1
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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.
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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
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2
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Shah R, Rodrigues R, Phillips V, Khatib M. The use of artificial dermal substitutes for repair of the donor site following harvesting of a radial forearm free flap: A systematic review. J Plast Reconstr Aesthet Surg 2024; 88:501-516. [PMID: 38101265 DOI: 10.1016/j.bjps.2023.11.046] [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] [Received: 08/14/2023] [Revised: 11/01/2023] [Accepted: 11/26/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Artificial dermal substitutes (ADMs) have been trialled to improve outcomes at the donor site following the harvesting of a radial forearm free flap (RFFF). This systematic review compares donor site aesthetic and functional outcomes, with the use of an ADM versus conventional practice. METHODS The databases Medline, Embase, Cochrane Library, Web of Science (Core Collection), and Scopus were searched for retrospective, prospective, and case-control studies and randomised control trials (RCTs) involving any ADM. Studies with adult patients having undergone RFFF harvesting and donor site repair with an ADM, commenting on appropriate clinical outcomes and without high risk of bias, were included. Direction-of-effect analysis was performed on relevant groupings of studies since heterogeneity in outcome measurement precluded meta-analyses. RESULTS Across eight non-comparative studies included, 132 patients had donor site coverage with AlloDerm™, Integra™, Matriderm™, or Rapiderm. Across 11 comparative studies included, 240 patients had donor site coverage with fish-skin matrix, AlloDerm™, amniotic membrane, MegaDerm™, Hyalomatrix, Integra™, or Matriderm™. Five out of 11 comparative studies demonstrated superior aesthetic outcomes with ADMs according to at least one aesthetic metric compared to controls, whilst 6/11 demonstrated superior functional outcomes with ADMs. No study demonstrated poorer aesthetic or functional outcomes with an ADM compared to conventional practice. CONCLUSIONS In summary, the lack of studies reporting poorer outcomes with them compared to conventional practices, and a cumulative effect direction in their favour, provide strong indications in support of the use of AlloDerm™, Integra™, or Matriderm™ grafts. Further comparative studies, including RCTs, are needed to reinforce these initial indications.
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Affiliation(s)
- Rahul Shah
- University of Cambridge, School of Clinical Medicine, Cambridge, UK.
| | - Raina Rodrigues
- Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | | | - Manaf Khatib
- Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
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3
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Cherry I, Tarhini L, Doan M, De Buys Roessingh A. Exploring the Place of Fish Skin Grafts with Omega-3 in Pediatric Wound Management. J Clin Med 2023; 13:112. [PMID: 38202119 PMCID: PMC10780036 DOI: 10.3390/jcm13010112] [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: 11/28/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024] Open
Abstract
Wound healing in the pediatric population is known to be a challenge and poorly studied. Split-thickness skin grafts, full-thickness skin grafts, and flaps overlap their applications with the growing field of cellular and tissue-based therapies. However, their role in pediatric reconstruction has yet to be defined. The Kerecis® Omega-3 wound patch, derived from decellularized codfish skin, has garnered attention due to its preserved microscopic architecture resembling the human extracellular matrix. This acellular dermal matrix acts as a scaffold, fostering dermal cell and capillary adhesion while harnessing omega-3 polyunsaturated fatty acids for granulation acceleration and antimicrobial effects. This study presents a comprehensive review and surgical protocol for utilizing Kerecis® fish skin in pediatric wound care. The research embraces a case series involving five patients with diverse wound locations. The Kerecis® Omega-3 wound patch underwent meticulous application and careful monitoring. The results highlight an average time of 48.6 days for complete epithelialization, yielding favorable outcomes with no hypertrophic scarring and mild retraction. Kerecis® fish skin grafting stands as a tool that not only accelerates healing but also addresses the multifaceted challenges associated with wound management in the pediatric population: the avoidance of donor site morbidity and improved postoperative pain control.
