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Gerster-Barzanji Z, Woodtli V, Klix M, Biedermann T, Schiestl C, Neuhaus K, Farkas M, Kamarachev J, Rittirsch D, Böttcher-Haberzeth S. Long-Term Histological Evaluation of a Novel Dermal Template in the Treatment of Pediatric Burns. Bioengineering (Basel) 2024; 11:1270. [PMID: 39768088 PMCID: PMC11672911 DOI: 10.3390/bioengineering11121270] [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: 11/13/2024] [Revised: 12/06/2024] [Accepted: 12/11/2024] [Indexed: 01/11/2025] Open
Abstract
For pediatric patients with full-thickness burns, achieving adequate dermal regeneration is essential to prevent inelastic scars that may hinder growth. Traditional autologous split-thickness skin grafts alone often fail to restore the dermal layer adequately. This study evaluates the long-term effect of using a NovoSorb® Biodegradable Temporizing Matrix (BTM) as a dermal scaffold in four pediatric patients, promoting dermal formation before autografting. Pediatric burn patients treated at the University Children's Hospital Zurich between 2020 and 2022 underwent a two-step treatment involving NovoSorb® BTM application, followed by autografting. Histological analysis, conducted through 22 punch biopsies taken up to 2.6 years post-application, demonstrated robust dermal reorganization, with mature epidermal regeneration and stable dermo-epidermal connections. Immunofluorescence staining showed rapid capillary ingrowth, while extracellular matrix components, including collagen and elastic fibers, gradually aligned over time, mimicking normal skin structure. By 2.6 years, the dermal layer displayed characteristics close to uninjured skin, with remnants of NovoSorb® BTM degrading within five months post-application. This study suggests that NovoSorb® BTM facilitates elastic scar formation, offering significant benefits for pediatric patients by reducing functional limitations associated with inelastic scarring.
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Affiliation(s)
- Zeena Gerster-Barzanji
- Paediatric Burn Center, Children’s Skin Center, Department of Surgery, University Children’s Hospital Zurich, Lenggstrasse 30, 8008 Zurich, Switzerland; (Z.G.-B.); (V.W.); (M.K.); (C.S.); (K.N.); (M.F.)
- Children’s Research Center (CRC), University Children’s Hospital Zurich, University of Zurich, Lenggstrasse 30, 8008 Zurich, Switzerland;
- Faculty of Medicine, University of Zurich (UZH), Rämistrasse 71, 8006 Zurich, Switzerland;
| | - Vivienne Woodtli
- Paediatric Burn Center, Children’s Skin Center, Department of Surgery, University Children’s Hospital Zurich, Lenggstrasse 30, 8008 Zurich, Switzerland; (Z.G.-B.); (V.W.); (M.K.); (C.S.); (K.N.); (M.F.)
- Children’s Research Center (CRC), University Children’s Hospital Zurich, University of Zurich, Lenggstrasse 30, 8008 Zurich, Switzerland;
- Faculty of Medicine, University of Zurich (UZH), Rämistrasse 71, 8006 Zurich, Switzerland;
| | - Mira Klix
- Paediatric Burn Center, Children’s Skin Center, Department of Surgery, University Children’s Hospital Zurich, Lenggstrasse 30, 8008 Zurich, Switzerland; (Z.G.-B.); (V.W.); (M.K.); (C.S.); (K.N.); (M.F.)
- Children’s Research Center (CRC), University Children’s Hospital Zurich, University of Zurich, Lenggstrasse 30, 8008 Zurich, Switzerland;
- Faculty of Medicine, University of Zurich (UZH), Rämistrasse 71, 8006 Zurich, Switzerland;
| | - Thomas Biedermann
- Children’s Research Center (CRC), University Children’s Hospital Zurich, University of Zurich, Lenggstrasse 30, 8008 Zurich, Switzerland;
- Faculty of Medicine, University of Zurich (UZH), Rämistrasse 71, 8006 Zurich, Switzerland;
- Tissue Biology Research Unit, Department of Surgery, University Children’s Hospital Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Clemens Schiestl
- Paediatric Burn Center, Children’s Skin Center, Department of Surgery, University Children’s Hospital Zurich, Lenggstrasse 30, 8008 Zurich, Switzerland; (Z.G.-B.); (V.W.); (M.K.); (C.S.); (K.N.); (M.F.)
