcomes to include survival proper. As the first facility dedicated to the care of burned children, originally designated the Shriners Burn Institute, the Galveston hospital remains the cornerstone of this endeavor. Shriners maintains charitable pediatric hospitals, provide care irrespective of the patient's or the family's ability to pay, and promote research. The sole criterion for admission at Shriners Hospitals for Children is the determination by a surgeon at a Shriners hospital that "the child's trouble may be corrected or improved." This philanthropic effort to provide medical care for children is one expression of the human commonality recognized by Shriners. In this article, we provide some background information on how this hospital came into existence as well as a global summary of its interventions toward greater survival and more complete rehabilitation of burned children. Based on the findings presented herein, we assert that there is less suffering and less loss of life due to childhood burns today than in previous years. We attribute much of this improvement to the simple voluntary collective decision by Shriners to provide alms for burned children.
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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.
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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
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