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Peake M, Dunnill C, Ibraheem K, Smith A, Clarke DJ, Georgopoulos NT. A novel method for the establishment of autologous skin cell suspensions: characterisation of cellular sub-populations, epidermal stem cell content and wound response-enhancing biological properties. Front Bioeng Biotechnol 2024; 12:1386896. [PMID: 38646012 PMCID: PMC11026634 DOI: 10.3389/fbioe.2024.1386896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction: Autologous cell suspension (ACS)-based therapy represents a highly promising approach for burns and chronic wounds. However, existing technologies have not achieved the desired clinical success due to several limitations. To overcome practical and cost-associated obstacles of existing ACS methods, we have established a novel methodology for rapid, enzymatic disaggregation of human skin cells and their isolation using a procedure that requires no specialist laboratory instrumentation and is performed at room temperature. Methods: Cells were isolated using enzymatic disaggregation of split-thickness human skin followed by several filtration steps for isolation of cell populations, and cell viability was determined. Individual population recovery was confirmed in appropriate culture medium types, and the presence of epidermal stem cells (EpSCs) within keratinocyte sub-populations was defined by flow cytometry via detection of CD49 and CD71. Positive mediators of wound healing secreted by ACS-derived cultures established on a collagen-based wound-bed mimic were detected by proteome arrays and quantified by ELISA, and the role of such mediators was determined by cell proliferation assays. The effect of ACS-derived conditioned-medium on myofibroblasts was investigated using an in-vitro model of myofibroblast differentiation via detection of α-SMA using immunoblotting and immunofluorescence microscopy. Results: Our methodology permitted efficient recovery of keratinocytes, fibroblasts and melanocytes, which remained viable upon long-term culture. ACS-derivatives comprised sub-populations with the CD49-high/CD71-low expression profile known to demarcate EpSCs. Via secretion of mitogenic factors and wound healing-enhancing mediators, the ACS secretome accelerated keratinocyte proliferation and markedly curtailed cytodifferentiation of myofibroblasts, the latter being key mediators of fibrosis and scarring. Discussion: The systematic characterisation of the cell types within our ACS isolates provided evidence for their superior cell viability and the presence of EpSCs that are critical drivers of wound healing. We defined the biological properties of ACS-derived keratinocytes, which include ability to secrete positive mediators of wound healing as well as suppression of myofibroblast cytodifferentiation. Thus, our study provides several lines of evidence that the established ACS isolates comprise highly-viable cell populations which can physically support wound healing and possess biological properties that have the potential to enhance not only the speed but also the quality of wound healing.
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Affiliation(s)
- Michael Peake
- School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Centre for Dermatology Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Chris Dunnill
- School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Khalidah Ibraheem
- School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Adrian Smith
- Department of General Surgery, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, United Kingdom
| | - Douglas J. Clarke
- School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Nikolaos T. Georgopoulos
- School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
- Biomolecular Sciences Research Centre, Industry and Innovation Research Institute, Sheffield Hallam University, Sheffield, United Kingdom
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2
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Nuutila K, Mistry R, Broomhead M, Eriksson E. Split-Thickness Skin and Dermal Pixel Grafts Can Be Expanded up to 500 Times to Re-Epithelialize a Full-Thickness Burn Wound. Adv Wound Care (New Rochelle) 2024; 13:176-186. [PMID: 37905500 DOI: 10.1089/wound.2023.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023] Open
Abstract
Objective: Autologous skin transplantation is limited by donor site availability for patients with extensive burns. The objective of this study was to demonstrate the feasibility and efficacy of split-thickness skin (STS) and dermal pixel grafts (PG) in the treatment of burns. Approach: The study was divided into three arms of validation, expansion, and combination that all followed the same study design. Sixteen deep partial-thickness burns were created on the dorsum of anesthetized pigs. Three days postinjury the burns were debrided and grafted with STS and dermal PGs. The PGs were prepared by harvesting two skin grafts (split-thickness skin graft [STSG] and dermal graft) from the same donor site going down in depth. The grafts were minced to 0.3 × 0.3 × 0.3 mm PGs and suspended in a small volume of hydrogel. Healing was monitored for 6, 10, 14, or 28 days. In the validation study the PGs at 1:2 expansion ratio were transplanted and compared with STSG and untreated controls. The expansion study investigated the maximum expansion potential of the PGs and the combination of the benefits of transplanting STS and dermal PGs together. Results: The validation study showed that when STS and dermal PGs were transplanted in a 1:2 ratio they fully re-epithelialized the wounds in 14 days. The expansion study demonstrated that using expansion ratios up to 1:500 the wounds were re-epithelialized by day 28. The combination study showed that there was no additional benefit to use STS and dermal PGs together. Innovation: Pixel grafting provides expansion ratios greater than conventional STSG. The possibility to harvest both STS and dermal PGs from the same donor area further reduces the need for healthy skin. Conclusion: STSG and dermal grafts can be minced to PGs with preserved viability and expanded up to 500 times to re-epithelialize a wound.