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Affiliation(s)
- Ibrahim Cherry
- Department of Plastic and Reconstructive Surgery, Université Libre de Bruxelles, 1070 Bruxelles, Belgium
| | - Lana Tarhini
- Faculty of Pharmaceutical Science, Université Libre de Bruxelles, 1070 Bruxelles, Belgium;
| | - Marie Doan
- Pediatric Surgery, Hôpital Riviera Chablais, 1847 Rennaz, Switzerland;
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4
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Dueppers P, Bozalka R, Kopp R, Menges AL, Reutersberg B, Schrimpf C, Moreno Rivero FJ, Zimmermann A. The Use of Intact Fish Skin Grafts in the Treatment of Necrotizing Fasciitis of the Leg: Early Clinical Experience and Literature Review on Indications for Intact Fish Skin Grafts. J Clin Med 2023; 12:6001. [PMID: 37762941 PMCID: PMC10532083 DOI: 10.3390/jcm12186001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/10/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Necrotizing fasciitis (NF) is a serious infectious disease that can initially place the patient's life in danger and, after successful surgical and antibiotic treatment, leaves extensive wounds with sometimes even exposed bones and tendons. Autologous skin grafts are not always possible or require adequate wound bed preparation. Novel intact fish skin grafts (iFSGs; Kerecis® Omega3 Wound, Kerecis hf, Isafjördur, Iceland) have already shown their potential to promote granulation in many other wound situations. Faster wound healing rates and better functional and cosmetic outcomes were observed due to their additionally postulated anti-inflammatory and analgesic properties. Therefore, iFSGs may also be essential in treating NF. We present our initial experience with iFSGs in treating leg wounds after NF and review the literature for the current spectrum of clinical use of iFSGs. CASE PRESENTATIONS We present two male patients (aged 60 and 69 years) with chronic or acute postsurgical extensive leg ulcers six weeks and six days after necrotizing fasciitis, respectively. Both suffered from diabetes mellitus without vascular pathologies of the lower limbs. A single application of one pre-meshed (Kerecis® Graftguide) and one self-meshed 300 cm2 iFSG (Kerecis® Surgiclose) was performed in our operation room after extensive surgical debridement and single circles of negative wound pressure therapy. Application and handling were easy. An excellent wound granulation was observed, even in uncovered tibia bone and tendons, accompanied by pain relief in both patients. Neither complications nor allergic reactions occurred. The patients received autologous skin grafting with excellent functional and cosmetic outcomes. CONCLUSIONS iFSGs have the potential to play a significant role in the future treatment of NF due to the fast promotion of wound granulation and pain relief. Our experience may encourage surgeons to use iFSGs in NF patients, although high-quality, large-sized studies are still required to confirm these results. The observed effects of iFSGs on wounds associated with NF may be transferred to other wound etiologies as well.
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Affiliation(s)
- Philip Dueppers
- Department of Vascular Surgery, University Hospital Zurich (USZ), University of Zurich (UZH), Raemistrasse 100, CH-8091 Zurich, Switzerland; (R.B.); (R.K.); (A.-L.M.); (B.R.); (C.S.); (A.Z.)
| | - Roland Bozalka
- Department of Vascular Surgery, University Hospital Zurich (USZ), University of Zurich (UZH), Raemistrasse 100, CH-8091 Zurich, Switzerland; (R.B.); (R.K.); (A.-L.M.); (B.R.); (C.S.); (A.Z.)
| | - Reinhard Kopp
- Department of Vascular Surgery, University Hospital Zurich (USZ), University of Zurich (UZH), Raemistrasse 100, CH-8091 Zurich, Switzerland; (R.B.); (R.K.); (A.-L.M.); (B.R.); (C.S.); (A.Z.)
| | - Anna-Leonie Menges
- Department of Vascular Surgery, University Hospital Zurich (USZ), University of Zurich (UZH), Raemistrasse 100, CH-8091 Zurich, Switzerland; (R.B.); (R.K.); (A.-L.M.); (B.R.); (C.S.); (A.Z.)
| | - Benedikt Reutersberg
- Department of Vascular Surgery, University Hospital Zurich (USZ), University of Zurich (UZH), Raemistrasse 100, CH-8091 Zurich, Switzerland; (R.B.); (R.K.); (A.-L.M.); (B.R.); (C.S.); (A.Z.)
