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Ria S, Chegini S, Ozbek L, Nigar E, Shorafa M. Use of Integra® on avascular tissue. Br J Oral Maxillofac Surg 2024; 62:367-372. [PMID: 38609744 DOI: 10.1016/j.bjoms.2023.11.022] [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: 09/23/2023] [Accepted: 11/28/2023] [Indexed: 04/14/2024]
Abstract
Integra® (Integra LifeSciences) is a well-known dermal regeneration template used in partial and full-thickness wound reconstruction. It can be applied directly on to vascular tissue to create a bed for a skin graft, which is often placed in a second surgery. We present our experience of its novel use in oral and maxillofacial surgery patients, using it directly on bone and cartilage (avascular tissue) without further skin grafting. Patients who required full-thickness excision of lesions down to bone or cartilage and who were treated using Integra® were included. After scalp or ear lesion resection, the collagenous dermal layer of Integra® was placed directly on to bone or cartilage and, along with its outer silicone epidermal layer, secured to the defect with absorbable sutures and a bolster dressing. The wounds were kept dry for 14 days, at which point the dressing and silicone were removed and patients continued regular wound care. Seventeen patients were included, 15 of whom had squamous cell carcinoma. One was lost to follow up. The rest achieved complete healing of the defect. Histology showed epidermis developing on the Integra® surface and at one year, the appearance of normal scarred skin. This novel approach could redefine the uses of Integra®, avoiding the need for free-flap surgery or skin grafting when reconstructing large defects. Further resection of close margins or recurrence is easier after reconstruction using dermal regeneration material than after reconstruction with a local or free flap.
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Affiliation(s)
- Sama Ria
- Department of Oral and Maxillofacial Surgery, Northwick Park Hospital, London, UK
| | - Soudeh Chegini
- Department of Oral and Maxillofacial Surgery, Northwick Park Hospital, London, UK
| | - Leyla Ozbek
- Department of Ear, Nose and Throat Surgery, Northwick Park Hospital, London, UK.
| | - Ezra Nigar
- Histopathology Department, Northwick Park Hospital, London, UK
| | - Mohammad Shorafa
- Department of Oral and Maxillofacial Surgery, Northwick Park Hospital, London, UK
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2
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Angolkar M, Paramshetti S, Gahtani RM, Al Shahrani M, Hani U, Talath S, Osmani RAM, Spandana A, Gangadharappa HV, Gundawar R. Pioneering a paradigm shift in tissue engineering and regeneration with polysaccharides and proteins-based scaffolds: A comprehensive review. Int J Biol Macromol 2024; 265:130643. [PMID: 38467225 DOI: 10.1016/j.ijbiomac.2024.130643] [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: 10/13/2023] [Revised: 02/16/2024] [Accepted: 03/03/2024] [Indexed: 03/13/2024]
Abstract
In the realm of modern medicine, tissue engineering and regeneration stands as a beacon of hope, offering the promise of restoring form and function to damaged or diseased organs and tissues. Central to this revolutionary field are biological macromolecules-nature's own blueprints for regeneration. The growing interest in bio-derived macromolecules and their composites is driven by their environmentally friendly qualities, renewable nature, minimal carbon footprint, and widespread availability in our ecosystem. Capitalizing on these unique attributes, specific composites can be tailored and enhanced for potential utilization in the realm of tissue engineering (TE). This review predominantly concentrates on the present research trends involving TE scaffolds constructed from polysaccharides, proteins and glycosaminoglycans. It provides an overview of the prerequisites, production methods, and TE applications associated with a range of biological macromolecules. Furthermore, it tackles the challenges and opportunities arising from the adoption of these biomaterials in the field of TE. This review also presents a novel perspective on the development of functional biomaterials with broad applicability across various biomedical applications.
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Affiliation(s)
- Mohit Angolkar
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education and Research (JSSAHER), Mysuru 570015, Karnataka, India
| | - Sharanya Paramshetti
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education and Research (JSSAHER), Mysuru 570015, Karnataka, India
| | - Reem M Gahtani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia.
| | - Mesfer Al Shahrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia.
| | - Umme Hani
- Department of Pharmaceutics, College of Pharmacy, King Khalid University, Abha 61421, Saudi Arabia.
| | - Sirajunisa Talath
- Department of Pharmaceutical Chemistry, RAK College of Pharmaceutical Sciences, RAK Medical and Health Sciences University, Ras Al Khaimah 11172, United Arab Emirates.
| | - Riyaz Ali M Osmani
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education and Research (JSSAHER), Mysuru 570015, Karnataka, India.
| | - Asha Spandana
- Department of Pharmaceutics, JSS College of Pharmacy, JSS Academy of Higher Education and Research (JSSAHER), Mysuru 570015, Karnataka, India.
| | | | - Ravi Gundawar
- Department of Pharmaceutical Quality Assurance, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal 576104, Karnataka, India.
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3
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Vaporidou N, Peroni F, Restelli A, Jalil MN, Dye JF. Artificial Skin Therapies; Strategy for Product Development. Adv Wound Care (New Rochelle) 2023; 12:574-600. [PMID: 36680749 DOI: 10.1089/wound.2022.0050] [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: 01/22/2023] Open
Abstract
Significance: Tissue-engineered artificial skin for clinical reconstruction can be regarded as an established practice. Bi-layered skin equivalents are available as established allogenic or autologous therapy, and various acellular skin replacements can support tissue repair. Moreover, there is considerable commonality between the skin and other soft tissue reconstruction products. This article presents an attempt to create a comprehensive global landscape review of advanced replacement materials and associated strategies for skin and soft tissue reconstruction. Recent Advances: There has been rapid growth in the number of commercial and pre-commercial products over the past decade. In this survey, 263 base products for advanced skin therapy have been identified, across 8 therapeutic categories, giving over 350 products in total. The largest market is in the United States, followed by the E.U. zone. However, despite these advances, and the investment of resources in each product development, there are key issues concerning the clinical efficacy, cost-benefit of products, and clinical impact. Each therapeutic strategy has relative merits and limitations. Critical Issues: A critical consideration in developing and evaluating products is the therapeutic modality, associated regulatory processes, and the potential for clinical adoption geographically, determined by regulatory territory, intellectual property, and commercial distribution factors. The survey identifies an opportunity for developments that improve basic efficacy or cost-benefit. Future Directions: The economic pressures on health care systems, compounded by the demands of our increasingly ageing population, and the imperative to distribute effective health care, create an urgent global need for effective and affordable products.
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Affiliation(s)
- Nephelie Vaporidou
- Division of Surgery and Interdisciplinary Sciences, University College London, London, United Kingdom
- Oxartis Ltd., Oxford, United Kingdom
| | | | | | - M Nauman Jalil
- Oxartis Ltd., Oxford, United Kingdom
- MADE Cymru, University of Wales Trinity Saint David, Swansea, Wales, United Kingdom
| | - Julian F Dye
- Oxartis Ltd., Oxford, United Kingdom
- Research Strategy and Development, University College London, London, United Kingdom
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4
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Hama R, Reinhardt JW, Ulziibayar A, Watanabe T, Kelly J, Shinoka T. Recent Tissue Engineering Approaches to Mimicking the Extracellular Matrix Structure for Skin Regeneration. Biomimetics (Basel) 2023; 8:biomimetics8010130. [PMID: 36975360 PMCID: PMC10046023 DOI: 10.3390/biomimetics8010130] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
Inducing tissue regeneration in many skin defects, such as large traumatic wounds, burns, other physicochemical wounds, bedsores, and chronic diabetic ulcers, has become an important clinical issue in recent years. Cultured cell sheets and scaffolds containing growth factors are already in use but have yet to restore normal skin tissue structure and function. Many tissue engineering materials that focus on the regeneration process of living tissues have been developed for the more versatile and rapid initiation of treatment. Since the discovery that cells recognize the chemical-physical properties of their surrounding environment, there has been a great deal of work on mimicking the composition of the extracellular matrix (ECM) and its three-dimensional network structure. Approaches have used ECM constituent proteins as well as morphological processing methods, such as fiber sheets, sponges, and meshes. This review summarizes material design strategies in tissue engineering fields, ranging from the morphology of existing dressings and ECM structures to cellular-level microstructure mimicry, and explores directions for future approaches to precision skin tissue regeneration.