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Affiliation(s)
- Kristo Nuutila
- Department of Combat Wound Care, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Riyam Mistry
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Elof Eriksson
- Applied Tissue Technologies LLC, Hingham, Massachusetts, USA
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3
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Greenstein E. Case 4. Partial-thickness donor-site wound. J Wound Care 2023; 32:S14-S15. [PMID: 38175772 DOI: 10.12968/jowc.2023.32.sup12a.s14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Affiliation(s)
- Emily Greenstein
- Nurse Practitioner (Podiatry/Wound Care), Essentia Health, Fargo, ND, US
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4
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Liu J, Qu L, Song B. A comparative study of full-thickness skin grafting with and without subcutaneous fat preservation. Int Wound J 2023; 20:1160-1167. [PMID: 36330586 PMCID: PMC10031216 DOI: 10.1111/iwj.13975] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022] Open
Abstract
Skin grafting is an important method of wound repair and reconstruction. Skin grafting can be classified using multiple classification criteria. We often perform full-thickness skin grafting (FTSG) for small wound areas; however, the traditional FTSG technique frequently causes postoperative scar depression at the donor site, especially in the abdomen. This study aimed to determine whether preserving the subcutaneous fat when performing FTSG can improve donor site prognosis. We reviewed 25 patients who underwent autologous FTSG in the last 3 years. Among them, subcutaneous fat was preserved in 11 patients (experimental group), whereas it was not preserved in 14 patients (control group). Using a 3D camera and the Patient and Observer Scar Assessment Scale (POSAS), we evaluated the donor site postoperatively. According to POSAS, vascularization was significantly more severe in the experimental group. The Antera 3D camera revealed more severe scar depression at the donor site in the control group. The processing time for graft take, subcutaneous fat trimming and donor site closure was less in the experimental group than in the control group. Preserving subcutaneous fat at the donor site improved patient outcomes by reducing donor site depression after FTSG.
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Affiliation(s)
- Jiaxi Liu
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'An, People's Republic of China
| | - Linghan Qu
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'An, People's Republic of China
| | - Baoqiang Song
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'An, People's Republic of China
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5
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Janowska A, Fidanzi C, Romanelli M, Iannone M, Oranges T, Montaquila F, Dini V. Fractional Epidermal Skin Grafts in Hard-to-Heal Wounds: Case Series. INT J LOW EXTR WOUND 2023:15347346231163637. [PMID: 36922790 DOI: 10.1177/15347346231163637] [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: 03/18/2023]
Abstract
Cellutome™ is a minimally invasive, automated system for harvesting fractional epidermal micrografts. This therapy is indicated for granulating, small size, poor exuding acute wounds. We enrolled 15 patients with 9 venous leg ulcers and 6 atypical ulcers. The micrografts were applied with a nonadherent dressing and covered with a polyurethane foam and multilayer bandage. We scheduled 3 weekly visits for the change of the secondary dressings and multilayer bandage and clinical assessment (Wound Bed Score [WBS], pain assessment, and healing rate). The lesions were measured with the Silhouette Star™ system, a software that allows measurement of perimeter and area from a digital image. The only symptom during the procedure was a sensation of warmth. The donor area healed in 2 weeks in all patients (n = 15). We reported an area reduction of 24.30% in typical ulcers and 38.82% in atypical ulcers after 3 weeks. The average WBS improved in all ulcers from 13.06 to 14.93. The average healing rate was 0.19 mm/day both in typical and atypical ulcers. Consequently, in our small case series fractionated epidermal graft treatment significantly promoted the healing rate in all chronic ulcers regardless of etiology. Future studies with larger case series will be needed.
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Affiliation(s)
- Agata Janowska
- Department of Dermatology, 9310University of Pisa, Pisa, Italy
| | | | - Marco Romanelli
- Department of Dermatology, 9310University of Pisa, Pisa, Italy
| | - Michela Iannone
- Department of Dermatology, 9310University of Pisa, Pisa, Italy
| | - Teresa Oranges
- Azienda Ospedaliero-Universitaria Ospedale Pediatrico Meyer, Florence, Italy
| | | | - Valentina Dini
- Department of Dermatology, 9310University of Pisa, Pisa, Italy
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6
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Khalil AF, Badr HI, Zaher A, Elshirbiny MF, Elnaggar AM, Badran M, Zayed AE, Abdelhalim MM, Amen MM. Repair of spina bifida cystica: an institutional experience. EGYPTIAN JOURNAL OF NEUROSURGERY 2023. [DOI: 10.1186/s41984-023-00185-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
Abstract
Objective
Although most cases with spina bifida cystica could be closed by primary skin closure with or without undermining its edges, about 25% of patients have large defects not amenable for closure by these simple methods. We conducted this study to review our techniques in closing spina bifida cystica defects.
Methods
We retrospectively reviewed the data of consecutive 21 patients diagnosed with spina bifida cystica in our setting. According to the surface area of the defect, the approach was decided; primary closure for small defects (11 cases) and flap-based approach for large defects (10 patients).
Results
The age of the included pediatric patients ranged between 3 and 75 days. For the primary closure cases, a vertical incision was done in seven cases. For the flap-based group, bilateral rotation transposition flap was done for circular defects (7 cases) while elliptical ones were repaired via bilateral V–Y flap. Complete skin healing was achieved after two weeks (range 12–18 days) in most cases. Complications were as follows; for the primary closure group, cerebrospinal fluid leakage (18.18%%), partial wound dehiscence (18.18%) and superficial surgical site infection (9.09%). In the flap-based group, CSF leakage (20%), superficial surgical site infection (10%), and distal flap necrosis (30%) were detected. Reoperation for wound complication was needed only in one case in the flap-based group.
Conclusions
Flap-based procedures are recommended for patients with large spina bifida cystica defects because of less tissue dissection and low complication rates. Primary closure should be kept for small defects.