| | - Claudia Schrimpf
- Department of Vascular Surgery, University Hospital Zurich (USZ), University of Zurich (UZH), Raemistrasse 100, CH-8091 Zurich, Switzerland; (R.B.); (R.K.); (A.-L.M.); (B.R.); (C.S.); (A.Z.)
| | - Francisco Jose Moreno Rivero
- Tissue Viability Service (Wound Care), University Hospital Zurich (USZ), Raemistrasse 100, CH-8091 Zurich, Switzerland;
| | - Alexander Zimmermann
- Department of Vascular Surgery, University Hospital Zurich (USZ), University of Zurich (UZH), Raemistrasse 100, CH-8091 Zurich, Switzerland; (R.B.); (R.K.); (A.-L.M.); (B.R.); (C.S.); (A.Z.)
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5
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Di Mitri M, Di Carmine A, Thomas E, Iacobacci G, Collautti E, D’Antonio S, Libri M, Gargano T, Lima M. Fish Skin Graft: Narrative Review and First Application for Abdominal Wall Dehiscence in Children. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5244. [PMID: 37718992 PMCID: PMC10501472 DOI: 10.1097/gox.0000000000005244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/20/2023] [Indexed: 09/19/2023]
Abstract
Acellular fish skin grafts (FSGs) are tissue-based products created by minimally processing the skin of the Atlantic cod (Gadus morhua). The FSG is rich in omega-3 and facilitates tissue regeneration by supporting revascularization and ingrowth in the proliferation and remodeling phases of wound healing. FSG is structurally more similar to human skin than antiviral-processed skin substitutes such as amniotic membrane, and there are no known prion, bacterial, or viral diseases that can be transmitted from North-Atlantic cod to humans. The FSG is processed using a proprietary method that preserves the structure and lipid composition of the skin. FSG is CE marked, and US Food and Drug Administration cleared for multiple clinical applications in partial and full-thickness wounds. FSG is currently the only acellular dermal matrix product that does not originate from mammalian tissues. For this narrative review, Medline and UpToDate were used to include a total of 21 articles published from 2015 to 2022 about fish skin graft use. We also reported a case of a 7-year-old boy who underwent treatment with FSG for abdominal wall dehiscence at our department of pediatric surgery, IRCCS Sant'Orsola-Malpighi, Alma Mater Studiorum, University of Bologna, University Hospital of Bologna. FSG provides a valuable and sustainable treatment that improves wound healing in both adult and pediatric populations. We described the first application of an FSG for wound dehiscence of the abdominal wall in a pediatric patient, reporting how FSG was completely reabsorbed and improved the skin's repair.
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Affiliation(s)
- Marco Di Mitri
- From Pediatric Surgery Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Annalisa Di Carmine
- From Pediatric Surgery Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Eduje Thomas
- From Pediatric Surgery Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giuseppe Iacobacci
- Sviluppo Professionale e Implementazione della Ricerca nelle Professioni Sanitarie, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Edoardo Collautti
- From Pediatric Surgery Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Simone D’Antonio
- From Pediatric Surgery Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Michele Libri
- From Pediatric Surgery Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Tommaso Gargano
- From Pediatric Surgery Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Mario Lima
- From Pediatric Surgery Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Xiao H, Chen X, Liu X, Wen G, Yu Y. Recent advances in decellularized biomaterials for wound healing. Mater Today Bio 2023; 19:100589. [PMID: 36880081 PMCID: PMC9984902 DOI: 10.1016/j.mtbio.2023.100589] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/07/2023] [Accepted: 02/18/2023] [Indexed: 02/24/2023] Open
Abstract
The skin is one of the most essential organs in the human body, interacting with the external environment and shielding the body from diseases and excessive water loss. Thus, the loss of the integrity of large portions of the skin due to injury and illness may lead to significant disabilities and even death. Decellularized biomaterials derived from the extracellular matrix of tissues and organs are natural biomaterials with large quantities of bioactive macromolecules and peptides, which possess excellent physical structures and sophisticated biomolecules, and thus, promote wound healing and skin regeneration. Here, we highlighted the applications of decellularized materials in wound repair. First, the wound-healing process was reviewed. Second, we elucidated the mechanisms of several extracellular matrix constitutes in facilitating wound healing. Third, the major categories of decellularized materials in the treatment of cutaneous wounds in numerous preclinical models and over decades of clinical practice were elaborated. Finally, we discussed the current hurdles in the field and anticipated the future challenges and novel avenues for research on decellularized biomaterials-based wound treatment.