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Affiliation(s)
- Rikako Hama
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
- Department of Biotechnology and Life Science, Graduate School of Engineering, Tokyo University of Agriculture and Technology, 2-24-16 Naka-Cho, Koganei 184-8588, Japan
| | - James W Reinhardt
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Anudari Ulziibayar
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Tatsuya Watanabe
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - John Kelly
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Toshiharu Shinoka
- Center for Regenerative Medicine, The Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
- Department of Cardiothoracic Surgery, The Heart Center, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
- Department of Surgery, Cardiovascular Tissue Engineering Program, Ohio State University, Columbus, OH 43210, USA
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5
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Ma J, Wu C. Bioactive inorganic particles-based biomaterials for skin tissue engineering. EXPLORATION (BEIJING, CHINA) 2022; 2:20210083. [PMID: 37325498 PMCID: PMC10190985 DOI: 10.1002/exp.20210083] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/09/2022] [Indexed: 06/15/2023]
Abstract
The challenge for treatment of severe cutaneous wound poses an urgent clinical need for the development of biomaterials to promote skin regeneration. In the past few decades, introduction of inorganic components into material system has become a promising strategy for improving performances of biomaterials in the process of tissue repair. In this review, we provide a current overview of the development of bioactive inorganic particles-based biomaterials used for skin tissue engineering. We highlight the three stages in the evolution of the bioactive inorganic biomaterials applied to wound management, including single inorganic materials, inorganic/organic composite materials, and inorganic particles-based cell-encapsulated living systems. At every stage, the primary types of bioactive inorganic biomaterials are described, followed by citation of the related representative studies completed in recent years. Then we offer a brief exposition of typical approaches to construct the composite material systems with incorporation of inorganic components for wound healing. Finally, the conclusions and future directions are suggested for the development of novel bioactive inorganic particles-based biomaterials in the field of skin regeneration.
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Affiliation(s)
- Jingge Ma
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructureShanghai Institute of CeramicsChinese Academy of SciencesShanghaiP. R. China
- Center of Materials Science and Optoelectronics EngineeringUniversity of Chinese Academy of SciencesBeijingP. R. China
| | - Chengtie Wu
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructureShanghai Institute of CeramicsChinese Academy of SciencesShanghaiP. R. China
- Center of Materials Science and Optoelectronics EngineeringUniversity of Chinese Academy of SciencesBeijingP. R. China
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6
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Lv K, Wang L, He X, Li W, Han L, Qin S. Application of Tilapia Skin Acellular Dermal Matrix to Induce Acute Skin Wound Repair in Rats. Front Bioeng Biotechnol 2022; 9:792344. [PMID: 35237588 PMCID: PMC8882825 DOI: 10.3389/fbioe.2021.792344] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 12/29/2021] [Indexed: 11/13/2022] Open
Abstract
Extracellular matrix (ECM) material with good biological activity is essential to simulate cell growth microenvironment, induce cell infiltration and angiogenesis, and promote the repair of large area acute skin wound. In this study, tilapia skin acellular dermal matrix (TADM) was prepared to simulate ECM microenvironment, which can promote substantial area acute wound healing in rats. The main component of TADM is type I collagen, which has good physical and chemical properties, biological activity and cell adhesion. TADM is a form of biomaterial with low immunogenicity, low risk of prion infection and lower economic cost than other related materials such as mammalian collagen biomaterials. Our results show that TADM can guide cell infiltration, angiogenesis, regulate the expression and secretion of inflammatory and skin repair correlated factors to promote tissue healing.
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Affiliation(s)
- Kangning Lv
- School of Ocean, Yantai University, Yantai, China
- Yantai Institute of Coastal Zone Research, Chinese Academy of Sciences, Yantai, China
| | - Lei Wang
- Yantai Institute of Coastal Zone Research, Chinese Academy of Sciences, Yantai, China
| | - Xiaoli He
- Yantai Institute of Coastal Zone Research, Chinese Academy of Sciences, Yantai, China
- School of Life Science, Yantai University, Yantai, China
| | - Wenjun Li
- Yantai Institute of Coastal Zone Research, Chinese Academy of Sciences, Yantai, China
| | - Lei Han
- School of Life Science, Yantai University, Yantai, China
| | - Song Qin
- Yantai Institute of Coastal Zone Research, Chinese Academy of Sciences, Yantai, China
- *Correspondence: Song Qin,
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7
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Xue M, Zhao R, March L, Jackson C. Dermal Fibroblast Heterogeneity and Its Contribution to the Skin Repair and Regeneration. Adv Wound Care (New Rochelle) 2022; 11:87-107. [PMID: 33607934 DOI: 10.1089/wound.2020.1287] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Significance: Dermal fibroblasts are the major cell type in the skin's dermal layer. These cells originate from distinct locations of the embryo and reside in unique niches in the dermis. Different dermal fibroblasts exhibit distinct roles in skin development, homeostasis, and wound healing. Therefore, these cells are becoming attractive candidates for cell-based therapies in wound healing. Recent Advances: Human skin dermis comprises multiple fibroblast subtypes, including papillary, reticular, and hair follicle-associated fibroblasts, and myofibroblasts after wounding. Recent studies reveal that these cells play distinct roles in wound healing and contribute to diverse healing outcomes, including nonhealing chronic wound or excessive scar formation, such as hypertrophic scars (HTS) and keloids, with papillary fibroblasts having antiscarring and reticular fibroblast scar-forming properties. Critical Issues: The identities and functions of dermal fibroblast subpopulations in many respects remain unknown. In this review, we summarize the current understanding of dermal fibroblast heterogeneity, including their defined cell markers and dermal niches, dynamic changes, and contributions to skin wound healing, with the emphasis on scarless healing, healing with excessive scars (HTS and keloids), chronic wounds, and the potential application of this heterogeneity for developing cell-based therapies that allow wounds to heal faster with less scarring. Future Directions: Heterogeneous dermal fibroblast populations and their functions are poorly characterized. Refining and advancing our understanding of dermal fibroblast heterogeneity and their participation in skin homeostasis and wound healing may create potential therapeutic applications for nonhealing chronic wounds or wounds that heal with excessive scarring.
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Affiliation(s)
- Meilang Xue
- Sutton Arthritis Research Laboratory, Institute of Bone and Joint Research, Kolling Institute of Medical Research, The University of Sydney at Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Ruilong Zhao
- Sutton Arthritis Research Laboratory, Institute of Bone and Joint Research, Kolling Institute of Medical Research, The University of Sydney at Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Lyn March
- Sutton Arthritis Research Laboratory, Institute of Bone and Joint Research, Kolling Institute of Medical Research, The University of Sydney at Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Christopher Jackson
- Sutton Arthritis Research Laboratory, Institute of Bone and Joint Research, Kolling Institute of Medical Research, The University of Sydney at Royal North Shore Hospital, St Leonards, New South Wales, Australia
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8
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Ma J, Qin C, Wu J, Zhang H, Zhuang H, Zhang M, Zhang Z, Ma L, Wang X, Ma B, Chang J, Wu C. 3D Printing of Strontium Silicate Microcylinder-Containing Multicellular Biomaterial Inks for Vascularized Skin Regeneration. Adv Healthc Mater 2021; 10:e2100523. [PMID: 33963672 DOI: 10.1002/adhm.202100523] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/27/2021] [Indexed: 12/12/2022]
Abstract
The reconstruction of dermal blood vessels is essential for skin regeneration process. However, the lack of vascular structure, insufficient angiogenesis induction, and ineffective graft-host anastomosis of the existing skin substitutes are major bottle-necks for permanent skin replacement in tissue engineering. In this study, the uniform strontium silicate (SS) microcylinders are successfully synthesized and integrated into the biomaterial ink to serve as stable cell-induced factors for angiogenesis, and then a functional skin substitute based on a vascularization-induced biomimetic multicellular system is prepared via a "cell-writing" bioprinting technology. With an unprecedented combination of vascularized skin-mimicking structure and vascularization-induced function, the SS-containing multicellular system exhibits outstanding angiogenic activity both in vitro and in vivo. As a result, the bioprinted skin substitutes significantly accelerate the healing of both acute and chronic wounds by promoting the graft-host integration and vascularized skin regeneration in three animal models. Therefore, the study provides a referable strategy to fabricate biomimetic multicellular constructs with angiogenesis-induced function for regeneration of vascularized complex and hierarchical tissues.