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7
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Epidermal-cell-based therapy as an adjunct to healing second degree burns—A randomized controlled pilot study. Burns 2022:S0305-4179(22)00239-X. [DOI: 10.1016/j.burns.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022]
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8
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Pi L, Yang L, Fang BR, Meng XX, Qian L. LncRNA MALAT1 from human adipose-derived stem cell exosomes accelerates wound healing via miR-378a/FGF2 axis. Regen Med 2022; 17:627-641. [PMID: 35822640 DOI: 10.2217/rme-2021-0170] [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: 11/21/2022] Open
Abstract
Aim: The effects of MALAT1 from human adipose-derived stem cell (ADSC) exosomes in skin wound healing were investigated. Material & methods: The viability, apoptosis and migration ability of human skin fibroblasts (HSFs) were evaluated by Cell Counting Kit-8 assay, flow cytometry and scratch assay, respectively. A mouse model was established to evaluate the role of exosomal MALAT1 in skin wound healing in vivo. Results: Human ADSC exosomes promoted the proliferation and migration of HSFs and increased MALAT1 expression. MALAT1 silencing in human ADSCs inhibited HSF viability and migration, promoted HSF apoptosis and inhibited angiogenesis by upregulating miR-378a. Overexpression of miR-378a inhibited the migration and proliferation of HSFs by downregulating FGF2 expression. ADSC exosomes promoted skin wound healing by mediating MALAT1 in vivo. Conclusion: Exosomal MALAT1 accelerated skin wound healing by regulating the miR-378a/FGF2 axis, suggesting that MALAT1 might be used as a potential target for cutaneous wound treatment.
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Affiliation(s)
- Li Pi
- Department of Burn & Plastic Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, P.R. China
| | - Li Yang
- Department of Burn & Plastic Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, P.R. China
| | - Bai-Rong Fang
- Department of Burn & Plastic Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, P.R. China
| | - Xian-Xi Meng
- Department of Burn & Plastic Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, P.R. China
| | - Li Qian
- Department of Burn & Plastic Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, P.R. China
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9
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Wu Y, Chen L, Mao X, Ru Z, Yu L, Chen M, Wang J, Chen J, Pang Q. Closure of Complex Wounds by a Simple Skin Stretching System Associated With Vacuum Sealing Drainage-Clinical Outcome of 34 Patients. INT J LOW EXTR WOUND 2021:15347346211032046. [PMID: 34279133 DOI: 10.1177/15347346211032046] [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: 11/15/2022]
Abstract
Management of complex wounds with large skin defects presents a real challenge for orthopedic or reconstructive surgeons. We developed a simple skin stretching system associated with vacuum sealing drainage to examine the efficiency and complication. A total of 34 patients with different types of complex wounds were retrospectively included from January 2015 to March 2021. All patients in the study were underwent the treatment by 2 stages. The method was used to the wounds from 4.71 to 169.65 cm2 with a median defect size of 25.13 cm2. The median time for wound closure was 11.5 days (range: 5-32 days), although the median absolute reduction was 2.08 cm2/day (range: 0.15-25.66 cm2/day). Depending on the site of the wounds, the cause of the wound, and the rate of max-width/max-length (W/L), these complex wounds could be separately divided into several groups. There were statistically significant differences in the median value of the above variables (P < .05 Kruskal-Wallis test). The results showed that different anatomical sites had different viscoelastic properties, the complex wounds caused by trauma were easier to close than caused by diabetic foot and the complex wounds in group A (W/L > 0.5) were more difficult to close than in group B (W/L ≤ 0.5). No major complications were encountered in this study. In summary, the results of our study showed that the simple skin stretching system associated with vacuum sealing drainage was a safe approach for closure of complex wounds. Nevertheless, more attention should be paid to the viscoelasticity of the wounds to ensure closure and avoid undue complications when applying the method.
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Affiliation(s)
- Yaojun Wu
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,74782Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Liang Chen
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,74782Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Xinliang Mao
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,74782Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | | | - Liying Yu
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,74782Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Mimi Chen
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,74782Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Jingnan Wang
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,74782Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Jiejie Chen
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,74782Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Qingjiang Pang
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,74782Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
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10
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Kanapathy M, Hachach-Haram N, Bystrzonowski N, Becker DL, Mosahebi A, Richards T. Epidermal graft encourages wound healing by down-regulation of gap junctional protein and activation of wound bed without graft integration as opposed to split-thickness skin graft. Int Wound J 2021; 18:332-341. [PMID: 33751815 PMCID: PMC8244016 DOI: 10.1111/iwj.13536] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 01/07/2023] Open
Abstract
Wound coverage by split-thickness skin graft (SSG) and epidermal graft (EG) shortens healing time, with comparable outcomes. However, the healing mechanism of EG is not as well understood as SSG. The difference in the healing mechanisms of EG and SSG was investigated using gap junctional proteins, proliferative marker, and cytokeratin markers. Paired punch biopsies were taken from the wound edge and wound bed from patients undergoing EG and SSG at weeks 0 and 1 to investigate wound edge keratinocyte migratory activities (connexins 43, 30, and 26), wound bed activation (Ki67), and the presence of graft integration to the wound bed (cytokeratins 14 and 6). Twenty-four paired biopsies were taken at weeks 0 and 1 (EG, n = 12; SSG, n = 12). Wound edge biopsies demonstrated down-regulation of connexins 43 (P = .023) and 30 (P = .027) after EG, indicating accelerated healing from the wound edge. At week 1, increased expression of Ki67 (P < .05) was seen after EG, indicating activation of cells within the wound bed. Keratinocytes expressing cytokeratins 6 and 14 were observed on all wounds treated with SSG but were absent at week 1 after EG, indicating the absence of graft integration following EG. Despite EG and SSG both being autologous skin grafts, they demonstrate different mechanisms of wound healing. EG accelerates wound healing from the wound edges and activates the wound bed despite not integrating into the wound bed at week 1 post-grafting as opposed to SSG, hence demonstrating properties comparable with a bioactive dressing instead of a skin substitute.
