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Bickerton S, Nizamoglu M, Emamdee R, Frew Q, Borrows E, Bangalore H, Hussey J, Khan W, Martin N, Barnes D, El-Muttardi N, Shelley OP, Dziewulski P. An eighteen-year review of intensive care requirements for paediatric burns in a regional burns service. J Plast Reconstr Aesthet Surg 2024; 91:258-267. [PMID: 38428234 DOI: 10.1016/j.bjps.2024.02.023] [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: 12/22/2023] [Accepted: 02/04/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION Advances in burns management have reduced mortality. Consequently, efficient resource management plays an increasingly important role in improving paediatric burns care. This study aims to assess the support requirements and outcomes of paediatric burns patients admitted to a burns centre intensive care unit in comparison to established benchmarks in burns care. METHOD A retrospective review of burns patients under the age of 16 years old, admitted to a regional burns service intensive care unit between March 1998 and March 2016 was conducted. RESULTS Our analysis included 234 patients, with the percentage of TBSA affected by burn injury ranging from 1.5% to 95.0%. The median (IQR) %TBSA was 20.0% (11.0-30.0), and the observed mortality rate was 2.6% (6/234). The median (IQR) length of stay was 0.7 days/%TBSA burn (0.4-1.2), 17.9% (41/229) required circulatory support and 2.6% (6/234) required renal replacement. Mortality correlated with smoke inhalation injury (P < 0.001), %TBSA burn (P = 0.049) and complications (P = 0.004) including infections (P = 0.013). CONCLUSIONS Among children with burn injuries who require intensive care, the presence of inhalational injury and the diagnosis of infection are positively correlated with mortality. Understanding the requirements for organ support can facilitate a more effective allocation of resources within a burns service.
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Affiliation(s)
- Shixin Bickerton
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK.
| | - Metin Nizamoglu
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - Russel Emamdee
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - Quentin Frew
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - Emma Borrows
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK; Paediatric Intensive Care, Great Ormond Street Hospital, London, UK
| | - Harish Bangalore
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK; Paediatric Intensive Care, Great Ormond Street Hospital, London, UK
| | - Joseph Hussey
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - Waseemullah Khan
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - Niall Martin
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK; Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, UK
| | - David Barnes
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - Naguib El-Muttardi
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - Odhran P Shelley
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK; Department of Surgery, Trinity College Dublin, Ireland
| | - Peter Dziewulski
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK; St Andrews Anglia Ruskin Research Group, Anglia Ruskin University, Chelmsford, UK
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Dargan D, Kazzazi D, Limnatitou D, Cochrane E, Stubbington Y, Shokrollahi K, Ralston D. Acute Management of Thermal Hand Burns in Adults: A 10-Year Review of the Literature. Ann Plast Surg 2021; 86:517-531. [PMID: 33675628 DOI: 10.1097/sap.0000000000002755] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Advances in the evidence base of acute thermal hand burns help to guide the management of these common injuries. The aim of this literature review was to evaluate recent evidence in the field over 10 years. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols methodology was used as a guide for this literature review. PubMed, MEDLINE, EMBASE, CINAHL, and Google Scholar were searched for English language articles related to hand burns published between 2009 and 2018 inclusive, and the Cochrane Library was reviewed. Exclusion criteria were as follows: participants younger than 18 years, scar or contracture management, rehabilitation, outcomes assessment, late reconstruction, and electrical or chemical burns. RESULTS An initial search retrieved 6493 articles, which was narrowed to 403 full-text articles that were reviewed independently by 3 of the authors and categorized. Of 202 included articles, there were 8 randomized controlled trials and 2 systematic reviews. Six evidence-based guidelines were reviewed. Referral of hand burns to specialist centers, use of telemedicine, early excision and grafting, and immediate static splintage have been recommended. Enzymatic debridement results in earlier intervention, more accurate burn assessment, preservation of vital tissue, and fewer skin grafts, and ideally requires regional anesthesia. Guidance on escharotomy emphasizes indication, technique and adequate intervention, and potential for enzymatic debridement. Inclusion of topical negative pressure, dermal regenerative templates, acellular dermal matrices, and noncellular skin substitutes in management has helped improve scar and functional outcomes. DISCUSSION The results of this literature review demonstrate that multiple national and international societies have published burns guidelines during the decade studied, with aspects directly relevant to hand burns, including the International Society for Burn Injuries guidelines. There are opportunities for evidence-based quality improvement across the field of hand burns in many centers. CONCLUSIONS More than 200 articles globally in 10 years outline advances in the understanding of acute management of thermal hand burns. Incorporating the evidence base into practice may facilitate optimization of triage referral pathways and acute management for hand burns.