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Affiliation(s)
- Jingge Ma
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure Shanghai Institute of Ceramics Chinese Academy of Sciences Shanghai 200050 P. R. China
- Center of Materials Science and Optoelectronics Engineering University of Chinese Academy of Sciences Beijing 100049 P. R. China
| | - Chen Qin
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure Shanghai Institute of Ceramics Chinese Academy of Sciences Shanghai 200050 P. R. China
- Center of Materials Science and Optoelectronics Engineering University of Chinese Academy of Sciences Beijing 100049 P. R. China
| | - Jinfu Wu
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure Shanghai Institute of Ceramics Chinese Academy of Sciences Shanghai 200050 P. R. China
- Center of Materials Science and Optoelectronics Engineering University of Chinese Academy of Sciences Beijing 100049 P. R. China
| | - Hongjian Zhang
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure Shanghai Institute of Ceramics Chinese Academy of Sciences Shanghai 200050 P. R. China
- Center of Materials Science and Optoelectronics Engineering University of Chinese Academy of Sciences Beijing 100049 P. R. China
| | - Hui Zhuang
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure Shanghai Institute of Ceramics Chinese Academy of Sciences Shanghai 200050 P. R. China
- Center of Materials Science and Optoelectronics Engineering University of Chinese Academy of Sciences Beijing 100049 P. R. China
| | - Meng Zhang
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure Shanghai Institute of Ceramics Chinese Academy of Sciences Shanghai 200050 P. R. China
- Center of Materials Science and Optoelectronics Engineering University of Chinese Academy of Sciences Beijing 100049 P. R. China
| | - Zhaowenbin Zhang
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure Shanghai Institute of Ceramics Chinese Academy of Sciences Shanghai 200050 P. R. China
- Center of Materials Science and Optoelectronics Engineering University of Chinese Academy of Sciences Beijing 100049 P. R. China
| | - Lingling Ma
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure Shanghai Institute of Ceramics Chinese Academy of Sciences Shanghai 200050 P. R. China
- Center of Materials Science and Optoelectronics Engineering University of Chinese Academy of Sciences Beijing 100049 P. R. China
| | - Xin Wang
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure Shanghai Institute of Ceramics Chinese Academy of Sciences Shanghai 200050 P. R. China
- Center of Materials Science and Optoelectronics Engineering University of Chinese Academy of Sciences Beijing 100049 P. R. China
| | - Bing Ma
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure Shanghai Institute of Ceramics Chinese Academy of Sciences Shanghai 200050 P. R. China
- Center of Materials Science and Optoelectronics Engineering University of Chinese Academy of Sciences Beijing 100049 P. R. China
| | - Jiang Chang
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure Shanghai Institute of Ceramics Chinese Academy of Sciences Shanghai 200050 P. R. China
- Center of Materials Science and Optoelectronics Engineering University of Chinese Academy of Sciences Beijing 100049 P. R. China
| | - Chengtie Wu
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure Shanghai Institute of Ceramics Chinese Academy of Sciences Shanghai 200050 P. R. China
- Center of Materials Science and Optoelectronics Engineering University of Chinese Academy of Sciences Beijing 100049 P. R. China
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9
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Rossi E, Salgarelli AC, Mandel VD, Magnoni C. Synergic effect of buccal fat pad pedicled flap and dermal acellular matrix for large cheek defect. Ital J Dermatol Venerol 2021; 156:244-247. [PMID: 33960754 DOI: 10.23736/s2784-8671.16.05386-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Reconstruction of large defects of the upper cheek defects still remains a challenge for the surgeon, who can apply different techniques. We present a new method involving the use of a dermal regeneration template to achieve an improved, faster healing of pedicled buccal fat flap in a 75-year-old woman affected by melanoma of the upper-middle cheek. The tumor involved soft tissue, zygomatic arch and periocular fact. The choice of the surgical technique consisted first in the creation of a buccal fat pad to restore the important lack of tissue over the underlying bones, and then in the position of a dermal acellular matrix (Integra® Dermal Regeneration Template; Integra LifeSciences Holdings Corporation, Plainsboro, NJ, USA). Three weeks later, once the neodermal formation was finished, a split thickness graft was placed. This is a not yet described association that represents a good surgical option for the restoration of large cheek defects that allows good functional and cosmetic result in older patient when minimal surgical invasion and operative duration are necessary because of a patient's general condition. The postoperative course with this surgical technique was regular and a good functional result was achieved. This technique provides an adequate functional coverage, a restoration of soft tissue lacking and an acceptable cosmetic result without ectropion.
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Affiliation(s)
- Elena Rossi
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Victor D Mandel
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy -
| | - Cristina Magnoni
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
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10
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Rastin H, Ramezanpour M, Hassan K, Mazinani A, Tung TT, Vreugde S, Losic D. 3D bioprinting of a cell-laden antibacterial polysaccharide hydrogel composite. Carbohydr Polym 2021; 264:117989. [PMID: 33910727 DOI: 10.1016/j.carbpol.2021.117989] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 12/17/2022]
Abstract
Bioink with inherent antibacterial activity is of particular interest for tissue engineering application due to the growing number of bacterial infections associated with impaired wound healing or bone implants. However, the development of cell-laden bioink with potent antibacterial activity while supporting tissue regeneration proved to be challenging. Here, we introduced a cell-laden antibacterial bioink based on Methylcellulose/Alginate (MC/Alg) hydrogel for skin tissue engineering via elimination of the risks associated with a bacterial infection. The key feature of the bioink is the use of gallium (Ga+3) in the design of bioink formulation with dual functions. First, Ga+3 stabilized the hydrogel bioink by the formation of ionic crosslinking with Alg chains. Second, the gallium-crosslinked bioink exhibited potent antibacterial activity toward both Gram-positive (Staphylococcus aureus) and Gram-negative (Pseudomonas aeruginosa) bacteria with a bactericidal rate of 99.99 %. In addition, it was found that the developed bioink supported encapsulated fibroblast cellular functions.
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Affiliation(s)
- Hadi Rastin
- School of Chemical Engineering and Advanced Materials, The University of Adelaide, South Australia, 5005, Australia; ARC Research Hub for Graphene Enabled Industry Transformation, The University of Adelaide, South Australia, 5005, Australia
| | - Mahnaz Ramezanpour
- Department of Surgery-Otolaryngology Head and Neck Surgery, The University of Adelaide, Woodville South, Australia
| | - Kamrul Hassan
- School of Chemical Engineering and Advanced Materials, The University of Adelaide, South Australia, 5005, Australia; ARC Research Hub for Graphene Enabled Industry Transformation, The University of Adelaide, South Australia, 5005, Australia
| | - Arash Mazinani
- School of Chemical Engineering and Advanced Materials, The University of Adelaide, South Australia, 5005, Australia; ARC Research Hub for Graphene Enabled Industry Transformation, The University of Adelaide, South Australia, 5005, Australia
| | - Tran Thanh Tung
- School of Chemical Engineering and Advanced Materials, The University of Adelaide, South Australia, 5005, Australia; ARC Research Hub for Graphene Enabled Industry Transformation, The University of Adelaide, South Australia, 5005, Australia
| | - Sarah Vreugde
- Department of Surgery-Otolaryngology Head and Neck Surgery, The University of Adelaide, Woodville South, Australia
| | - Dusan Losic
- School of Chemical Engineering and Advanced Materials, The University of Adelaide, South Australia, 5005, Australia; ARC Research Hub for Graphene Enabled Industry Transformation, The University of Adelaide, South Australia, 5005, Australia.
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11
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Rezapour-Lactoee A, Yeganeh H, Gharibi R, Milan PB. Enhanced healing of a full-thickness wound by a thermoresponsive dressing utilized for simultaneous transfer and protection of adipose-derived mesenchymal stem cells sheet. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2020; 31:101. [PMID: 33140201 DOI: 10.1007/s10856-020-06433-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 09/24/2020] [Indexed: 06/11/2023]
Abstract
To boost the healing process in a full-thickness wound, a simple and efficient strategy based on adipose-derived mesenchymal stem cells (ADSCs) transplantation is described in this work. To increase the chance of ADSCs immobilization in the wound bed and prevent its migration, these cells are fully grown on the surface of a thermoresponsive dressing membrane under in vitro condition. Then, the cells sheet with their secreted extracellular matrix (ECM) is transferred to the damaged skin with the help of this dressing membrane. This membrane remains on wound bed and acts both as a cell sheet transfer vehicle, after external reduction of temperature, and protect wound during the healing process like a common wound dressing. The visual inspection of wounded skin (rat animal model) at selected time intervals shows a higher wound closure rate for ADSCs treated group. For this group of rats, the better quality of reconstructed tissue is approved by results of histological and immunohistochemical analysis since the higher length of the new epidermis, the higher thickness of re-epithelialization layer, a higher level of neovascularization and capillary density, and the least collagen deposition are detected in the healed tissue.
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Affiliation(s)
- Alireza Rezapour-Lactoee
- Cellular and Molecular Research Center, Qom University of Medical Sciences, Qom, Iran
- Department of Tissue Engineering, School of Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Hamid Yeganeh
- Iran Polymer and Petrochemical Institute, Tehran, P.O. Box:14965/115, Iran.
| | - Reza Gharibi
- Faculty of Chemistry, Kharazmi University, Tehran, Iran
| | - Peiman Brouki Milan
- Department of Tissue Engineering and Regenerative Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
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12
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Low ZWK, Li Z, Owh C, Chee PL, Ye E, Dan K, Chan SY, Young DJ, Loh XJ. Recent innovations in artificial skin. Biomater Sci 2020; 8:776-797. [PMID: 31820749 DOI: 10.1039/c9bm01445d] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The skin is a "smart", multifunctional organ that is protective, self-healing and capable of sensing and many forms of artificial skins have been developed with properties and functionalities approximating those of natural skin. Starting from specific commercial products for the treatment of burns, progress in two fields of research has since allowed these remarkable materials to be viable skin replacements for a wide range of dermatological conditions. This review maps out the development of bioengineered skin replacements and synthetic skin substitutes, including electronic skins. The specific behaviors of these skins are highlighted, and the performances of both types of artificial skins are evaluated against this. Moving beyond mere replication, highly advanced artificial skin materials are also identified as potential augmented skins that can be used as flexible electronics for health-care monitoring and other applications.