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Affiliation(s)
- Huimin Xiao
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.,College of Fisheries and Life Science, Shanghai Ocean University, Shanghai, 201306, China
| | - Xin Chen
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.,College of Fisheries and Life Science, Shanghai Ocean University, Shanghai, 201306, China
| | - Xuanzhe Liu
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Gen Wen
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.,College of Fisheries and Life Science, Shanghai Ocean University, Shanghai, 201306, China
| | - Yaling Yu
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.,Institute of Microsurgery on Extremities, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
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7
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Hill DM, Hickerson WL, Carter JE. A Risk-Benefit Review of Currently Used Dermal Substitutes for Burn Wounds. J Burn Care Res 2023; 44:S26-S32. [PMID: 36567472 DOI: 10.1093/jbcr/irac131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
While split-thickness autologous skin grafts remain the most common method of definitive burn wound closure, dermal substitutes have emerged as an attractive option. There are many advantages of utilizing a dermal substitute, notably reducing the need for donor tissue and subsequent iatrogenic creation of a secondary wound. However, there are disadvantages with each that most be weighed and factored into the decision. And most come at a high initial financial cost. There is little comparative literature of the various available and emerging products. This analysis was performed to objectively present risks and benefits of each option.
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Affiliation(s)
- David M Hill
- Department of Pharmacy, Regional One Health, 877 Jefferson Avenue, Memphis, Tennessee 38103, USA
| | | | - Jeffrey E Carter
- Louisiana State University Health Sciences Center, 2000 Canal Street, New Orleans, Louisiana 70112, USA
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8
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Ciprandi G, Kjartansson H, Grussu F, Baldursson BT, Frattaroli J, Urbani U, Zama M. Use of acellular intact fish skin grafts in treating acute paediatric wounds during the COVID-19 pandemic: a case series. J Wound Care 2022; 31:824-831. [DOI: 10.12968/jowc.2022.31.10.824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Objective: More specific strategies are needed to support children requiring skin grafting. Our goal was to identify procedures that reduce operating times, post-operative complications, pain and length of hospital stay. Patient safety, optimal wound bed support and quick micro-debridement with locoregional anaesthesia were prioritised. Ultimately, a novel acellular fish skin graft (FSG) derived from north Atlantic cod was selected for use. Method: We admitted consecutive paediatric patients with various lesions requiring skin grafting for definitive wound closure. All FSGs were applied and bolstered in the operating room following debridement. Results: In a cohort of 15 patients, the average age was 8 years and 9 months (4 years 1 month–13 years 5 months). Negative pressure wound therapy (NPWT) was given to 12 patients. Rapid wound healing was observed in all patients, with a wound area coverage of 100% and complete healing in 95% of wounds. Time until engraftment in patients receiving NPWT was reduced by about a half (to an average 12 days) from our standard experience of 21 days. Ten patients received locoregional anaesthesia and were discharged after day surgery. The operating time was <60 minutes, and no complications or allergic reactions were reported. Excellent pliability of the healed wound was achieved in all patients, without signs of itching and scratching in the postoperative period. This case series is the first and largest using FSG to treat paediatric patients with different wound aetiologies. We attribute the rapid transition to acute wound status and the good pliability of the new epidermal–dermal complex to the preserved molecular components of the FSG, including omega-3. Conclusion: FSG represents an innovative and sustainable solution for paediatric wound care that results in shorter surgery time and reduced hospital stays, with accelerated wound healing times.