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Affiliation(s)
| | - Diana Kazzazi
- From the Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital
| | | | - Elliott Cochrane
- From the Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital
| | | | - Kayvan Shokrollahi
- Mersey Regional Burns Centre, St Helens and Knowsley Teaching Hospitals NHS Trust, Whiston Hospital, Merseyside, Prescot, United Kingdom
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Lo CH, Chong E, Akbarzadeh S, Brown WA, Cleland H. A systematic review: Current trends and take rates of cultured epithelial autografts in the treatment of patients with burn injuries. Wound Repair Regen 2019; 27:693-701. [DOI: 10.1111/wrr.12748] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/15/2019] [Accepted: 07/07/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Cheng H. Lo
- Victorian Adult Burns Service Melbourne Victoria Australia
- Department of Surgery, Central Clinical SchoolMonash University Melbourne Victoria Australia
| | - Elaine Chong
- Centre for Eye Research AustraliaRoyal Victorian Eye & Ear Hospital East Melbourne Victoria Australia
| | - Shiva Akbarzadeh
- Skin Bioengineering LaboratoryVictorian Adult Burns Service Melbourne Victoria Australia
| | - Wendy A. Brown
- Department of Surgery, Central Clinical SchoolMonash University Melbourne Victoria Australia
| | - Heather Cleland
- Victorian Adult Burns Service Melbourne Victoria Australia
- Department of Surgery, Central Clinical SchoolMonash University Melbourne Victoria Australia
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Watt SM, Pleat JM. Stem cells, niches and scaffolds: Applications to burns and wound care. Adv Drug Deliv Rev 2018; 123:82-106. [PMID: 29106911 DOI: 10.1016/j.addr.2017.10.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 10/19/2017] [Accepted: 10/22/2017] [Indexed: 12/11/2022]
Abstract
The importance of skin to survival, and the devastating physical and psychological consequences of scarring following reparative healing of extensive or difficult to heal human wounds, cannot be disputed. We discuss the significant challenges faced by patients and healthcare providers alike in treating these wounds. New state of the art technologies have provided remarkable insights into the role of skin stem and progenitor cells and their niches in maintaining skin homeostasis and in reparative wound healing. Based on this knowledge, we examine different approaches to repair extensive burn injury and chronic wounds, including full and split thickness skin grafts, temporising matrices and scaffolds, and composite cultured skin products. Notable developments include next generation skin substitutes to replace split thickness skin autografts and next generation gene editing coupled with cell therapies to treat genodermatoses. Further refinements are predicted with the advent of bioprinting technologies, and newly defined biomaterials and autologous cell sources that can be engineered to more accurately replicate human skin architecture, function and cosmesis. These advances will undoubtedly improve quality of life for patients with extensive burns and difficult to heal wounds.
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Affiliation(s)
- Suzanne M Watt
- Stem Cell Research, Nuffield Division of Clinical Laboratory Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9BQ, UK.
| | - Jonathan M Pleat
- Department of Plastic and Reconstructive Surgery, North Bristol NHS Trust and University of Bristol, Westbury on Trym, Bristol BS9 3TZ, UK.