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Affiliation(s)
- Muholan Kanapathy
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Nadine Hachach-Haram
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Nicola Bystrzonowski
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - David L Becker
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Institute of Medical Biology, A*Star, Immunos, Biomedical Grove, Singapore
| | - Afshin Mosahebi
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
| | - Toby Richards
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
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11
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Xu J, Chang R, Zhang W, Zhang C, Zhu D, Liu F, Yang Y. Skin stretch suturing with Nice knots in the treatment of small- or medium-sized wounds. J Orthop Surg Res 2020; 15:488. [PMID: 33092648 PMCID: PMC7579834 DOI: 10.1186/s13018-020-02007-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/06/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To investigate the clinical efficacy and outcomes of skin stretch suturing with self-locking sliding Nice knots in the treatment of small- or medium-sized wounds. METHODS From June 2015 to May 2018, 26 patients with small- or medium-sized wounds were included in the present study. Skin stretch suturing with self-locking slide Nice knots was performed to gradually close the soft-tissue defects in these patients. The time of wound closure and healing was recorded. The color and blood supply of the skin, cutaneous sensation, the stretch of skin, and the hair growth situation of the skin wound were observed and recorded. RESULTS There were 17 males and 9 females with an average age of 30.65 years (range, 15-48 years). The areas of the soft-tissue defects were between 3.2 × 7.1 cm and 8.0 × 15.2 cm. All patients underwent stretch suturing with self-locking slide Nice knots to close the soft-tissue defects. All wounds were successfully closed and healed. The mean time of wound closure was 10.69 days (range, 5-20 days), and the mean time of wound healing was 16.85 days (range, 10-24 days). The cutaneous sensation of skin wound recovered normally, and the color of the skin wounds was the same as that of normal skin at the last follow-up. The hair growth situation of the skin wounds also returned to normal. CONCLUSIONS This study revealed that Nice knots yielded an accepted clinical result as a new method to close small- or medium-sized wounds that was simple and less minimally invasive, resulted in progressive tension, did not return to previous results, and partially replace flaps or free skin grafts.
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Affiliation(s)
- Jianmin Xu
- Department of Orthopaedics, Juye People's Hospital, Heze, Shandong, China
| | - Rui Chang
- Department of Orthopaedics, Juye People's Hospital, Heze, Shandong, China
- Yudong Gu's Academician Workstation, Heze Boai External Microscopic Orthopedic Hospital, Heze, Shandong, China
| | - Wei Zhang
- Department of Orthopaedics, Juye People's Hospital, Heze, Shandong, China
| | - Chengcheng Zhang
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Dezhi Zhu
- Department of Orthopedics, Heze Peony People's Hospital, Heze, Shandong, China
| | - Fanxiao Liu
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 250021, Jinan, Shandong, China.
| | - Yongliang Yang
- Department of Orthopedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 250021, Jinan, Shandong, China.
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12
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Khan AA, Khan IM, Nguyen PP, Lo E, Chahadeh H, Cerniglia M, Noriega JA. Skin Graft Techniques. Clin Podiatr Med Surg 2020; 37:821-835. [PMID: 32919607 DOI: 10.1016/j.cpm.2020.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Management of extensive lower extremity soft tissue and skin loss can be a very difficult to achieve by any surgeon. There can be several associated comorbidities that need to be considered and addressed with these patients. The approach is multifactorial and requires commitment from both the surgeon as well as the patient. There are several protocols that have been formulated throughout the literature addressing soft tissue and skin coverage of the limbs. This article provides a review of the literature and describes the evaluation, harvesting, transplantation, and management of skin grafting techniques to the lower extremities.
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Affiliation(s)
- Arshad A Khan
- Department of Orthopedic Surgery, Indiana University School of Medicine, Gary/Northwest, Gary, IN, USA; SpineTech Neurosurgeons, SpineTech Brain and Spine of South East Texas, Shenandoah, TX, USA.