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Affiliation(s)
- Zhi Wei Kenny Low
- Institute of Materials Research and Engineering, A*STAR, 2Fusionopolis Way, Innovis, #08-03, Singapore 138634.
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13
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Dermal regenerative matrix use in burn patients: A systematic review. J Plast Reconstr Aesthet Surg 2019; 72:1741-1751. [PMID: 31492583 DOI: 10.1016/j.bjps.2019.07.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/19/2019] [Accepted: 07/27/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Dermal regenerative matrices (DRMs) have been used for several decades in the treatment of acute and reconstructive burn injury. The objective of this study was to perform a systematic review of the literature to assess clinical outcomes and safety profile of DRMs in full-thickness burn injury. METHODS Comprehensive searches of MEDLINE, EMBASE, CINAHL, and Cochrane Library were performed from 1988 to 2017. Two independent reviewers completed preliminary and full-text screening of all articles. English-language articles reporting on DRM use in patients with full-thickness burn injury were included. RESULTS Literature search generated 914 unique articles. Following screening, 203 articles were assessed for eligibility, and 72 met inclusion criteria for analysis. DRM was applied to1084 patients (74% acute burns, 26% burn reconstruction). Of the twelve studies that described changes in ROM, significant improvement was observed in 95% of reconstructive patients. The most frequently treated reconstructive sites were the neck, hand/wrist, lower extremity, and axilla. Vancouver scar scale was used in eight studies and indicated a significant improvement in the scar quality with DRM. The overall complication rate was 13%, most commonly infection, graft loss, hematoma formation, and contracture. CONCLUSIONS Although variability in functional and cosmetic outcomes was observed, DRM demonstrates improvements in ROM and scar appearance without objective regression. Essential demographic data were lacking in many studies, highlighting the need for future standardization of reporting outcomes in burns following application of dermal substitutes.
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14
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Brovold M, Almeida JI, Pla-Palacín I, Sainz-Arnal P, Sánchez-Romero N, Rivas JJ, Almeida H, Dachary PR, Serrano-Aulló T, Soker S, Baptista PM. Naturally-Derived Biomaterials for Tissue Engineering Applications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1077:421-449. [PMID: 30357702 PMCID: PMC7526297 DOI: 10.1007/978-981-13-0947-2_23] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Naturally-derived biomaterials have been used for decades in multiple regenerative medicine applications. From the simplest cell microcarriers made of collagen or alginate, to highly complex decellularized whole-organ scaffolds, these biomaterials represent a class of substances that is usually first in choice at the time of electing a functional and useful biomaterial. Hence, in this chapter we describe the several naturally-derived biomaterials used in tissue engineering applications and their classification, based on composition. We will also describe some of the present uses of the generated tissues like drug discovery, developmental biology, bioprinting and transplantation.
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Affiliation(s)
- Matthew Brovold
- Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC, USA
| | - Joana I Almeida
- Health Research Institute of Aragón (IIS Aragón), Zaragoza, Spain
| | - Iris Pla-Palacín
- Health Research Institute of Aragón (IIS Aragón), Zaragoza, Spain
| | - Pilar Sainz-Arnal
- Health Research Institute of Aragón (IIS Aragón), Zaragoza, Spain
- Aragon Health Sciences Institute (IACS), Zaragoza, Spain
| | | | - Jesus J Rivas
- Health Research Institute of Aragón (IIS Aragón), Zaragoza, Spain
| | - Helen Almeida
- Health Research Institute of Aragón (IIS Aragón), Zaragoza, Spain
| | - Pablo Royo Dachary
- Instituto de Investigación Sanitária de Aragón (IIS Aragón), Zaragoza, Spain
- Liver Transplant Unit, Gastroenterology Department, Lozano Blesa University Hospital, Zaragoza, Spain
| | - Trinidad Serrano-Aulló
- Instituto de Investigación Sanitária de Aragón (IIS Aragón), Zaragoza, Spain
- Liver Transplant Unit, Gastroenterology Department, Lozano Blesa University Hospital, Zaragoza, Spain
| | - Shay Soker
- Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC, USA.
| | - Pedro M Baptista
- Instituto de Investigación Sanitária de Aragón (IIS Aragón), Zaragoza, Spain.
- Center for Biomedical Research Network Liver and Digestive Diseases (CIBERehd), Zaragoza, Spain.
- Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain.
- Biomedical and Aerospace Engineering Department, Universidad Carlos III de Madrid, Madrid, Spain.
- Fundación ARAID, Zaragoza, Spain.
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15
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Li W, Yu Q, Yao H, Zhu Y, Topham PD, Yue K, Ren L, Wang L. Superhydrophobic hierarchical fiber/bead composite membranes for efficient treatment of burns. Acta Biomater 2019; 92:60-70. [PMID: 31096044 DOI: 10.1016/j.actbio.2019.05.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/14/2019] [Accepted: 05/09/2019] [Indexed: 01/16/2023]
Abstract
One of the current challenges in burn wound care is the development of multifunctional dressings that can protect the wound from bacteria or organisms and promote skin regeneration and tissue reconstitution. To this end, we report the design and fabrication of a composite electrospun membrane, comprised of electrospun polylactide: poly(vinyl pyrrolidone)/polylactide: poly(ethylene glycol) (PLA:PVP/PLA:PEG) core/shell fibers loaded with bioactive agents, as a functionally integrated wound dressing for efficient burns treatment. Different mass ratios of PLA:PVP in the shell were screened to optimize mechanical, physicochemical, and biological properties, in addition to controlled release profiles of loaded antimicrobial peptides (AMPs) from the fibers for desirable antibacterial activity. Fibroblasts were shown to readily adhere and proliferate when cultured on the membrane, indicating good in vitro cytocompatibility. The introduction of PLA beads by electrospraying on one side of the membrane resulted in biomimetic micro-nanostructures similar to those of lotus leaves. This designer structure rendered the composite membranes with superhydrophobic property to inhibit the adhesion/spreading of exogenous bacteria and other microbes. The administration of the resulting composite fibrous membrane on burnt skin in an infected rat model led to faster healing than a conventional product (sterile silicone membrane) and control detailed herein. These composite fibrous membranes loaded with bioactive drugs provide an integrated strategy for promoting burn wound healing and skin regeneration. STATEMENT OF SIGNIFICANCE: To address an urgent need in complex clinical requirements on developing a new generation of wound dressings with integrated functionalities. This article reports research work on a hierarchical fiber/bead composite membranes design, which combines a lotus-leaf-like superhydrophobic surface with drugs preloaded in the core and shell of fibers for effective burn treatment. This demonstrates a balance between simplified preparation processes and increased multifunctionality of the wound dressings. The creation of hierarchically structured surfaces can be readily achieved by electrospinning, and the composite dressings possessed a considerable mechanical strength, effective wound exudate absorption and permeability, good biocompatibility, broad antibacterial ability and promoting wound healing etc. Thus, our work unveils a promising strategy for the development of functionally integrated wound dressings for burn wound care.
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Affiliation(s)
- Weichang Li
- South China Advanced Institute for Soft Matter Science and Technology, School of Molecular Science and Engineering, South China University of Technology, Guangzhou 510640, China; State Key Laboratory of Luminescent Materials and Devices, South China University of Technology, Guangzhou 510640, China
| | - Qianqian Yu
- South China Advanced Institute for Soft Matter Science and Technology, School of Molecular Science and Engineering, South China University of Technology, Guangzhou 510640, China
| | - Hang Yao
- School of Chemistry and Chemical Engineering, Yangzhou University, Yangzhou 225009, China; National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, China
| | - Yue Zhu
- South China Advanced Institute for Soft Matter Science and Technology, School of Molecular Science and Engineering, South China University of Technology, Guangzhou 510640, China
| | - Paul D Topham
- Aston Institute of Materials Research, Aston University, Birmingham B4 7ET, UK
| | - Kan Yue
- South China Advanced Institute for Soft Matter Science and Technology, School of Molecular Science and Engineering, South China University of Technology, Guangzhou 510640, China; State Key Laboratory of Luminescent Materials and Devices, South China University of Technology, Guangzhou 510640, China
| | - Li Ren
- National Engineering Research Center for Tissue Restoration and Reconstruction, Guangzhou 510006, China.
| | - Linge Wang
- South China Advanced Institute for Soft Matter Science and Technology, School of Molecular Science and Engineering, South China University of Technology, Guangzhou 510640, China; State Key Laboratory of Luminescent Materials and Devices, South China University of Technology, Guangzhou 510640, China.