- Children’s Research Center (CRC), University Children’s Hospital Zurich, University of Zurich, Lenggstrasse 30, 8008 Zurich, Switzerland;
- Faculty of Medicine, University of Zurich (UZH), Rämistrasse 71, 8006 Zurich, Switzerland;
| | - Kathrin Neuhaus
- Paediatric Burn Center, Children’s Skin Center, Department of Surgery, University Children’s Hospital Zurich, Lenggstrasse 30, 8008 Zurich, Switzerland; (Z.G.-B.); (V.W.); (M.K.); (C.S.); (K.N.); (M.F.)
- Children’s Research Center (CRC), University Children’s Hospital Zurich, University of Zurich, Lenggstrasse 30, 8008 Zurich, Switzerland;
- Faculty of Medicine, University of Zurich (UZH), Rämistrasse 71, 8006 Zurich, Switzerland;
| | - Melinda Farkas
- Paediatric Burn Center, Children’s Skin Center, Department of Surgery, University Children’s Hospital Zurich, Lenggstrasse 30, 8008 Zurich, Switzerland; (Z.G.-B.); (V.W.); (M.K.); (C.S.); (K.N.); (M.F.)
- Children’s Research Center (CRC), University Children’s Hospital Zurich, University of Zurich, Lenggstrasse 30, 8008 Zurich, Switzerland;
- Faculty of Medicine, University of Zurich (UZH), Rämistrasse 71, 8006 Zurich, Switzerland;
| | - Jivko Kamarachev
- Faculty of Medicine, University of Zurich (UZH), Rämistrasse 71, 8006 Zurich, Switzerland;
- Department of Dermatology, University Hospital of Zurich, Wagistrasse 18, 8952 Schlieren, Switzerland
| | - Daniel Rittirsch
- Department of Plastic and Reconstructive Surgery, Klinik am Sonnenberg, Leibnizstrasse 19, 65191 Wiesbaden, Germany
| | - Sophie Böttcher-Haberzeth
- Paediatric Burn Center, Children’s Skin Center, Department of Surgery, University Children’s Hospital Zurich, Lenggstrasse 30, 8008 Zurich, Switzerland; (Z.G.-B.); (V.W.); (M.K.); (C.S.); (K.N.); (M.F.)
- Children’s Research Center (CRC), University Children’s Hospital Zurich, University of Zurich, Lenggstrasse 30, 8008 Zurich, Switzerland;
- Faculty of Medicine, University of Zurich (UZH), Rämistrasse 71, 8006 Zurich, Switzerland;
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Rajaram R, Zhang M, Premaratne G, Ng S. Novosorb ® BTM- history, production and application in challenging wounds. Front Bioeng Biotechnol 2024; 12:1450973. [PMID: 39634098 PMCID: PMC11615573 DOI: 10.3389/fbioe.2024.1450973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 10/30/2024] [Indexed: 12/07/2024] Open
Abstract
Novosorb® Biodegradable Temporising Matrix (BTM) is an entirely synthetic dermal matrix that is gaining popularity in the management of challenging wounds. Not only does it provide a framework in which to grow an organised neodermis, it is also especially resistant to infection. Today, the matrix is available as a 2 mm thick open cell polyurethane foam with a non-degrading sealing membrane. Its current form is the result of numerous in vitro and in vivo experiments that examined its shape, biodegradation, inflammatory response, and cytotoxicity. Clinical data on the use of BTM in a variety of cases is novel and presents early insights into its ability to foster wound healing where otherwise improbable. This review presents the history and development of Novosorb® BTM as well as all the currently available clinical data on its efficacy in difficult wounds such as: major burns, necrotising soft tissue infection, chronic wounds and in non graftable wound beds.