| | - Isra M Khan
- Chicago Foot and Ankle Deformity Correction Center, Chicago, IL, USA; 111 Vision Park Boulevard, Suite 200, Shenandoah, TX 77384, USA
| | - Phi P Nguyen
- McGowan Medical School, Houston, TX, USA; MIA Plastic Surgery, 4126 Southwest Fwy Suite 999, Houston, TX 77027, USA; MILA Med Spa Group, Houston, TX, USA
| | - Erwin Lo
- University of Texas Medical Branch, Mischer Neuroscience Institute, Houston, TX, USA; Brain and Spine Center of Southeast Texas, 6025 Metropolitan Drive, Suite 205, Beaumont, TX 77706, USA
| | - Hassan Chahadeh
- Vision Park of Surgery Center, 111 Vision Park Boulevard, Suite 200, Shenandoah, TX 77384, USA
| | - Mathew Cerniglia
- Private Practice, 816 Towne Ct Suite 100, Saginaw, TX 76179, USA
| | - James A Noriega
- Department of Surgery, LSU School of Medicine, Our Lady of Lourdes Hospital, 203 West Brentwood Boulevard, Suite 2, Lafayette, LA 70506, USA
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13
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Kanapathy M, Bystrzonowski N, Hachach-Haram N, Twyman L, Becker DL, Richards T, Mosahebi A. Lower donor site morbidity and higher patient satisfaction with epidermal grafting in comparison to split thickness skin grafting: A randomized controlled trial (EPIGRAAFT Trial). J Plast Reconstr Aesthet Surg 2020; 73:1556-1564. [PMID: 32532631 DOI: 10.1016/j.bjps.2020.03.006] [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] [Received: 09/11/2019] [Revised: 02/22/2020] [Accepted: 03/07/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Split thickness skin grafting (SSG) is an important modality for wound coverage; however, it leads to donor site morbidity. Epidermal grafting (EG) is a promising option for autologous skin grafting which offers minimal donor site morbidity, though it is not known if EG is an effective clinical alternative for SSG. This study compared the efficacy of EG as an alternative to SSG in terms of wound healing outcomes, donor site morbidity, patient satisfaction and adverse events. METHODS EPIGRAAFT is a Phase 2, randomized, open-label trial with two parallel groups: EG and SSG. Patients referred for skin grafting with a healthy granulating wound bed were included. The co-primary endpoints were the proportion of wounds healed and donor site healing time. The secondary endpoints include donor site morbidity measured using Vancouver Scar Scale, mean time for complete wound healing, patient satisfaction assessed using a validated skin grafting questionnaire and incidence of adverse events. RESULTS Of the 61 patients screened, 44 patients were randomized. There was no difference in the proportion of wounds healed at 6 weeks (p=0.366) and 3 months(p=0.24) as well as the mean time for wound healing (p=0.12). EG resulted in lower donor site morbidity (p=0.001), faster donor site healing time (EG: 4.86 days vs. SSG: 21.32 days) (p<0.0001), and higher overall satisfaction (p<0.001). There were no adverse events reported. CONCLUSION This study demonstrated that EG has superior donor site outcomes with faster donor site healing and lower morbidity compared to SSG, while having comparable wound healing outcomes. Patients receiving EG also experienced higher donor site satisfaction compared to SSG. ClinicalTrials.gov identifier: NCT02535481.
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Affiliation(s)
- Muholan Kanapathy
- Division of Surgery & Interventional Science, University College London, United Kingdom; Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, United Kingdom
| | - Nicola Bystrzonowski
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, United Kingdom
| | - Nadine Hachach-Haram
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, United Kingdom
| | - Lucy Twyman
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, United Kingdom
| | - David L Becker
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Institute of Medical Biology, A*Star, Immunos, Biomedical Grove, Singapore
| | - Toby Richards
- Division of Surgery & Interventional Science, University College London, United Kingdom; Faculty of Health and Medical Sciences, University of Western Australia.
| | - Afshin Mosahebi
- Division of Surgery & Interventional Science, University College London, United Kingdom; Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, United Kingdom
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14
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Keirouz A, Chung M, Kwon J, Fortunato G, Radacsi N. 2D and 3D electrospinning technologies for the fabrication of nanofibrous scaffolds for skin tissue engineering: A review. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2020; 12:e1626. [DOI: 10.1002/wnan.1626] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Antonios Keirouz
- School of Engineering, Institute for Materials and Processes The University of Edinburgh Edinburgh UK
- Empa, Swiss Federal Laboratories for Materials Science and Technology Laboratory for Biomimetic Membranes and Textiles St. Gallen Switzerland
| | - Michael Chung
- School of Engineering, Institute for Materials and Processes The University of Edinburgh Edinburgh UK
- Empa, Swiss Federal Laboratories for Materials Science and Technology Laboratory for Biomimetic Membranes and Textiles St. Gallen Switzerland
| | - Jaehoon Kwon
- School of Engineering, Institute for Materials and Processes The University of Edinburgh Edinburgh UK
| | - Giuseppino Fortunato
- Empa, Swiss Federal Laboratories for Materials Science and Technology Laboratory for Biomimetic Membranes and Textiles St. Gallen Switzerland
| | - Norbert Radacsi
- School of Engineering, Institute for Materials and Processes The University of Edinburgh Edinburgh UK
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15
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Vaheb M, Karrabi M, Khajeh M, Asadi A, Shahrestanaki E, Sahebkar M. Evaluation of the Effect of Platelet-Rich Fibrin on Wound Healing at Split-Thickness Skin Graft Donor Sites: A Randomized, Placebo-Controlled, Triple-Blind Study. INT J LOW EXTR WOUND 2020; 20:29-36. [DOI: 10.1177/1534734619900432] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Split-thickness skin grafting (STSG) is widely used to heal wounds resulting from trauma, burns, and chronic wounds. This study aimed to determine the true effect of platelet-rich fibrin (PRF) on patients with burn wounds requiring STSG during treatment of donor wounds. This randomized, triple-blind clinical trial was conducted on patients who referred to the burn ward of Vasei Hospital of Sabzevar, Iran, from May 2017 to May 2018. The donor site was randomly divided into 2 groups: PRF and control (Vaseline petrolatum gauze) using Vaseline gauze. In the intervention group, the PRF gel was applied to the wound and covered with Vaseline gauze and wet dressing. Conversely, only Vaseline gauze and wet dressing were applied to the control group. Outcome evaluation was conducted using paired t test and Wilcoxon signed rank-sum test, as appropriate, on days 8 and 15. The mean age of the patients was 33.10 ± 2.60 years, and 51.50% were male. The mean wound healing time in the PRF and control groups was 11.80 ± 3.51 and 16.30 ± 4.32 days, respectively ( P < .001). The PRF group showed significantly higher wound healing rates than the control group at 8 and 15 days dressing ( P < .001 and P < .001, respectively). Moreover, the mean wound healing for all wound healing indices diagnosed by 2 specialists in PRF was higher than control group on days 8 and 15 ( P < .001). We found a statistically significant difference on days 8 and 15 regarding the mean pain levels between the 2 groups ( P < .001). The findings showed that PRF can significantly increase the time and rate of donor wound healing compared with conventional treatment and also reduce the severity of pain.