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16
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Yu JR, Navarro J, Coburn JC, Mahadik B, Molnar J, Holmes JH, Nam AJ, Fisher JP. Current and Future Perspectives on Skin Tissue Engineering: Key Features of Biomedical Research, Translational Assessment, and Clinical Application. Adv Healthc Mater 2019; 8:e1801471. [PMID: 30707508 PMCID: PMC10290827 DOI: 10.1002/adhm.201801471] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/04/2019] [Indexed: 12/20/2022]
Abstract
The skin is responsible for several important physiological functions and has enormous clinical significance in wound healing. Tissue engineered substitutes may be used in patients suffering from skin injuries to support regeneration of the epidermis, dermis, or both. Skin substitutes are also gaining traction in the cosmetics and pharmaceutical industries as alternatives to animal models for product testing. Recent biomedical advances, ranging from cellular-level therapies such as mesenchymal stem cell or growth factor delivery, to large-scale biofabrication techniques including 3D printing, have enabled the implementation of unique strategies and novel biomaterials to recapitulate the biological, architectural, and functional complexity of native skin. This progress report highlights some of the latest approaches to skin regeneration and biofabrication using tissue engineering techniques. Current challenges in fabricating multilayered skin are addressed, and perspectives on efforts and strategies to meet those limitations are provided. Commercially available skin substitute technologies are also examined, and strategies to recapitulate native physiology, the role of regulatory agencies in supporting translation, as well as current clinical needs, are reviewed. By considering each of these perspectives while moving from bench to bedside, tissue engineering may be leveraged to create improved skin substitutes for both in vitro testing and clinical applications.
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Affiliation(s)
- Justine R Yu
- Fischell Department of Bioengineering, University of Maryland, College Park, College Park, MD, 20742, USA
- NIH/NBIB Center for Engineering Complex Tissues, University of Maryland, College Park, College Park, MD, 20742, USA
- University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Javier Navarro
- Fischell Department of Bioengineering, University of Maryland, College Park, College Park, MD, 20742, USA
- NIH/NBIB Center for Engineering Complex Tissues, University of Maryland, College Park, College Park, MD, 20742, USA
| | - James C Coburn
- Fischell Department of Bioengineering, University of Maryland, College Park, College Park, MD, 20742, USA
- Division of Biomedical Physics, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD, 20903, USA
| | - Bhushan Mahadik
- Fischell Department of Bioengineering, University of Maryland, College Park, College Park, MD, 20742, USA
- NIH/NBIB Center for Engineering Complex Tissues, University of Maryland, College Park, College Park, MD, 20742, USA
| | - Joseph Molnar
- Wake Forest Baptist Medical Center, Winston-Salem, NC, 27157, USA
| | - James H Holmes
- Wake Forest Baptist Medical Center, Winston-Salem, NC, 27157, USA
| | - Arthur J Nam
- Division of Plastic, Reconstructive and Maxillofacial Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Baltimore, MD, 21201, USA
| | - John P Fisher
- Fischell Department of Bioengineering, University of Maryland, College Park, College Park, MD, 20742, USA
- NIH/NBIB Center for Engineering Complex Tissues, University of Maryland, College Park, College Park, MD, 20742, USA
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17
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Kreimendahl F, Marquardt Y, Apel C, Bartneck M, Zwadlo-Klarwasser G, Hepp J, Jockenhoevel S, Baron JM. Macrophages significantly enhance wound healing in a vascularized skin model. J Biomed Mater Res A 2019; 107:1340-1350. [PMID: 30724457 DOI: 10.1002/jbm.a.36648] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/17/2019] [Accepted: 01/29/2019] [Indexed: 12/24/2022]
Abstract
Tissue-engineered dermo-epidermal skin grafts could be applied for the treatment of large skin wounds or used as an in vitro wound-healing model. However, there is currently no skin replacement model that includes both, endothelial cells to simulate vascularization, and macrophages to regulate wound healing and tissue regeneration. Here, we describe for the first time a tissue-engineered, fully vascularized dermo-epidermal skin graft based on a fibrin hydrogel scaffold, using exclusively human primary cells. We show that endothelial cells and human dermal fibroblasts form capillary-like structures within the dermis whereas keratinocytes form the epithelial cell layer. Macrophages played a key role in controlling the number of epithelial cells and their morphology after skin injury induced with a CO2 laser. The activation of selected cell types was confirmed by mRNA analysis. Our data underline the important role of macrophages in vascularized skin models for application as in vitro wound healing models or for skin replacement therapy. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 1340-1350, 2019.
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Affiliation(s)
- Franziska Kreimendahl
- Department of Biohybrid & Medical Textiles (BioTex), AME-Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Yvonne Marquardt
- Department of Dermatology and Allergology, RWTH Aachen University Hospital, Aachen, Germany
| | - Christian Apel
- Department of Biohybrid & Medical Textiles (BioTex), AME-Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Matthias Bartneck
- Department of Medicine III, Medical Faculty, RWTH Aachen, Aachen, Germany
| | | | - Julia Hepp
- Department of Dermatology and Allergology, RWTH Aachen University Hospital, Aachen, Germany
| | - Stefan Jockenhoevel
- Department of Biohybrid & Medical Textiles (BioTex), AME-Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Jens Malte Baron
- Department of Dermatology and Allergology, RWTH Aachen University Hospital, Aachen, Germany
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18
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Natesan S, Wrice NL, Christy RJ. Peroxisome proliferator‐activated receptor‐α agonist and all‐
trans
retinoic acid induce epithelial differentiation of subcutaneous adipose‐derived stem cells from debrided burn skin. J Cell Biochem 2018; 120:9213-9229. [DOI: 10.1002/jcb.28197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 11/12/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Shanmugasundaram Natesan
- Combat Trauma and Burn Injury Research United States Army Institute of Surgical Research Fort Sam Houston Texas
| | - Nicole L. Wrice
- Combat Trauma and Burn Injury Research United States Army Institute of Surgical Research Fort Sam Houston Texas
| | - Robert J. Christy
- Combat Trauma and Burn Injury Research United States Army Institute of Surgical Research Fort Sam Houston Texas
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19
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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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20
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Velasco D, Quílez C, Garcia M, del Cañizo JF, Jorcano JL. 3D human skin bioprinting: a view from the bio side. ACTA ACUST UNITED AC 2018. [DOI: 10.2217/3dp-2018-0008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Based on the 3D printing technologies and the concepts developed in tissue engineering during the last decades, 3D bioprinting is emerging as the most innovative and promising technology for the generation of human tissues and organs. In the case of skin bioprinting, thanks to the research process carried out during the last years, interfollicular skin has been printed with a structural and functional quality that paves the way for clinical and industrial applications. This review analyzes the present achievements and the future improvements that this area must bring about if bioprinted skin is to become widely used. We have made an effort to integrate the technological and the biological/biomedical sides of the subject.
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Affiliation(s)
- Diego Velasco
- Department of Bioengineering & Aerospace Engineering, Universidad Carlos III de Madrid (UC3M), Spain
- Department of Basic Research, Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
| | - Cristina Quílez
- Department of Bioengineering & Aerospace Engineering, Universidad Carlos III de Madrid (UC3M), Spain
| | - Marta Garcia
- Department of Bioengineering & Aerospace Engineering, Universidad Carlos III de Madrid (UC3M), Spain
- Department of Basic Research, Division of Epithelial Biomedicine, CIEMAT-CIBERER, Madrid, Spain
- Department of Basic Research, Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
| | - Juan F del Cañizo
- Department of Surgery, Universidad Complutense de Madrid, Experimental Medicine & Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jose L Jorcano
- Department of Bioengineering & Aerospace Engineering, Universidad Carlos III de Madrid (UC3M), Spain
- Department of Basic Research, Division of Epithelial Biomedicine, CIEMAT-CIBERER, Madrid, Spain
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21
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Li Z, Maitz P. Cell therapy for severe burn wound healing. BURNS & TRAUMA 2018; 6:13. [PMID: 29854856 PMCID: PMC5971426 DOI: 10.1186/s41038-018-0117-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/26/2018] [Indexed: 12/14/2022]
Abstract
Cell therapy has emerged as an important component of life-saving procedures in treating burns. Over past decades, advances in stem cells and regenerative medicine have offered exciting opportunities of developing cell-based alternatives and demonstrated the potential and feasibility of various stem cells for burn wound healing. However, there are still scientific and technical issues that should be resolved to facilitate the full potential of the cellular devices. More evidence from large, randomly controlled trials is also needed to understand the clinical impact of cell therapy in burns. This article aims to provide an up-to-date review of the research development and clinical applications of cell therapies in burn wound healing and skin regeneration.
