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Louri NA, Dey N, AlHasan RN, Abdulla SH, Elsakka M, Gulreez R, Darwish AH, Kadalmani B, Al Khalifa KBA. Abdominoplasty Panniculus as a Source for Human Acellular Dermis: A Preliminary Report. Tissue Eng Regen Med 2022; 19:727-738. [PMID: 35325403 PMCID: PMC9294103 DOI: 10.1007/s13770-022-00439-3] [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: 08/11/2021] [Revised: 01/07/2022] [Accepted: 02/02/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND In extensive deep dermal burn injuries, split-thickness skin graft (STSG) has been the most preferred treatment option for resurfacing burn wounds. A thick split-thickness skin graft is ideal for preventing graft contracture but is associated with delayed donor healing and the lack of adequate donor skin. When applied with STSG, the dermal substitutes offer better-reconstructed skin than STSG alone. Human-derived acellular dermal matrix (HADM) obtained from cadaver skin is a dermal equivalent with good clinical outcomes. However, high cost and limited cadaver donor skin availability limit its clinical utility. Developing a low-cost preparation method and finding an alternate source of human donated skin can help reduce the cost. The objective of this study was to explore the feasibility of making HADM from abdominoplasty panniculus skin. METHODS Skin samples were collected from the abdominoplasty panniculus of ten eligible donors with their informed consent. A combination of low-cost reagents-sodium chloride and hypotonic solution (water for injection) was used for decellularizing the skin. Characterization of the prepared Acellular Dermis Matrix prototype was done. RESULTS The skin was deepidermized with one molar NaCl treatment at 37 °C for 24 h. The deepidermized dermis became acellular with hypotonic solution treatment at 4 °C for two weeks. The hematoxylin and eosin staining and cytotoxicity test confirmed the acellularity and non-cytotoxicity of the prepared HADM prototype. The HADM prototype also facilitated the formation of neo-epithelium in the 3D cell co-culture model. CONCLUSION This study confirms that abdominoplasty panniculus can be a viable alternative for HADM preparation. Further characterization studies are required to prove the concept.
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Affiliation(s)
- Nayef Abdulrahman Louri
- Department of Plastic Surgery and Burn Unit, Bahrain Defence Force Royal Medical Services Military Hospital, Riffa, Southern Governorate, 28743, Bahrain.
| | - Nigamananda Dey
- Department of Plastic Surgery and Burn Unit, Bahrain Defence Force Royal Medical Services Military Hospital, Riffa, Southern Governorate, 28743, Bahrain
- Department of Animal Science, Bharathidasan University, Tiruchirappalli, Tamil Nadu, 620024, India
| | - Rashed N AlHasan
- Department of Plastic Surgery and Burn Unit, Bahrain Defence Force Royal Medical Services Military Hospital, Riffa, Southern Governorate, 28743, Bahrain
| | - Safa Hassan Abdulla
- Department of Pathology, Bahrain Defence Force Royal Medical Services, Riffa, Bahrain
| | - Mohamed Elsakka
- Department of Plastic Surgery and Burn Unit, Bahrain Defence Force Royal Medical Services Military Hospital, Riffa, Southern Governorate, 28743, Bahrain
| | - Rasheeqa Gulreez
- Department of Plastic Surgery and Burn Unit, Bahrain Defence Force Royal Medical Services Military Hospital, Riffa, Southern Governorate, 28743, Bahrain
| | | | - Balamuthu Kadalmani
- Department of Animal Science, Bharathidasan University, Tiruchirappalli, Tamil Nadu, 620024, India
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Dearman BL, Greenwood JE. Scale-up of a Composite Cultured Skin Using a Novel Bioreactor Device in a Porcine Wound Model. J Burn Care Res 2021; 42:1199-1209. [PMID: 33640976 DOI: 10.1093/jbcr/irab034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Extensive deep-burn management with a two-stage strategy can reduce reliance on skin autografts; a biodegradable polyurethane scaffold to actively temporize the wound and later an autologous composite cultured skin (CCS) for definitive closure. The materials fulfilling each stage have undergone in vitro and in vivo pretesting in "small" large animal wounds. For humans, producing multiple, large CCSs requires a specialized bioreactor. This article reports a system used to close large porcine wounds. Three Large White pigs were used, each with two wounds (24.5 cm × 12 cm) into which biodegradable dermal scaffolds were implanted. A sample from discarded tissue allowed isolation/culture of autologous fibroblasts and keratinocytes. CCS production began by presoaking a 1-mm-thick biodegradable polyurethane foam in autologous plasma. In the bioreactor cassette, fibroblasts were seeded into the matrix with thrombin until established, followed by keratinocytes. The CCSs were applied onto integrated dermal scaffolds on day 35, alongside a sheet skin graft (30% of one wound). Serial punch biopsies, trans-epidermal water loss readings (TEWL), and wound measurements indicated epithelialization. During dermal scaffold integration, negligible wound contraction was observed (average 4.5%). After CCS transplantation, the control skin grafts were "taken" by day 11 when visible islands of epithelium were clinically observed on 2/3 CCSs. Closure was confirmed histologically, with complete epithelialization by day 63 post-CCS transplantation (CCS TEWL ~ normal skin average 11.9 g/m2h). Four of six wounds demonstrated closure with robust, stratified epithelium. Generating large pieces of CCS capable of healing large wounds is thus possible using a specialized designed bioreactor.