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Affiliation(s)
- Guido Ciprandi
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Hilmar Kjartansson
- Landspitali University Hospital, Reykjavik, Iceland
- Kerecis Limited, Reykjavik, Iceland
| | - Francesca Grussu
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Baldur T Baldursson
- Landspitali University Hospital, Reykjavik, Iceland
- Kerecis Limited, Reykjavik, Iceland
| | - Jacopo Frattaroli
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Urbano Urbani
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
| | - Mario Zama
- Division of Plastic and Maxillofacial Surgery, Bambino Gesu' Children's Hospital, Research Institute, Rome, Italy
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9
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Luze H, Nischwitz SP, Smolle C, Zrim R, Kamolz LP. The Use of Acellular Fish Skin Grafts in Burn Wound Management-A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:912. [PMID: 35888631 PMCID: PMC9323726 DOI: 10.3390/medicina58070912] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/08/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Burn wound healing and management continues to be a major challenge for patients and health care providers resulting in a considerable socio-economic burden. Recent advances in the development of applicable xenografts as an alternative to split-thickness skin grafts have allowed for the development of acellular fish skin. Acellular fish skin acts as a skin substitute, reducing inflammatory responses and advancing proinflammatory cytokines that promote wound healing. Due to these beneficial wound healing properties, acellular fish skin might represent an effective treatment approach in burn wound management. Materials and Methods: A systematic review of the literature, up to March 2022, was conducted using the electronic databases PubMed and Web of Science. Titles and abstracts were screened for the following key terms (variably combined): "fish skin", "fish skin grafts", "acellular fish skin", "Omega3 Wound matrix", "xenograft", "burn injury", "burns". Results: In total, 14 trials investigating the effects of acellular fish skin in burn wounds or split-thickness donor sites were determined eligible and included in the present review. Existing evidence on the use of acellular fish skin indicates an acceleration of wound healing, reduction in pain and necessary dressing changes as well as treatment-related costs and improved aesthetic and functional outcomes compared to conventional treatment options. Conclusions: Acellular fish skin xenografts may represent an effective, low-cost alternative in treatment of superficial- and partial-thickness burns. However, results mainly originate from preclinical and small cohort studies. Future larger cohort studies are warranted to elucidate the full potential of this promising approach.
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Affiliation(s)
- Hanna Luze
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (S.P.N.); (C.S.); (R.Z.); (L.-P.K.)
- Research Unit for Tissue Regeneration, Repair and Reconstruction c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Sebastian Philipp Nischwitz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (S.P.N.); (C.S.); (R.Z.); (L.-P.K.)
- Research Unit for Tissue Regeneration, Repair and Reconstruction c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Christian Smolle
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (S.P.N.); (C.S.); (R.Z.); (L.-P.K.)
| | - Robert Zrim
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (S.P.N.); (C.S.); (R.Z.); (L.-P.K.)
- International University of Monaco, 98000 Monaco-Ville, Monaco
| | - Lars-Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria; (S.P.N.); (C.S.); (R.Z.); (L.-P.K.)
- COREMED—Cooperative Centre for Regenerative Medicine, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria
- Research Unit for Safety in Health c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
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10
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Dawson KA, Mickelson MA, Blong AE, L Walton RA. Management of severe burn injuries with novel treatment techniques including maggot debridement and applications of acellular fish skin grafts and autologous skin cell suspension in a dog. J Am Vet Med Assoc 2022; 260:428-435. [PMID: 34843435 DOI: 10.2460/javma.20.10.0579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 3-year-old 27-kg female spayed American Bulldog with severe burn injuries caused by a gasoline can explosion was evaluated. CLINICAL FINDINGS The dog had extensive partial- and full-thickness burns with 50% of total body surface area affected. The burns involved the dorsum extending from the tail to approximately the 10th thoracic vertebra, left pelvic limb (involving 360° burns from the hip region to the tarsus), inguinal area bilaterally, right medial aspect of the thigh, and entire perineal region. Additional burns affected the margins of the pinnae and periocular regions, with severe corneal involvement bilaterally. TREATMENT AND OUTCOME The dog was hospitalized in the hospital's intensive care unit for 78 days. Case management involved provision of aggressive multimodal analgesia, systemic support, and a combination of novel debridement and reconstructive techniques. Debridement was facilitated by traditional surgical techniques in combination with maggot treatment. Reconstructive surgeries involved 6 staged procedures along with the use of novel treatments including applications of widespread acellular fish (cod) skin graft and autologous skin cell suspension. CLINICAL RELEVANCE The outcome for the dog of the present report highlighted the successful use of maggot treatment and applications of acellular cod skin and autologous skin cell suspension along with aggressive systemic management and long-term multimodal analgesia with debridement and wound reconstruction for management of severe burn injuries encompassing 50% of an animal's total body surface area.