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Affiliation(s)
- Zhe Li
- Burns Unit, Concord Hospital, Concord, New South Wales 2139 Australia
- Skin Laboratory, NSW Statewide Burns Service, Concord, New South Wales Australia
- Discipline of Surgery, University of Sydney Medical School, Camperdown, New South Wales Australia
| | - Peter Maitz
- Burns Unit, Concord Hospital, Concord, New South Wales 2139 Australia
- Skin Laboratory, NSW Statewide Burns Service, Concord, New South Wales Australia
- Discipline of Surgery, University of Sydney Medical School, Camperdown, New South Wales Australia
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22
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Gu BK, Choi DJ, Park SJ, Kim YJ, Kim CH. 3D Bioprinting Technologies for Tissue Engineering Applications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1078:15-28. [PMID: 30357616 DOI: 10.1007/978-981-13-0950-2_2] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Three-dimensional (3D) printing (rapid prototyping or additive manufacturing) technologies have received significant attention in various fields over the past several decades. Tissue engineering applications of 3D bioprinting, in particular, have attracted the attention of many researchers. 3D scaffolds produced by the 3D bioprinting of biomaterials (bio-inks) enable the regeneration and restoration of various tissues and organs. These 3D bioprinting techniques are useful for fabricating scaffolds for biomedical and regenerative medicine and tissue engineering applications, permitting rapid manufacture with high-precision and control over size, porosity, and shape. In this review, we introduce a variety of tissue engineering applications to create bones, vascular, skin, cartilage, and neural structures using a variety of 3D bioprinting techniques.
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Affiliation(s)
- Bon Kang Gu
- Laboratory of Tissue Engineering, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Dong Jin Choi
- Laboratory of Tissue Engineering, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Sang Jun Park
- Laboratory of Tissue Engineering, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Young-Jin Kim
- Department of Biomedical Engineering, Catholic University of Daegu, Gyeongsan, South Korea
| | - Chun-Ho Kim
- Laboratory of Tissue Engineering, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea.
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23
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Velasquillo C, Silva-Bermudez P, Vázquez N, Martínez A, Espadín A, García-López J, Medina-Vega A, Lecona H, Pichardo-Baena R, Ibarra C, Shirai K. In vitro
and in vivo
assessment of lactic acid-modified chitosan scaffolds for potential treatment of full-thickness burns. J Biomed Mater Res A 2017; 105:2875-2891. [DOI: 10.1002/jbm.a.36132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 05/26/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Cristina Velasquillo
- Biotecnología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra; Av. México Xochimilco No. 289 Col. Arenal de Guadalupe C.P. 14389 Ciudad de México México
| | - Phaedra Silva-Bermudez
- Unidad de Ingeniería de Tejidos, Terapia Celular y Medicina Regenerativa, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra; Av. México Xochimilco No. 289 Col. Arenal de Guadalupe C.P. 14389 Ciudad de México México
| | - Nadia Vázquez
- Biotecnología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra; Av. México Xochimilco No. 289 Col. Arenal de Guadalupe C.P. 14389 Ciudad de México México
- Posgrado en Ciencias Biológicas, Universidad Nacional Autónoma de México. Ciudad Universitaria; No. 3000, C.P. 04360 Ciudad de México México
| | - Alan Martínez
- Biotecnología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra; Av. México Xochimilco No. 289 Col. Arenal de Guadalupe C.P. 14389 Ciudad de México México
| | - Andres Espadín
- Departamento de Biotecnología, Laboratorio de Biopolímeros; Universidad Autónoma Metropolitana Unidad Iztapalapa; San Rafael Atlixco No. 186 Col. Vicentina C.P. 09340 Ciudad de México México
| | - Julieta García-López
- Unidad de Ingeniería de Tejidos, Terapia Celular y Medicina Regenerativa, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra; Av. México Xochimilco No. 289 Col. Arenal de Guadalupe C.P. 14389 Ciudad de México México
| | - Antonio Medina-Vega
- Cirugía Pediátrica, Instituto Nacional de Pediatría; Insurgentes Sur No. 3700, Letra C, CP. 04530 Ciudad de México México
| | - Hugo Lecona
- Bioterio y Cirugía Experimental, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra; Av. México Xochimilco No. 289 Col. Arenal de Guadalupe C.P. 14389 Ciudad de México México
| | - Raúl Pichardo-Baena
- Servicio de Anatomía Patológica y Microscopia Electrónica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra; Av. México Xochimilco No. 289 Col. Arenal de Guadalupe C.P.14389 Ciudad de México México
| | - Clemente Ibarra
- Unidad de Ingeniería de Tejidos, Terapia Celular y Medicina Regenerativa, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra; Av. México Xochimilco No. 289 Col. Arenal de Guadalupe C.P. 14389 Ciudad de México México
| | - Keiko Shirai
- Departamento de Biotecnología, Laboratorio de Biopolímeros; Universidad Autónoma Metropolitana Unidad Iztapalapa; San Rafael Atlixco No. 186 Col. Vicentina C.P. 09340 Ciudad de México México
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Yoon C, Lee J, Jeong H, Lee S, Sohn T, Chung S. Rapid preparation of a noncultured skin cell suspension that promotes wound healing. Cell Tissue Bank 2017; 18:131-141. [DOI: 10.1007/s10561-017-9615-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 02/23/2017] [Indexed: 10/20/2022]
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Klar AS, Biedermann T, Simmen-Meuli C, Reichmann E, Meuli M. Comparison of in vivo immune responses following transplantation of vascularized and non-vascularized human dermo-epidermal skin substitutes. Pediatr Surg Int 2017; 33:377-382. [PMID: 27999947 DOI: 10.1007/s00383-016-4031-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Autologous bio-engineered dermo-epidermal skin substitutes (DESS) represent an alternative therapeutic option for a definitive treatment of skin defects in human patients. Largely, the interaction of host immune cells with transplanted DESS is considered to be essential for the granulation tissue formation, graft take, and its functionality. The aim of this study was to compare the spatiotemporal distribution and density of host-derived monocytes/macrophages and granulocytes in vascularized (vascDESS) versus non-vascularized DESS (non-vascDESS) in a rat model. METHODS Keratinocytes and the stromal vascular fraction (SVF) were derived from human skin or human adipose tissue, respectively. Human SVF containing both endothelial and mesenchymal/stromal progenitors was used to develop a vascularized collagen type I-based dermal component in vitro. The donor-matched, monolayer-expanded adipose stromal cells lacking endothelial cells were used as a negative control. Subsequently, human keratinocytes were seeded on top of hydrogels to build dermo-epidermal skin grafts. After transplantation onto full-thickness skin wounds on the back of immuno-incompetent rats, grafts were excised and analyzed after 1 and 3 weeks. The expression of distinct inflammatory cell markers specific for host-derived monocytes/macrophages (CD11b, CD68) or granulocytes (HIS48) was analyzed by immunofluorescence microscopy. RESULTS All skin grafts were infiltrated by host-derived monocytes/macrophages (CD11b+, CD68+) and granulocytes (HIS48+) between 1-3 week post-transplantation. When compared to non-vascDESS, the vascDESS showed an increased granulocyte infiltration at all time points analyzed with the majority of cells scattered throughout the whole dermal part. Whereas a moderate number of rat monocytes/macrophages (CD11b+, CD68+) were found in vascDESS at 1 week, only a few cells were detected in non-vascDESS. We observed a time-dependent decrease of monocytes/macrophages in all transplants at 3 weeks. CONCLUSIONS These results demonstrate a distinct spatiotemporal distribution of monocytes/macrophages as well as granulocytes in our transplants that closely resemble the one observed during physiological wound healing. The differences identified between vascDESS and non-vascDESS may indicate that human endothelial cells lining blood capillaries of vascDESS accelerate infiltration of monocytes and leukocytes.