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Abstract
BACKGROUND Pure regenerative healing with little to no donor morbidity remains an elusive goal for both surgeon and patient. The ability to engineer and promote the development of like tissue holds so much promise, and efforts in this direction are slowly but steadily advancing. METHODS Products selected and reviewed reflect historical precedence and importance and focus on current clinically available products in use. Emerging technologies we anticipate will further expand our therapeutic options are introduced. The topic of tissue engineering is incredibly broad in scope, and as such the authors have focused their review on that of constructs specifically designed for skin and wound healing. A review of pertinent and current clinically related literature is included. RESULTS Products such as biosynthetics, biologics, cellular promoting factors, and commercially available matrices can be routinely found in most modern health care centers. Although to date no complete regenerative or direct identical soft-tissue replacement exists, currently available commercial components have proven beneficial in augmenting and improving some types of wound healing scenarios. Cost, directed specificity, biocompatibility, and bioburden tolerance are just some of the impending challenges to adoption. CONCLUSIONS Quality of life and in fact the ability to sustain life is dependent on our most complex and remarkable organ, skin. Although pure regenerative healing and engineered soft-tissue constructs elude us, surgeons and health care providers are slowly gaining comfort and experience with concepts and strategies to improve the healing of wounds.
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Abstract
The hand is commonly affected in burn injuries. Joints and extensor tendons are vulnerable given their superficial location. Durable coverage that permits relative frictionless tendon gliding and minimizes scar contracture is required to optimize functional outcomes. When soft tissue donor sites are limited, the use of dermal skin substitutes provides stable coverage with minimal scarring, good mobility, and acceptable appearance. A comprehensive review of dermal skin substitutes and their use with burn reconstruction of the hand is provided.
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Affiliation(s)
- Ian C Sando
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340, USA
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340, USA.
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Beaudoin Cloutier C, Goyer B, Perron C, Guignard R, Larouche D, Moulin VJ, Germain L, Gauvin R, Auger FA. In Vivo Evaluation and Imaging of a Bilayered Self-Assembled Skin Substitute Using a Decellularized Dermal Matrix Grafted on Mice. Tissue Eng Part A 2017; 23:313-322. [PMID: 27958884 DOI: 10.1089/ten.tea.2016.0296] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
As time to final coverage is the essence for better survival outcome in severely burned patients, we have continuously strived to reduce the duration for the preparation of our bilayered self-assembled skin substitutes (SASS). These SASS produced in vitro by the self-assembly approach have a structure and functionality very similar to native skin. Recently, we have shown that a decellularized dermal matrix preproduced by the self-assembly approach could be used as a template to further obtain self-assembled skin substitute using a decellularized dermal template (SASS-DM) in vitro. Thus, the production period with patient cells was then reduced to about 1 month. Herein, preclinical animal experiments have been performed to confirm the integration and evolution of such a graft and compare the maturation of SASS and SASS-DM in vivo. Both tissues, reconstructed from adult or newborn cells, were grafted on athymic mice. Green fluorescent protein-transfected keratinocytes were also used to follow grafted tissues weekly for 6 weeks using an in vivo imaging system (IVIS). Cell architecture and differentiation were studied with histological and immunofluorescence analyses at each time point. Graft integration, macroscopic evolution, histological analyses, and expression of skin differentiation markers were similar between both skin substitutes reconstructed from either newborn or adult cells, and IVIS observations confirmed the efficient engraftment of SASS-DM. In conclusion, our in vivo graft experiments on a mouse model demonstrated that the SASS-DM had equivalent macroscopic, histological, and differentiation evolution over a 6-week period, when compared with the SASS. The tissue-engineered SASS-DM could improve clinical availability and advantageously shorten the time necessary for the definitive wound coverage of severely burned patients.