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Affiliation(s)
- Rohan Rajaram
- Department of Plastic and Reconstructive Surgery, Austin Health, Heidelberg, VIC, Australia
| | - Min Zhang
- Department of Plastic and Reconstructive Surgery, Austin Health, Heidelberg, VIC, Australia
| | - Gehan Premaratne
- Department of Plastic and Reconstructive Surgery, Austin Health, Heidelberg, VIC, Australia
- Department of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Sally Ng
- Department of Plastic and Reconstructive Surgery, Austin Health, Heidelberg, VIC, Australia
- Department of Surgery (Austin Precinct), The University of Melbourne, VIC, Australia
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Marquez JL, Nuckles B, Tausinga T, Foley B, Sudbury D, Sueoka S, Zang C, Lewis P, Goodwin I. Analysis of the Radial Forearm Phalloplasty Donor Site: Do Dermal Matrices Improve Donor Site Morbidity? PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6114. [PMID: 39228422 PMCID: PMC11368217 DOI: 10.1097/gox.0000000000006114] [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: 02/21/2024] [Accepted: 07/01/2024] [Indexed: 09/05/2024]
Abstract
Background The radial forearm free flap is frequently chosen for phalloplasty; however, flap size required for phalloplasty is associated with a large scar burden and functional concerns. We sought to investigate donor site functionality, aesthetics, and volume deficits in a cohort of individuals who underwent radial forearm phalloplasty (RFP) with donor site skin grafting alone or dermal substitute and subsequent skin grafting. Methods Donor site functionality was assessed using the quick Disabilities of Arm, Shoulder, and Hand (qDASH). Patient- and clinician-reported aesthetics were assessed using the Patient and Observer Scar Assessment Scale (POSAS). An Artec Leo three-dimensional scanner was used to measure volumetric differences from the donor site forearm and contralateral forearm. Results Fifteen patients who underwent RFP agreed to participate. No statistically significant differences were identified between different donor site closure methods regarding qDASH, patient-reported POSAS, or total volumetric deficits. A blinded clinician reported that POSAS approached significance at 4.7 for biodegradable temporizing matrix (BTM), 4.2 for Integra, and 3.0 for split-thickness skin graft (P = 0.05). No statistically significant differences were identified regarding distal, middle, or proximal volume deficits; however, a trend was observed regarding total volumetric deficits with BTM experiencing the lowest deficit (10.3 cm3) and skin graft experiencing the highest deficit (21.5 cm3, P = 0.82). Conclusions The addition of dermal matrix (BTM or Integra) to the treatment algorithm for RFP did not show statistically significant improvement in donor site volume deficits, patient-reported scar appearance (POSAS), or functionality (qDASH).
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Affiliation(s)
- Jessica L. Marquez
- From the Division of Plastic Surgery, Department of Surgery, The University of Utah Hospital, Salt Lake City, Utah
| | - Brandon Nuckles
- From the Division of Plastic Surgery, Department of Surgery, The University of Utah Hospital, Salt Lake City, Utah
| | - Telisha Tausinga
- From the Division of Plastic Surgery, Department of Surgery, The University of Utah Hospital, Salt Lake City, Utah
| | - Brittany Foley
- From the Division of Plastic Surgery, Department of Surgery, The University of Utah Hospital, Salt Lake City, Utah
| | - Dallin Sudbury
- Department of Orthopedics, The University of Utah Hospital, Salt Lake City, Utah
| | - Stephanie Sueoka
- Department of Orthopedics, The University of Utah Hospital, Salt Lake City, Utah
| | - Chong Zang
- Division of Epidemiology, Department of Internal Medicine, The University of Utah Hospital, Salt Lake City, Utah
| | - Priya Lewis
- From the Division of Plastic Surgery, Department of Surgery, The University of Utah Hospital, Salt Lake City, Utah
| | - Isak Goodwin
- From the Division of Plastic Surgery, Department of Surgery, The University of Utah Hospital, Salt Lake City, Utah
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Feng Z, Wang S, Huang W, Bai W. A potential bilayer skin substitute based on electrospun silk-elastin-like protein nanofiber membrane covered with bacterial cellulose. Colloids Surf B Biointerfaces 2024; 234:113677. [PMID: 38043505 DOI: 10.1016/j.colsurfb.2023.113677] [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: 10/05/2023] [Revised: 11/15/2023] [Accepted: 11/25/2023] [Indexed: 12/05/2023]
Abstract
Skin substitutes are designed to promote wound healing by replacing extracellular matrix. Silk-elastin-like protein is a renewable extracellular matrix-like material that integrated the advantages of silk and elastin-like protein. In this study, electrospun silk-elastin-like protein (SELP) nanofiber membrane covered with bacterial cellulose (BC) was created as a potential skin substitute to mimic gradient structure of epidermis and dermis of skin. The two layers were glued together using adhesive SELP containing 3,4-dihydroxyphenylalanine (DOPA) converted from tyrosine by tyrosinase. Skin topical drugs commonly used in clinical practice can penetrate through the SELP/BC barrier, and the rate of penetration is proportional to drug concentration. BC with dense fibrous structure can act as a barrier to preserve the inner SELP layer and prevent bacterial invasion, with a blocking permeation efficiency over 99% against four species of bacteria. Cell experiments demonstrated that the reticular fibers of SELP could provide an appropriate growth environment for skin cells proliferation and adhesion, which is considered to promote tissue repair and regeneration. The promising results support this strategy to fabricate a silk-elastin-like protein-based biomaterial for skin substitutes in the clinical treatment of full skin injuries and ulcers.