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Affiliation(s)
- Mojtaba Vaheb
- Sabzevar University of Medical Sciences, Sabzevar, Iran
| | | | - Mahtab Khajeh
- Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Alireza Asadi
- Sabzevar University of Medical Sciences, Sabzevar, Iran
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16
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Qureshi AA, Kirsner RS. Evidence-Based Review of Clinical Applications and Outcomes of Automated Epidermal Grafting. CURRENT DERMATOLOGY REPORTS 2019. [DOI: 10.1007/s13671-019-00270-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Ki SH, Ma SH, Choi JH, Sim SH, Kim HM. Treating skin graft donor sites: a comparative study between remnant skin use and polyurethane foam. J Wound Care 2019; 28:469-477. [DOI: 10.12968/jowc.2019.28.7.469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: Excess remnant skin is retained for use in additional grafting in case of split-thickness skin graft (STSG) failure. We hypothesise that regrafting with remnant skin offers greater efficacy and advantages in wound healing and donor site appearance. Methods: Skin graft donor sites were assessed by comparing those regrafted with remnant skin with those treated with polyurethane foam dressing. Healing time, pain, patient satisfaction, itching sensation, skin stiffness and irregularity between regrafting and foam dressing were compared. The aesthetic satisfaction of donor site was evaluated by four board-certified plastic surgeons. The differences were tested statistically. Results: A total of 39 patients received a STSG due to skin or soft tissue wounds caused by burn, trauma and cancer reconstruction. The donor site healing time was shorter with remnant skin regrafting compared with foam dressing. There was no difference with respect to donor site pain between the two treatment groups. At two weeks after skin graft, patient satisfaction was higher in those treated with remnant skin than in those treated with foam dressing. Aesthetic assessment was improved after 12 weeks. Conclusion: Donor site dressing using remnant skin appears to improve wound healing and enhance the aesthetic outcome of donor sites.
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Affiliation(s)
- Sae Hwi Ki
- Department of Plastic Surgery, Inha University Hospital, Incheon, Korea
- Department of Plastic Surgery, Inha University School of Medicine, Incheon, Korea
| | - Sung Hwan Ma
- Department of Plastic Surgery, Inha University Hospital, Incheon, Korea
| | - Jong Hwan Choi
- Department of Plastic Surgery, Inha University Hospital, Incheon, Korea
| | - Seung Hyun Sim
- Department of Plastic Surgery, Inha University Hospital, Incheon, Korea
| | - Hyung Muk Kim
- Department of Plastic Surgery, Inha University Hospital, Incheon, Korea
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18
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Gould L, Li WW. Defining complete wound closure: Closing the gap in clinical trials and practice. Wound Repair Regen 2019; 27:201-224. [DOI: 10.1111/wrr.12707] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/11/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Lisa Gould
- South Shore Hospital Center for Wound Healing Weymouth Massachusetts
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19
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Skin-Derived Stem Cells for Wound Treatment Using Cultured Epidermal Autografts: Clinical Applications and Challenges. Stem Cells Int 2018; 2018:4623615. [PMID: 29765411 PMCID: PMC5889868 DOI: 10.1155/2018/4623615] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/03/2018] [Indexed: 12/15/2022] Open
Abstract
The human skin fulfills important barrier, sensory, and immune functions-all of which contribute significantly to health and organism integrity. Widespread skin damage requires immediate treatment and coverage because massive skin loss fosters the invasion of pathogens, causes critical fluid loss, and may ultimately lead to death. Since the skin is a highly immunocompetent organ, autologous transplants are the only viable approach to permanently close a widespread skin wound. Despite the development of tissue-saving autologous transplantation techniques such as mesh and Meek grafts, treatment options for extensive skin damage remain severely limited. Yet, the skin is also a rich source of stem and progenitor cells. These cells promote wound healing under physiological conditions and are potential sources for tissue engineering approaches aiming to augment transplantable tissue by generating cultured epidermal autografts (CEAs). Here, we review autologous tissue engineering strategies as well as transplantation products based on skin-derived stem cells. We further provide an overview of clinical trial activities in the field and discuss relevant translational and clinical challenges associated with the use of these products.
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20
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Guogienė I, Kievišas M, Grigaitė A, Braziulis K, Rimdeika R. Split-thickness skin grafting: early outcomes of a clinical trial using different graft thickness. J Wound Care 2018; 27:5-13. [PMID: 29333934 DOI: 10.12968/jowc.2018.27.1.5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE In clinical practice, split-thickness skin graft (STSG) transplantation remains the gold standard for covering large skin defects. Currently, there is no consensus on the optimal thickness of skin grafts. The purpose of our study was to compare the early healing processes of recipient and donor wounds after STSG transplantation using grafts of different thickness. METHOD This prospective, randomised clinical trial included 84 patients that underwent STSG transplantation surgery for post-burn, post-traumatic or postoperative skin defects. Patients were randomised to receive a skin graft of either 0.2mm, 0.3mm or 0.4mm thickness. After skin transplantation, the wound healing parameters of both the recipient and donor wounds were evaluated after three days, one week, two weeks and one month. RESULTS The greatest mean epithelialisation scores and highest rate of complete wound epithelialisation were identified in the recipient and donor wounds of the 0.2mm transplant group, at all time points. When the recipient wound pain scores were evaluated, the greatest visual analogue scale (VAS) values were found in the 0.2mm transplant group. The opposite result was found for the donor wound, where the highest VAS scores were identified in the 0.4mm transplant group. There were no significant differences, at any follow-up period, when wound secretion, erythema, swelling, localised warmth and fluctuation were compared. CONCLUSION The early healing of recipient wounds after STSG transplantation with grafts of various thickness differed considerably, especially regarding wound epithelialisation and pain.