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Affiliation(s)
- Agnes S Klar
- Tissue Biology Research Unit, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Thomas Biedermann
- Tissue Biology Research Unit, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Claudia Simmen-Meuli
- Department of Plastic, Reconstructive, Aesthetical, and Hand Surgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Ernst Reichmann
- Tissue Biology Research Unit, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Martin Meuli
- Department of Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
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Shizhao J, Yongjun Z, Lisen Z, pengfei L, Xiaopeng Z, Guangyi W, Shihui Z, Xiaoyan H, Shichu X, Zhaofan X. Short- and long-term outcomes of small auto- and cryopreserved allograft skin grafting in those with >60%TBSA deep burn wounds. Burns 2017; 43:206-214. [DOI: 10.1016/j.burns.2016.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 04/07/2016] [Accepted: 07/19/2016] [Indexed: 10/21/2022]
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Cubo N, Garcia M, del Cañizo JF, Velasco D, Jorcano JL. 3D bioprinting of functional human skin: production and
in vivo
analysis. Biofabrication 2016; 9:015006. [DOI: 10.1088/1758-5090/9/1/015006] [Citation(s) in RCA: 254] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
Early burn excision has reduced the mortality from major burns. This practice presents the problem of wound coverage after excision, since the availability of autologous donor sites is limited in very large burns. This article reviews the methods available for covering burn wounds. Methods of expanding autologous skin are discussed as well as techniques using allogeneic tissue and xenograft. Newer synthetic skin substitutes have become an important advance and are also described. Cultured skin replacements are also discussed along with their shortfalls. The treatment of a patient with major burns may require the use of many different skin substitutes, as none is entirely satisfactory on its own.
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Affiliation(s)
- DL Chester
- West Midlands Regional Burns Unit, Birmingham, UK,
| | - RPG Papini
- West Midlands Regional Burns Unit, Birmingham, UK
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Rezapour-Lactoee A, Yeganeh H, Ostad SN, Gharibi R, Mazaheri Z, Ai J. Thermoresponsive polyurethane/siloxane membrane for wound dressing and cell sheet transplantation: In-vitro and in-vivo studies. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 69:804-14. [PMID: 27612775 DOI: 10.1016/j.msec.2016.07.067] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 07/20/2016] [Accepted: 07/24/2016] [Indexed: 01/01/2023]
Abstract
Polyurethane/siloxane based wound dressing for transferring fibroblast cell sheet to wounded skin and ability to provide an optimum condition for cellular activity at damaged tissue was prepared in this research. The dressing was made thermoresponsive, via the introduction of a poly(N-isopropyl acrylamide) copolymer into the backbone of dressing. The ability of membrane for adhesion, growth, and proliferation of fibroblast cells was improved via surface modification with gelatin. The optimized dressing exhibited appropriate tensile strength (4.5MPa) and elongation at break (80%) to protect wound against physical forces. Due to controlled equilibrium water absorption of about 89% and water vapor transmission rate of 2040g/m(2)day, the dressing could maintain the favorable moist environment over moderate to high exuding wounds. The grown cell sheet on dressing membrane could easily roll up from the surface just with lowering the temperature. The in vivo study of the wound dressed with cell loaded membrane confirmed the accelerated healing and production of tissue with complete re-epithelization, enhanced vascularization, and increased collagen deposition on the damaged area.
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Affiliation(s)
- Alireza Rezapour-Lactoee
- Department of Tissue Engineering, School of Advanced Medical Technologies, Tehran University of Medical Sciences, 14177-55469 Tehran, Iran
| | - Hamid Yeganeh
- Iran Polymer and Petrochemical Institute, P.O. Box: 14965/115, Tehran, Iran.
| | - Seyed Nasser Ostad
- Department of Tissue Engineering, School of Advanced Medical Technologies, Tehran University of Medical Sciences, 14177-55469 Tehran, Iran; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tehran University of Medical Sciences, 16 Azar St, Enqelab Sq, Tehran 1417614411, Iran.
| | - Reza Gharibi
- Department of Tissue Engineering, School of Advanced Medical Technologies, Tehran University of Medical Sciences, 14177-55469 Tehran, Iran
| | - Zohreh Mazaheri
- Department of Anatomical Sciences, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Jafar Ai
- Department of Tissue Engineering, School of Advanced Medical Technologies, Tehran University of Medical Sciences, 14177-55469 Tehran, Iran
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Chhetri DK, Head C, Revazova E, Hart S, Bhuta S, Berke GS. Lamina Propria Replacement Therapy with Cultured Autologous Fibroblasts for Vocal Fold Scars. Otolaryngol Head Neck Surg 2016; 131:864-70. [PMID: 15577782 DOI: 10.1016/j.otohns.2004.07.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES: To develop a canine model of vocal fold scar and to evaluate its treatment with lamina propria replacement therapy using autologous cultured fibroblasts. MATERIALS AND METHODS: Full thickness of the lamina propria layer in canine vocal folds was injured with a laser. Fibroblasts were cultured and expanded in the laboratory from a buccal mucosal biopsy. The scarred vocal folds were treated with 3 weekly injections of fourth, fifth, and sixth passage autologous fibroblasts. Mucosal waves and acoustic parameters were measured at baseline, after scarification, and several months after injection therapy. Histologic evaluation of the vocal folds for fibroblasts, collagen, elastin, reticulin, and hyaluronic acid was performed. RESULTS: Nine beagle dogs were used, and 1 animal served as control. Vocal fold scarring resulted in absent or severely limited mucosal waves and significantly worse acoustic parameters. Significant improvements in mucosal waves and acoustic parameters were obtained after lamina propria replacement therapy. After therapy, mucosal waves became normal in 4 animals and near normal in the other 4. No statistical difference was found in mucosal waves between baseline and post-therapy. All animals tolerated therapy without complications. The treated vocal folds demonstrated an increased density of fibroblasts, collagen, and reticulin, a decreased density of elastin, and no change in hyaluronic acid. CONCLUSIONS AND SIGNIFICANCE: Therapeutic options for vocal fold scars are limited. Lamina propria replacement therapy in the form of autologous cultured fibroblasts improves mucosal pliability and returns normal or near normal mucosal waves in experimentally scarred vocal folds. This novel therapeutic modality may hold new promise for treating vocal fold scars.
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Affiliation(s)
- Dinesh K Chhetri
- Division of Head and Neck Surgery, Department of Surgery, UCLA School of Medicine, Los Angeles, California 90095, USA.
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Cellulose acetate based 3-dimensional electrospun scaffolds for skin tissue engineering applications. Carbohydr Polym 2015; 133:251-61. [DOI: 10.1016/j.carbpol.2015.06.109] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 06/24/2015] [Accepted: 06/25/2015] [Indexed: 10/23/2022]
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Rapid creation of skin substitutes from human skin cells and biomimetic nanofibers for acute full-thickness wound repair. Burns 2015; 41:1764-1774. [PMID: 26187057 DOI: 10.1016/j.burns.2015.06.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 12/15/2022]
Abstract
Creation of functional skin substitutes within a clinically acceptable time window is essential for timely repair and management of large wounds such as extensive burns. The aim of this study was to investigate the possibility of fabricating skin substitutes via a bottom-up nanofiber-enabled cell assembly approach and using such substitutes for full-thickness wound repair in nude mice. Following a layer-by-layer (L-b-L) manner, human primary skin cells (fibroblasts and keratinocytes) were rapidly assembled together with electrospun polycaprolactone (PCL)/collagen (3:1, w/w; 8%, w/v) nanofibers into 3D constructs, in which fibroblasts and keratinocytes were located in the bottom and upper portion respectively. Following culture, the constructs developed into a skin-like structure with expression of basal keratinocyte markers and deposition of new matrix while exhibiting good mechanical strength (as high as 4.0 MPa by 14 days). Treatment of the full-thickness wounds created on the back of nude mice with various grafts (acellular nanofiber meshes, dermal substitutes, skin substitutes and autografts) revealed that 14-day-cultured skin substitutes facilitated a rapid wound closure with complete epithelialization comparable to autografts. Taken together, skin-like substitutes can be formed by L-b-L assembling human skin cells and biomimetic nanofibers and they are effective to heal acute full-thickness wounds in nude mice.
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Varkey M, Ding J, Tredget EE. Advances in Skin Substitutes-Potential of Tissue Engineered Skin for Facilitating Anti-Fibrotic Healing. J Funct Biomater 2015; 6:547-63. [PMID: 26184327 PMCID: PMC4598670 DOI: 10.3390/jfb6030547] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/30/2015] [Accepted: 06/30/2015] [Indexed: 02/06/2023] Open
Abstract
Skin protects the body from exogenous substances and functions as a barrier to fluid loss and trauma. The skin comprises of epidermal, dermal and hypodermal layers, which mainly contain keratinocytes, fibroblasts and adipocytes, respectively, typically embedded on extracellular matrix made up of glycosaminoglycans and fibrous proteins. When the integrity of skin is compromised due to injury as in burns the coverage of skin has to be restored to facilitate repair and regeneration. Skin substitutes are preferred for wound coverage when the loss of skin is extensive especially in the case of second or third degree burns. Different kinds of skin substitutes with different features are commercially available; they can be classified into acellular skin substitutes, those with cultured epidermal cells and no dermal components, those with only dermal components, and tissue engineered substitutes that contain both epidermal and dermal components. Typically, adult wounds heal by fibrosis. Most organs are affected by fibrosis, with chronic fibrotic diseases estimated to be a leading cause of morbidity and mortality. In the skin, fibroproliferative disorders such as hypertrophic scars and keloid formation cause cosmetic and functional problems. Dermal fibroblasts are understood to be heterogeneous; this may have implications on post-burn wound healing since studies have shown that superficial and deep dermal fibroblasts are anti-fibrotic and pro-fibrotic, respectively. Selective use of superficial dermal fibroblasts rather than the conventional heterogeneous dermal fibroblasts may prove beneficial for post-burn wound healing.