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Affiliation(s)
- Zhaoxuan Feng
- Key Laboratory of Engineering Biology for Low-Carbon Manufacturing, Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, 32 West 7th Avenue, Tianjin Airport Economic Area, Tianjin 300308, China
| | - Sijia Wang
- Key Laboratory of Engineering Biology for Low-Carbon Manufacturing, Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, 32 West 7th Avenue, Tianjin Airport Economic Area, Tianjin 300308, China
| | - Wenxin Huang
- College of Biotechnology, Tianjin University of Science and Technology, Tianjin 300457, China
| | - Wenqin Bai
- Key Laboratory of Engineering Biology for Low-Carbon Manufacturing, Tianjin Institute of Industrial Biotechnology, Chinese Academy of Sciences, 32 West 7th Avenue, Tianjin Airport Economic Area, Tianjin 300308, China.
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Pappalardo A, Alvarez Cespedes D, Fang S, Herschman AR, Jeon EY, Myers KM, Kysar JW, Abaci HE. Engineering edgeless human skin with enhanced biomechanical properties. SCIENCE ADVANCES 2023; 9:eade2514. [PMID: 36706190 PMCID: PMC9882972 DOI: 10.1126/sciadv.ade2514] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/23/2022] [Indexed: 06/01/2023]
Abstract
Despite the advancements in skin bioengineering, 3D skin constructs are still produced as flat tissues with open edges, disregarding the fully enclosed geometry of human skin. Therefore, they do not effectively cover anatomically complex body sites, e.g., hands. Here, we challenge the prevailing paradigm by engineering the skin as a fully enclosed 3D tissue that can be shaped after a body part and seamlessly transplanted as a biological clothing. Our wearable edgeless skin constructs (WESCs) show enhanced dermal extracellular matrix (ECM) deposition and mechanical properties compared to conventional constructs. WESCs display region-specific cell/ECM alignment, as well as physiologic anisotropic mechanical properties. WESCs replace the skin in full-thickness wounds of challenging body sites (e.g., mouse hindlimbs) with minimal suturing and shorter surgery time. This study provides a compelling technology that may substantially improve wound care and suggests that the recapitulation of the tissue macroanatomy can lead to enhanced biological function.
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Affiliation(s)
- Alberto Pappalardo
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - David Alvarez Cespedes
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Shuyang Fang
- Department of Mechanical Engineering, School of Engineering and Applied Science, Columbia University, New York, NY 10027, USA
| | - Abigail R. Herschman
- Department of Mechanical Engineering, School of Engineering and Applied Science, Columbia University, New York, NY 10027, USA
| | - Eun Young Jeon
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Kristin M. Myers
- Department of Mechanical Engineering, School of Engineering and Applied Science, Columbia University, New York, NY 10027, USA
| | - Jeffrey W. Kysar
- Department of Mechanical Engineering, School of Engineering and Applied Science, Columbia University, New York, NY 10027, USA
- Department of Otolaryngology - Head & Neck Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Hasan Erbil Abaci
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY 10032, USA
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