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Affiliation(s)
- Inga Guogienė
- Department of Plastic and Reconstructive Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mantas Kievišas
- Department of Plastic and Reconstructive Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Augustina Grigaitė
- Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kęstutis Braziulis
- Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rytis Rimdeika
- Professor, Head of Department; Department of Plastic and Reconstructive Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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21
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Hosomi K, Nagai F, Yuzuriha S. Small-slice thin-thickness skin harvesting in a net pattern for patients with skin vulnerability. BURNS OPEN 2018. [DOI: 10.1016/j.burnso.2017.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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22
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Buehrer G, Arkudas A, Horch RE. Treatment of standardised wounds with pure epidermal micrografts generated with an automated device. Int Wound J 2017; 14:856-863. [PMID: 28217852 DOI: 10.1111/iwj.12721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 01/05/2017] [Accepted: 01/17/2017] [Indexed: 12/16/2022] Open
Abstract
In this study, we analysed the effects of pure epidermal micrografts generated with an automated device in a standardised human wound model. Epidermal micrografts were harvested using an automated device. Micrografts were then transplanted onto split-skin donor sites. The target area was only partially covered with transplants to create an intra-individual control area. Wounds were evaluated by subjective assessment as well as measurements with combined laser and white light spectroscopy and cutometry. The epidermal graft sites remained completely stable, whereas control sites offered partially unstable and blistering areas. Statistically, no measurable difference in the speed of initial reepithelialisation could be shown. However, there was an increased pliability and softness of the treated areas that correlated with the subjective impression of both investigators and patients. There was a significantly higher relative haemoglobin concentration, measurable in treated and untreated areas at 4 weeks and 6 months. Cutometry showed no differences in skin properties between treated and untreated areas. This study shows an effect of epidermal micrografts in a standardised human wound model and supports the positive impact of keratinocytes on early wound healing as described in literature. Long-term effects of epidermal grafting deserve further studies.
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Affiliation(s)
- Gregor Buehrer
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuernberg (FAU), Erlangen, Germany
| | - Andreas Arkudas
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuernberg (FAU), Erlangen, Germany
| | - Raymund E Horch
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuernberg (FAU), Erlangen, Germany
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23
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Kanapathy M, Hachach‐Haram N, Bystrzonowski N, Connelly JT, O'Toole EA, Becker DL, Mosahebi A, Richards T. Epidermal grafting for wound healing: a review on the harvesting systems, the ultrastructure of the graft and the mechanism of wound healing. Int Wound J 2017; 14:16-23. [PMID: 27785878 PMCID: PMC7950150 DOI: 10.1111/iwj.12686] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 10/07/2016] [Indexed: 12/13/2022] Open
Abstract
Epidermal grafting for wound healing involves the transfer of the epidermis from a healthy location to cover a wound. The structural difference of the epidermal graft in comparison to the split-thickness skin graft and full-thickness skin graft contributes to the mechanism of effect. While skin grafting is an epidermal transfer, little is known about the precise mechanism of wound healing by epidermal graft. This paper aims to explore the evolution of the epidermal graft harvesting system over the last five decades, the structural advantages of epidermal graft for wound healing and the current hypotheses on the mechanism of wound healing by epidermal graft. Three mechanisms are proposed: keratinocyte activation, growth factor secretion and reepithelialisation from the wound edge. We evaluate and explain how these processes work and integrate to promote wound healing based on the current in vivo and in vitro evidence. We also review the ongoing clinical trials evaluating the efficacy of epidermal graft for wound healing. The epidermal graft is a promising alternative to the more invasive conventional surgical techniques as it is simple, less expensive and reduces the surgical burden for patients in need of wound coverage.