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11
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Bay C, Chizmar Z, Reece EM, Yu JZ, Winocour J, Vorstenbosch J, Winocour S. Comparison of Skin Substitutes for Acute and Chronic Wound Management. Semin Plast Surg 2021; 35:171-180. [PMID: 34526865 DOI: 10.1055/s-0041-1731463] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Chronic and acute wounds, such as diabetic foot ulcers and burns, respectively, can be difficult to treat, especially when autologous skin transplantations are unavailable. Skin substitutes can be used as a treatment alternative by providing the structural elements and growth factors necessary for reepithelialization and revascularization from a nonautologous source. As of 2020, there are 76 commercially available skin substitute products; this article provides a review of the relevant literature related to the major categories of skin substitutes available.
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Affiliation(s)
- Caroline Bay
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Zachary Chizmar
- Michael E. DeBakey Department of Surgery, Division of General Surgery, Baylor College of Medicine, Houston, Texas
| | - Edward M Reece
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Jessie Z Yu
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Julian Winocour
- Department of Plastic Surgery, Vanderbilt University, Nashville, Tennessee
| | | | - Sebastian Winocour
- Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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Li D, Sun WQ, Wang T, Gao Y, Wu J, Xie Z, Zhao J, He C, Zhu M, Zhang S, Wang P, Mo X. Evaluation of a novel tilapia-skin acellular dermis matrix rationally processed for enhanced wound healing. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 127:112202. [PMID: 34225854 DOI: 10.1016/j.msec.2021.112202] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 04/21/2021] [Accepted: 05/16/2021] [Indexed: 12/14/2022]
Abstract
Acellular Dermal Matrix (ADM) is mainly made with human or porcine skins and has the risk of zoonotic virus transmission. The fish skin-derived ADM could overcome the shortcoming. Fish skin acellular matrix has been used as wound dressing, but there is few systematic studies on tilapia-skin acellular dermal matrix (TS-ADM). In the present study, a novel TS-ADM was made by an alkaline decellularization process and γ-irradiation. The physical properties, biocompatibility, pre-clinical safety and wound healing activity of TS-ADM were systematically evaluated for its value as a functionally bioactive wound dressing. Histopathological analysis (hematoxylin and eosin staining, 4,6-diamidino-2-phenylindole (DAPI) staining) and DNA quantification both proved that the nuclear components of tilapia skin were removed sufficiently in TS-ADM. Compared to the commercial porcine acellular dermal matrix (DC-ADM), TS-ADM has distinctive features in morphology, thermal stability, degradability and water vapor transmission. TS-ADM was more readily degradable than DC-ADM in vitro and in vivo. In both rat and mini-pig skin wound healing experiments, TS-ADM was shown to significantly promote granulation growth, collagen deposition, angiogenesis and re-epithelialization, which may be attributed to the high expression of transforming growth factor-beta 1 (TGF-β1), alpha-smooth muscle actin (α-SMA) and CD31. Herein, the novel TS-ADM, used as a low-cost bioactive dressing, could form a microenvironment conducive to wound healing.