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Affiliation(s)
- Chanel Beaudoin Cloutier
- 1 Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX and Département de chirurgie, Faculté de Médecine, Université Laval , Quebec, Canada .,2 Centre de recherche du CHU de Québec-Université Laval , Axe médecine régénératrice, Quebec, Canada .,3 Department of Plastic Surgery, Faculty of Medicine, University of Montreal , Quebec, Canada
| | - Benjamin Goyer
- 1 Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX and Département de chirurgie, Faculté de Médecine, Université Laval , Quebec, Canada .,2 Centre de recherche du CHU de Québec-Université Laval , Axe médecine régénératrice, Quebec, Canada
| | - Cindy Perron
- 1 Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX and Département de chirurgie, Faculté de Médecine, Université Laval , Quebec, Canada .,2 Centre de recherche du CHU de Québec-Université Laval , Axe médecine régénératrice, Quebec, Canada
| | - Rina Guignard
- 1 Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX and Département de chirurgie, Faculté de Médecine, Université Laval , Quebec, Canada .,2 Centre de recherche du CHU de Québec-Université Laval , Axe médecine régénératrice, Quebec, Canada
| | - Danielle Larouche
- 1 Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX and Département de chirurgie, Faculté de Médecine, Université Laval , Quebec, Canada .,2 Centre de recherche du CHU de Québec-Université Laval , Axe médecine régénératrice, Quebec, Canada
| | - Véronique J Moulin
- 1 Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX and Département de chirurgie, Faculté de Médecine, Université Laval , Quebec, Canada .,2 Centre de recherche du CHU de Québec-Université Laval , Axe médecine régénératrice, Quebec, Canada
| | - Lucie Germain
- 1 Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX and Département de chirurgie, Faculté de Médecine, Université Laval , Quebec, Canada .,2 Centre de recherche du CHU de Québec-Université Laval , Axe médecine régénératrice, Quebec, Canada
| | - Robert Gauvin
- 1 Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX and Département de chirurgie, Faculté de Médecine, Université Laval , Quebec, Canada .,4 Centre Québécois sur les Matériaux Fonctionnels (CQMF) , Quebec, Canada
| | - François A Auger
- 1 Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX and Département de chirurgie, Faculté de Médecine, Université Laval , Quebec, Canada .,2 Centre de recherche du CHU de Québec-Université Laval , Axe médecine régénératrice, Quebec, Canada
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Dreifke MB, Jayasuriya AA, Jayasuriya AC. Current wound healing procedures and potential care. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2014; 48:651-62. [PMID: 25579968 DOI: 10.1016/j.msec.2014.12.068] [Citation(s) in RCA: 275] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 12/05/2014] [Accepted: 12/17/2014] [Indexed: 02/06/2023]
Abstract
In this review, we describe current and future potential wound healing treatments for acute and chronic wounds. The current wound healing approaches are based on autografts, allografts, and cultured epithelial autografts, and wound dressings based on biocompatible and biodegradable polymers. The Food and Drug Administration approved wound healing dressings based on several polymers including collagen, silicon, chitosan, and hyaluronic acid. The new potential therapeutic intervention for wound healing includes sustained delivery of growth factors, and siRNA delivery, targeting microRNA, and stem cell therapy. In addition, environment sensors can also potentially utilize to monitor and manage microenvironment at wound site. Sensors use optical, odor, pH, and hydration sensors to detect such characteristics as uric acid level, pH, protease level, and infection - all in the hopes of early detection of complications.
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Affiliation(s)
- Michael B Dreifke
- Department of Orthopaedic Surgery, College of Medicine and Life Sciences, The University of Toledo, Toledo, OH 43614-5807, USA
| | - Amil A Jayasuriya
- Undergraduate Program, Department of Human Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
| | - Ambalangodage C Jayasuriya
- Department of Orthopaedic Surgery, College of Medicine and Life Sciences, The University of Toledo, Toledo, OH 43614-5807, USA.
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Zielins ER, Atashroo DA, Maan ZN, Duscher D, Walmsley GG, Hu M, Senarath-Yapa K, McArdle A, Tevlin R, Wearda T, Paik KJ, Duldulao C, Hong WX, Gurtner GC, Longaker MT. Wound healing: an update. Regen Med 2014; 9:817-30. [DOI: 10.2217/rme.14.54] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Wounds, both chronic and acute, continue to be a tremendous socioeconomic burden. As such, technologies drawn from many disciplines within science and engineering are constantly being incorporated into innovative wound healing therapies. While many of these therapies are experimental, they have resulted in new insights into the pathophysiology of wound healing, and in turn the development of more specialized treatments for both normal and abnormal wound healing states. Herein, we review some of the emerging technologies that are currently being developed to aid and improve wound healing after cutaneous injury.