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Affiliation(s)
- Muholan Kanapathy
- Division of Surgery & Interventional ScienceUniversity College LondonLondonUK
- London Wound Healing Group, Department of Plastic and Reconstructive SurgeryRoyal Free NHS Foundation Trust HospitalLondonUK
| | - Nadine Hachach‐Haram
- London Wound Healing Group, Department of Plastic and Reconstructive SurgeryRoyal Free NHS Foundation Trust HospitalLondonUK
| | - Nicola Bystrzonowski
- London Wound Healing Group, Department of Plastic and Reconstructive SurgeryRoyal Free NHS Foundation Trust HospitalLondonUK
| | - John T Connelly
- Centre for Cell Biology and Cutaneous Research, The Blizard InstituteBarts and The London School of Medicine and Dentistry, Queen Mary University of LondonLondonUK
| | - Edel A O'Toole
- Centre for Cell Biology and Cutaneous Research, The Blizard InstituteBarts and The London School of Medicine and Dentistry, Queen Mary University of LondonLondonUK
| | - David L Becker
- Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
- Institute of Medical BiologyA*Star, Immunos, Biomedical GroveSingaporeSingapore
| | - Afshin Mosahebi
- Division of Surgery & Interventional ScienceUniversity College LondonLondonUK
- London Wound Healing Group, Department of Plastic and Reconstructive SurgeryRoyal Free NHS Foundation Trust HospitalLondonUK
| | - Toby Richards
- Division of Surgery & Interventional ScienceUniversity College LondonLondonUK
- London Wound Healing Group, Department of Plastic and Reconstructive SurgeryRoyal Free NHS Foundation Trust HospitalLondonUK
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24
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Epidermal Graft Accelerates the Healing of Acute Wound: A Self-controlled Case Report. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1119. [PMID: 27975024 PMCID: PMC5142490 DOI: 10.1097/gox.0000000000001119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/13/2016] [Indexed: 11/25/2022]
Abstract
Wound care represents a significant socioeconomic burden, with over half of chronic wounds taking up to a year to heal. Measures to accelerate wound healing are beneficial to patients and also reduce the cost and burden of wound management. Epidermal grafting (EG) is an emerging option for autologous skin grafting in the outpatient setting to improve wound healing. Although several case series have previously reported good clinical outcome with EG, the healing rate in comparison to conservative wound management is not known. In this report, we compare the weekly healing rate of 2 separate wounds in the same patient, one treated with EG and the other with dressings. The treated wound showed accelerated healing, with the healing rate being the highest at the first 2 weeks after EG. The average healing time of the treated wound was 40% faster compared with the control wound. EG accelerates healing of acute wounds, potentially reducing the healthcare cost and surgical burden.
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25
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Abstract
Chronic wounds are an increasingly prevalent disease with a significant healthcare burden. These wounds often do not respond to standard of care therapy alone, requiring the use of adjuvant therapies. Epidermal grafting, previously utilized primarily for correction of leukoderma, is increasingly being recognized as a beneficial therapy for wounds, both acute and chronic. Epidermal grafting has been shown to be effective in the management of chronic wounds, with successful healing in refractory patients. It has not only been shown to be effective, but it is also associated with lower cost and morbidity than traditional skin grafting techniques as well as improved donor site healing. Through the use of a novel epidermal harvesting system, the CelluTome™ Epidermal Harvesting System (KCI, an Acelity company, San Antonio, TX), this treatment modality has become more standardized, reproducible, and easy to use as well as less time consuming, making its use in the clinical setting more convenient and beneficial. Epidermal grafting, therefore, represents a promising, efficacious, and cost-effective option for treatment of refractory non-healing wounds.
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Affiliation(s)
- Andrea D Maderal
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine
| | - Robert S Kirsner
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine
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26
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Cai SS, Gowda AU, Chopra K, Waldman R, Silverman RP, Rasko YM. A Case Series of Complex Recalcitrant Wounds Treated with Epidermal Grafts Harvested from an Automated Device. Cureus 2016; 8:e853. [PMID: 27909641 PMCID: PMC5130354 DOI: 10.7759/cureus.853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: Epidermal grafting has several advantages over full-thickness or split-thickness grafts in the treatment of complex non-healing wounds. These include the low risk of donor site complications, minimal patient discomfort, and abstention from the operating room. Traditionally, the lack of reliable epidermal harvesting techniques has limited its clinical utilization. The development of an automated suction blister epidermal graft (SBEG) harvesting device may facilitate clinical utilization of this technique. The authors present a case series of multimorbid patients who were poor surgical candidates and were treated with this technique. Methods: A retrospective review of all patients treated with CelluTome™ Epidermal Harvesting System (KCI, an Acelity company, San Antonio, TX) prior to May 2016 at our institution was conducted. Results: A total of 12 patients underwent 14 epidermal grafting procedures. Multiple comorbidities were identified, including smoking (33%), immunosuppression by immunotherapy or steroids (25%), chronic venous insufficiency (25%), diabetes mellitus (25%), malignancy (25%), polysubstance abuse (17%), HIV/AIDS (17%), and peripheral artery disease (8%). Among the two acute wounds (≤ 3 months) and 10 chronic wounds, the average wound size was 49.1 cm2 (± 77.6 cm2) and the median wound duration was 5.7 months (interquartile range: 4.1 - 15.8 months) before SBEG was attempted. These complex wounds had failed prior therapies, such as local wound care (100%), incision and drainage (58%), vacuum-assisted closure (33%), split-thickness skin graft (16%), and hyperbaric oxygen (8%). Following the procedure, all donor sites healed within one week. Three patients were lost to follow-up. Of the remaining nine patients, four patients had complete resolution of their wounds at a median follow-up of 13.1 weeks (interquartile range: 6.8-17.3 weeks). Among those with partial resolutions, the average wound size was 4.2 cm2 (± 2.1 cm2) with an average wound reduction of 79% (± 23%). No donor or recipient site complications were observed. Conclusions: The automated SBEG harvesting device is an effective and safe option for treating complex non-healing wounds in multimorbid patients who may be poor surgical candidates. This procedure demonstrates minimal contraindications to its use and donor or recipient site complications.
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Affiliation(s)
- Stephen S Cai
- Division of Plastic Surgery, University of Maryland School of Medicine
| | - Arvind U Gowda
- Department of Plastic and Reconstructive Surgery, Yale School of Medicine
| | - Karan Chopra
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital
| | - Rachel Waldman
- Division of Plastic Surgery, University of Maryland School of Medicine
| | | | - Yvonne M Rasko
- Division of Plastic Surgery, University of Maryland School of Medicine
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