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Affiliation(s)
- Dongsheng Li
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai 201620, PR China
| | - Wendell Q Sun
- Institute of Biothermal Science and Technology, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, PR China
| | - Tong Wang
- School of Life Sciences, Yantai University, Yantai 264005, PR China
| | - Yonglin Gao
- School of Life Sciences, Yantai University, Yantai 264005, PR China
| | - Jinglei Wu
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai 201620, PR China
| | - Zeping Xie
- School of Pharmaceutical Sciences, Binzhou Medical University, Yantai 264003, PR China
| | - Juanjuan Zhao
- School of Pharmaceutical Sciences, Binzhou Medical University, Yantai 264003, PR China
| | - Chuanglong He
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai 201620, PR China
| | - Meifang Zhu
- State Key Lab of Chemical Fibers & Polymer Materials, College of Materials Science & Engineering, Donghua University, Shanghai 201620, PR China
| | - Shumin Zhang
- School of Pharmaceutical Sciences, Binzhou Medical University, Yantai 264003, PR China
| | - Peng Wang
- Department of Plastic and Aesthetic Center, Yantai Yuhuangding Hospital, Yantai 264000, PR China.
| | - Xiumei Mo
- Shanghai Engineering Research Center of Nano-Biomaterials and Regenerative Medicine, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai 201620, PR China.
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Mathew-Steiner SS, Roy S, Sen CK. Collagen in Wound Healing. Bioengineering (Basel) 2021; 8:63. [PMID: 34064689 PMCID: PMC8151502 DOI: 10.3390/bioengineering8050063] [Citation(s) in RCA: 237] [Impact Index Per Article: 79.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/27/2021] [Accepted: 05/01/2021] [Indexed: 12/12/2022] Open
Abstract
Normal wound healing progresses through inflammatory, proliferative and remodeling phases in response to tissue injury. Collagen, a key component of the extracellular matrix, plays critical roles in the regulation of the phases of wound healing either in its native, fibrillar conformation or as soluble components in the wound milieu. Impairments in any of these phases stall the wound in a chronic, non-healing state that typically requires some form of intervention to guide the process back to completion. Key factors in the hostile environment of a chronic wound are persistent inflammation, increased destruction of ECM components caused by elevated metalloproteinases and other enzymes and improper activation of soluble mediators of the wound healing process. Collagen, being central in the regulation of several of these processes, has been utilized as an adjunct wound therapy to promote healing. In this work the significance of collagen in different biological processes relevant to wound healing are reviewed and a summary of the current literature on the use of collagen-based products in wound care is provided.
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Affiliation(s)
| | | | - Chandan K. Sen
- Indiana Center for Regenerative Medicine and Engineering, School of Medicine, Indiana University, Indianapolis, IN 46202, USA; (S.S.M.-S.); (S.R.)
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Chen H, Yin B, Hu B, Zhang B, Liu J, Jing Y, Fan Z, Tian Y, Wei X, Zhang W. Acellular fish skin enhances wound healing by promoting angiogenesis and collagen deposition. Biomed Mater 2021; 16. [PMID: 33730695 DOI: 10.1088/1748-605x/abef7a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/17/2021] [Indexed: 12/20/2022]
Abstract
Acellular matrix is a type of promising biomaterial for wound healing promotion. Although acellular bovine and porcine tissues have proven effective, religious restrictions and risks of disease transmission remain barriers to their clinical use. Acellular fish skin (AFS), given its similarity to human skin structure and without the aforementioned disadvantages, is thus seen as an attractive alternative. This study aims to fabricate AFS from the skin of black carp (Mylopharyngodon piceus), evaluate its physical and mechanical properties and assess its impact on wound healing. The results showed that AFS has a highly porous structure, along with high levels of hydrophilicity, water-absorption property and permeability. Furthermore, physical characterization showed the high tensile strength of AFS in dry and wet states, and high stitch tear resistance, indicating great potential in clinical applications. Cell Counting Kit-8 was used to test the viability of L929 cells when culturing in the extracts of AFS. Compared with the control group, there is no significant difference in optical density value when culturing in the extracts of AFS at days 1, 3 and 7 (*p> 0.05).In vivowound healing evaluation then highlighted its promotion of angiogenesis and collagen synthesis, its function in anti-inflammation and acceleration in wound healing. Therefore, this study suggests that AFS has potential as a promising alternative to mammal-derived or traditional wound dressing.