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Affiliation(s)
- Bronwyn L Dearman
- Skin Engineering Laboratory, Adult Burn Centre, Royal Adelaide Hospital, SA, Australia.,Faculty of Health Sciences, The University of Adelaide, SA, Australia
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Rios-Galacho M, Martinez-Moreno D, López-Ruiz E, Galvez-Martin P, Marchal JA. An overview on the manufacturing of functional and mature cellular skin substitutes. TISSUE ENGINEERING PART B-REVIEWS 2021; 28:1035-1052. [PMID: 34652978 DOI: 10.1089/ten.teb.2021.0131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
There are different types of skin diseases due to chronic injuries that impede the natural healing process of the skin. Tissue engineering (TE) has focused on the development of bioengineered skin or skin substitutes that cover the wound, providing the necessary care to restore the functionality of injured skin. There are two types of substitutes: acellular skin substitutes (ASSs), which offer a low response of the body, and cellular skin substitutes (CSSs), which incorporate living cells and appear as a great alternative in the treatment of skin injuries due to them presenting a greater interaction and integration with the rest of the body. For the development of a CSS, it is necessary to select the most suitable biomaterials, cell components, and methodology of biofabrication for the wound to be treated. Moreover, these CSSs are immature substitutes that must undergo a maturing process in specific bioreactors, guaranteeing their functionality. The bioreactor simulates the natural state of maturation of the skin by controlling parameters such as temperature, pressure, or humidity, allowing a homogeneous maturation of the CSSs in an aseptic environment. The use of bioreactors not only contributes to the maturation of the CSSs, but also offers a new way of obtaining large sections of skin substitutes or natural skin from small portions acquired from the patient, donor, or substitute. Based on the innovation of this technology and the need to develop efficient CSSs, this work offers an update on bioreactor technology in the field of skin regeneration.
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Affiliation(s)
| | | | - Elena López-Ruiz
- Universidad de Jaen, 16747, Department of Health Sciences, Jaen, Andalucía, Spain;
| | | | - Juan Antonio Marchal
- University of Granada, humqn Anatomy and embriology, avd del conocimiento nº 11, Granada, Granada, Spain, 18016;
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Huh MI, Yi SJ, Lee KP, Kim HK, An SH, Kim DB, Ryu RH, Kim JS, Lim JO. Full Thickness Skin Expansion ex vivo in a Newly Developed Reactor and Evaluation of Auto-Grafting Efficiency of the Expanded Skin Using Yucatan Pig Model. Tissue Eng Regen Med 2018; 15:629-638. [PMID: 30603584 PMCID: PMC6171704 DOI: 10.1007/s13770-018-0154-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Skin grafts are required in numerous clinical procedures, such as reconstruction after skin removal and correction of contracture or scarring after severe skin loss caused by burns, accidents, and trauma. The current standard for skin defect replacement procedures is the use of autologous skin grafts. However, donor-site tissue availability remains a major obstacle for the successful replacement of skin defects and often limits this option. The aim of this study is to effectively expand full thickness skin to clinically useful size using an automated skin reactor and evaluate auto grafting efficiency of the expanded skin using Yucatan female pigs. METHODS We developed an automated bioreactor system with the functions of real-time monitoring and remote-control, optimization of grip, and induction of skin porosity for effective tissue expansion. We evaluated the morphological, ultra-structural, and mechanical properties of the expanded skin before and after expansion using histology, immunohistochemistry, and tensile testing. We further carried out in vivo grafting study using Yucatan pigs to investigate the feasibility of this method in clinical application. RESULTS The results showed an average expansion rate of 180%. The histological findings indicated that external expansion stimulated cellular activity in the isolated skin and resulted in successful grafting to the transplanted site. Specifically, hyperplasia did not appear at the auto-grafted site, and grafted skin appeared similar to normal skin. Furthermore, mechanical stimuli resulted in an increase in COL1A2 expression in a suitable environment. CONCLUSIONS These findings provided insight on the potential of this expansion system in promoting dermal extracellular matrix synthesis in vitro. Conclusively, this newly developed smart skin bioreactor enabled effective skin expansion ex vivo and successful grafting in vivo in a pig model.
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Affiliation(s)
- Man-Il Huh
- Biomedical Research Institute, Joint Institute for Regenerative Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944 Republic of Korea
- School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944 Republic of Korea
| | - Soo-Jin Yi
- Biomedical Research Institute, Joint Institute for Regenerative Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944 Republic of Korea
- School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944 Republic of Korea
| | - Kyung-Pil Lee
- Biomedical Research Institute, Joint Institute for Regenerative Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944 Republic of Korea
- School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944 Republic of Korea
| | - Hong Kyun Kim
- Biomedical Research Institute, Joint Institute for Regenerative Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944 Republic of Korea
- School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu, 41944 Republic of Korea
| | - Sang-Hyun An
- Daegu-Gyeongbuk Medical Innovation Foundation, 88 Dongnae-ro (360-4 Dongnae-dong), Dong-gu, Daegu, 41061 Republic of Korea
| | - Dan-Bi Kim
- Daegu-Gyeongbuk Medical Innovation Foundation, 88 Dongnae-ro (360-4 Dongnae-dong), Dong-gu, Daegu, 41061 Republic of Korea
| | - Rae-Hyung Ryu
- Daegu-Gyeongbuk Medical Innovation Foundation, 88 Dongnae-ro (360-4 Dongnae-dong), Dong-gu, Daegu, 41061 Republic of Korea
| | - Jun-Sik Kim
- Daegu-Gyeongbuk Medical Innovation Foundation, 88 Dongnae-ro (360-4 Dongnae-dong), Dong-gu, Daegu, 41061 Republic of Korea
| | - Jeong Ok Lim
- Biomedical Research Institute, Joint Institute for Regenerative Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944 Republic of Korea
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