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Affiliation(s)
- Elizabeth R Zielins
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, 257 Campus Drive, Stanford, CA 94305–5148, USA
| | - David A Atashroo
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, 257 Campus Drive, Stanford, CA 94305–5148, USA
| | - Zeshaan N Maan
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, 257 Campus Drive, Stanford, CA 94305–5148, USA
| | - Dominik Duscher
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, 257 Campus Drive, Stanford, CA 94305–5148, USA
| | - Graham G Walmsley
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, 257 Campus Drive, Stanford, CA 94305–5148, USA
| | - Michael Hu
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, 257 Campus Drive, Stanford, CA 94305–5148, USA
- Department of Surgery, John A Burns School of Medicine, University of Hawai'i, Honolulu, HI
| | - Kshemendra Senarath-Yapa
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, 257 Campus Drive, Stanford, CA 94305–5148, USA
| | - Adrian McArdle
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, 257 Campus Drive, Stanford, CA 94305–5148, USA
| | - Ruth Tevlin
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, 257 Campus Drive, Stanford, CA 94305–5148, USA
| | - Taylor Wearda
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, 257 Campus Drive, Stanford, CA 94305–5148, USA
| | - Kevin J Paik
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, 257 Campus Drive, Stanford, CA 94305–5148, USA
| | - Christopher Duldulao
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, 257 Campus Drive, Stanford, CA 94305–5148, USA
| | - Wan Xing Hong
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, 257 Campus Drive, Stanford, CA 94305–5148, USA
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Geoffrey C Gurtner
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, 257 Campus Drive, Stanford, CA 94305–5148, USA
| | - Michael T Longaker
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Division of Plastic Surgery, Stanford University School of Medicine, 257 Campus Drive, Stanford, CA 94305–5148, USA
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Delivery of epithelial autografts and cutaneous wound healing in burn patients. Burns 2013; 40:166-8. [PMID: 24054550 DOI: 10.1016/j.burns.2013.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 07/10/2013] [Indexed: 11/22/2022]
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Killat J, Reimers K, Choi CY, Jahn S, Vogt PM, Radtke C. Cultivation of keratinocytes and fibroblasts in a three-dimensional bovine collagen-elastin matrix (Matriderm®) and application for full thickness wound coverage in vivo. Int J Mol Sci 2013; 14:14460-74. [PMID: 23852021 PMCID: PMC3742254 DOI: 10.3390/ijms140714460] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 06/18/2013] [Accepted: 06/25/2013] [Indexed: 01/21/2023] Open
Abstract
New skin substitutes for burn medicine or reconstructive surgery pose an important issue in plastic surgery. Matriderm® is a clinically approved three-dimensional bovine collagen-elastin matrix which is already used as a dermal substitute of full thickness burn wounds. The drawback of an avital matrix is the limited integration in full thickness skin defects, depending on the defect size. To further optimize this process, Matriderm® has also been studied as a matrix for tissue engineering of skin albeit long-term cultivation of the matrix with cells has been difficult. Cells have generally been seeded onto the matrix with high cell loss and minimal time-consuming migration. Here we developed a cell seeded skin equivalent after microtransfer of cells directly into the matrix. First, cells were cultured, and microinjected into Matriderm®. Then, cell viability in the matrix was determined by histology in vitro. As a next step, the skin substitute was applied in vivo into a full thickness rodent wound model. The wound coverage and healing was observed over a period of two weeks followed by histological examination assessing cell viability, proliferation and integration into the host. Viable and proliferating cells could be found throughout the entire matrix. The presented skin substitute resembles healthy skin in morphology and integrity. Based on this study, future investigations are planned to examine behaviour of epidermal stem cells injected into a collagen-elastin matrix under the aspects of establishment of stem cell niches and differentiation.
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Affiliation(s)
- Jasper Killat
- Department of Plastic, Hand- and Reconstructive Surgery, Hannover Medical School, Hannover D-30659, Germany.
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