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Affiliation(s)
- Hongchi Chen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, People's Republic of China
| | - Bohao Yin
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, People's Republic of China
| | - Bin Hu
- Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, People's Republic of China
| | - Baokun Zhang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, People's Republic of China
| | - Jingwen Liu
- Wuxi 9th People's Hospital Affiliated to Soochow University, 999 Liangxi Road, Wuxi 214100, People's Republic of China
| | - Yingzhe Jing
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, People's Republic of China
| | - Zhiyuan Fan
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, People's Republic of China
| | - Yuchen Tian
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, People's Republic of China
| | - Xiaojuan Wei
- Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, People's Republic of China
| | - Wei Zhang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, People's Republic of China
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Cruz MA, Araujo TA, Avanzi IR, Parisi JR, de Andrade ALM, Rennó ACM. Collagen from Marine Sources and Skin Wound Healing in Animal Experimental Studies: a Systematic Review. MARINE BIOTECHNOLOGY (NEW YORK, N.Y.) 2021; 23:1-11. [PMID: 33404918 DOI: 10.1007/s10126-020-10011-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/29/2020] [Indexed: 06/12/2023]
Abstract
Collagen (Col) from marine organisms has been emerging as an important alternative for commercial Col and it has been considered highly attractive by the industry. Despite the positive effects of Col from marine origin, there is still limited understanding of the effects of this natural biomaterial in the process of wound healing in animal studies. In this context, the purpose of this study was to perform a systematic review of the literature to examine the effects of Col from different marine species in the process of skin tissue healing using experimental models of skin wound. The search was carried out according to the orientations of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and the descriptors of the Medical Subject Headings (MeSH) were defined: "marine collagen," "spongin," "spongin," "skin," and "wound." A total of 42 articles were retrieved from the databases PubMed and Scopus. After the eligibility analyses, this review covers the different marine sources of Col reported in 10 different papers from the beginning of 2011 through the middle of 2019. The results were based mainly on histological analysis and it demonstrated that Col-based treatment resulted in a higher deposition of granulation tissue, stimulation of re-epitalization and neoangiogenesis and increased amount of Col of the wound, culminating in a more mature morphological aspect. In conclusion, this review demonstrates that marine Col from different species presented positive effects on the process of wound skin healing in experimental models used, demonstrating the huge potential of this biomaterial for tissue engineering proposals.
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Affiliation(s)
- Matheus Almeida Cruz
- Department of Biosciences, Federal University of São Paulo (UNIFESP), Lab 342, 136 Silva Jardim Street, Santos, SP, 11015020, Brazil
| | - Tiago Akira Araujo
- Department of Biosciences, Federal University of São Paulo (UNIFESP), Lab 342, 136 Silva Jardim Street, Santos, SP, 11015020, Brazil
| | - Ingrid Regina Avanzi
- Department of Biosciences, Federal University of São Paulo (UNIFESP), Lab 342, 136 Silva Jardim Street, Santos, SP, 11015020, Brazil
- São Paulo State Faculty of Technology (FATEC), 350 Senador Feijó Avenue, Santos, SP, 11015502, Brazil
| | - Julia Risso Parisi
- Department of Biosciences, Federal University of São Paulo (UNIFESP), Lab 342, 136 Silva Jardim Street, Santos, SP, 11015020, Brazil
- Department of Physical Therapy, Federal University of São Carlos (UFSCar), km 235 Washington Luís Road, São Carlos, SP, 13565905, Brazil
| | - Ana Laura Martins de Andrade
- Department of Physical Therapy, Federal University of São Carlos (UFSCar), km 235 Washington Luís Road, São Carlos, SP, 13565905, Brazil
| | - Ana Claudia Muniz Rennó
- Department of Biosciences, Federal University of São Paulo (UNIFESP), Lab 342, 136 Silva Jardim Street, Santos, SP, 11015020, Brazil.
- Department of Physical Therapy, Federal University of São Carlos (UFSCar), km 235 Washington Luís Road, São Carlos, SP, 13565905, Brazil.
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