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Affiliation(s)
- Mathew Varkey
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, University of Alberta, 2D3.81 WMSHC, 8440-112 Street, Edmonton, AB T6G 2B7, Canada.
| | - Jie Ding
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, University of Alberta, 2D3.81 WMSHC, 8440-112 Street, Edmonton, AB T6G 2B7, Canada.
| | - Edward E Tredget
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, University of Alberta, 2D3.81 WMSHC, 8440-112 Street, Edmonton, AB T6G 2B7, Canada.
- Critical Care Medicine, University of Alberta, 2D3.81 WMSHC, 8440-112 Street, Edmonton, AB T6G 2B7, Canada.
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Marine-derived biological macromolecule-based biomaterials for wound healing and skin tissue regeneration. Int J Biol Macromol 2015; 77:24-35. [DOI: 10.1016/j.ijbiomac.2015.02.050] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 01/15/2015] [Accepted: 02/25/2015] [Indexed: 11/23/2022]
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Hulsen J, Diederich R, Neumeister MW, Bueno RA. Integra® dermal regenerative template application on exposed tendon. Hand (N Y) 2014; 9:539-42. [PMID: 25414619 PMCID: PMC4235916 DOI: 10.1007/s11552-014-9630-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Tendon without paratenon presents the reconstructive surgeon with a tissue coverage challenge. Integra® dermal regenerative template has been shown to initiate a stable, vascularized bed for skin grafting over tendon. However, histological processes that occur during incorporation have not been described. The purpose of this study is to characterize the pattern of changes that occur when Integra® is applied to an avascular tendon. We hypothesize that vascular incorporation will originate from the wound periphery and proceed toward the tendon center. METHODS A full-thickness defect was created over a denuded Achilles tendon in a single hind limb in eight New Zealand white rabbits. Integra was placed over the avascular tendon, and the limb was dressed and splinted. Two animals were euthanized at each timepoint (weeks 1, 2, 3, and 4), and hematoxylin and eosin (H&E)-stained tissue specimens were microscopically evaluated. RESULTS Week 1 specimens demonstrated limited adherence between Integra and the tendon, while myofibroblasts were found encircling the tendon. No cellularity was noted centrally. At week 2, the dermis-Integra junction had increasing vascularity and the central portion developed increasing cellularity. By week 3, Integra was completely revascularized. At week 4, Integra had the histological appearance of normal dermis. CONCLUSION Neovascularization of Integra® over exposed tendon occurs from the peripheral tissue. Ingrowth proceeds from the dermis-Integra interface toward the center of the graft. Four weeks after application to the denuded tendon, Integra has the histological appearance of native dermis.
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Affiliation(s)
- John Hulsen
- />Department of Plastic Surgery, The Ohio State University, 915 Olentagy River Road, Suite 2100, Columbus, OH 43212-3153 USA
| | - Ryan Diederich
- />Division of Plastic Surgery, Southern Illinois University School of Medicine, PO Box 19653, Springfield, IL 62794-9653 USA
| | - Michael W. Neumeister
- />Division of Plastic Surgery, Southern Illinois University School of Medicine, PO Box 19653, Springfield, IL 62794-9653 USA
| | - Reuben A. Bueno
- />Division of Plastic Surgery, Southern Illinois University School of Medicine, PO Box 19653, Springfield, IL 62794-9653 USA
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Klar AS, Böttcher-Haberzeth S, Biedermann T, Michalak K, Kisiel M, Reichmann E, Meuli M. Differential expression of granulocyte, macrophage, and hypoxia markers during early and late wound healing stages following transplantation of tissue-engineered skin substitutes of human origin. Pediatr Surg Int 2014; 30:1257-64. [PMID: 25326120 DOI: 10.1007/s00383-014-3616-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Human pigmented tissue-engineered skin substitutes represent an advanced therapeutic option to treat skin defects. The inflammatory response is one of the major factors determining integration and long-term survival of such a graft in vivo. The aim of the present study was to investigate the spatiotemporal distribution of host-derived macrophage and granulocyte graft infiltration as well as hypoxia-inducible factor 1 alpha (HIF-1-alpha) expression in a (nu/nu) rat model. METHODS Keratinocytes, melanocytes, and fibroblasts derived from human skin biopsies were isolated, cultured, and expanded in vitro. Dermal fibroblasts were seeded into collagen type I hydrogels that were subsequently covered by keratinocytes and melanocytes in 5:1 ratio. These pigmented dermo-epidermal skin substitutes were transplanted onto full-thickness skin wounds on the back of immuno-incompetent rats and analyzed at early (1 and 3 weeks) and late (6 and 12 weeks) stages of wound healing. The expression of distinct inflammatory cell markers specific for granulocytes (HIS48) or macrophages (CD11b, CD68), as well as HIF-1-alpha were analyzed and quantified by immunofluorescence microscopy. RESULTS Our data demonstrate that granulocytes infiltrate the entire graft at 1 week post-transplantation. This was followed by monocyte/macrophage recruitment to the graft at 3-12 weeks. The macrophages were initially restricted to the borders of the graft (early stages), and were then found throughout the entire graft (late stages). We observed a time-dependent decrease of macrophages. Only a few graft-infiltrating granulocytes were found between 6-12 weeks, mostly at the graft borders. A heterogeneous expression of HIF-1-alpha was observed at both early and late wound healing stages. CONCLUSIONS Our findings demonstrate the spatiotemporal distribution of inflammatory cells in our transplants closely resembles the one documented for physiological wound healing.
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Affiliation(s)
- Agnieszka S Klar
- Tissue Biology Research Unit, University Children's Hospital Zurich, Zurich, Switzerland
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Helmedag MJ, Weinandy S, Marquardt Y, Baron JM, Pallua N, Suschek CV, Jockenhoevel S. The effects of constant flow bioreactor cultivation and keratinocyte seeding densities on prevascularized organotypic skin grafts based on a fibrin scaffold. Tissue Eng Part A 2014; 21:343-52. [PMID: 25159286 DOI: 10.1089/ten.tea.2013.0640] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Organotypic full-thickness skin grafts (OTSG) are already an important technology for treating various skin conditions and are well established for skin research and development. These obvious benefits are often impaired by the need of laborious production, their noncomplete autologous composition, and, most importantly, their lack of included vasculature. Therefore, our study focused on combining a prevascularized dermal layer with an epidermis to cultivate full-thickness skin grafts incorporating capillary-like networks. It has been shown that prevascularization accelerates ingrowth of tissue-engineered grafts, and it is a prerequisite to circumvent diffusion limits due to graft thickness. To obtain such a graft, we chose a dermal layer incorporating human umbilical vein endothelial cells (HuVEC) amid human dermal fibroblasts within a fibrin-based scaffold, seeded apically with human foreskin keratinocytes (hfKC). Our research investigated the used concept's feasibility, as well as the effect of hfKC addition on the development of a well-connected capillary-like network after approximately 21 days. In addition, we evaluated the utilization of a custom-made constant flow bioreactor for simplified cultivation of these grafts, therefore possibly easing graft production and presumably increasing their cost effectiveness. Skin grafts were assessed by conventional two-dimensional histology. In addition, software-assisted three-dimensional evaluation of the capillary-like structure networks was performed by two-photon laser scanning microscopy (TPLSM) and subsequent image processing was done with ImagePro(®) Analyzer 7.0 software, thereby evaluating its platform technology power in the field of prevascularized skin grafts. All samples showed a capillary-like structure network, but we could report a significant reduction of its total length after 14 days of tri-culture with 5×10(5)/cm(2) seeded hfKC, possibly indicating nutritional deficiencies for this particular high cell density experimental setup. Lower concentrations of hfKC did not affect the formation of the capillary-like structures significantly. The developed bioreactor simplified cultivation of prevascularized OTSG. However, a flow-dependent reduction of capillary-like structures in 1 and 5 mL/min flow conditions occurred. We conclude that our technique for creating prevascularized OTSG is feasible. In addition, TPLSM is well suited for analyzing the prevascularization process. We hypothesize that the handling benefits of our bioreactor can be preserved by using considerably lower flow rates while not impairing the forming of capillary-like structure networks.
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Affiliation(s)
- Marius Julian Helmedag
- 1 Department for Tissue Engineering & Textile Implants, Institute of Applied Medical Engineering, Helmholtz Institute Applied Medical Engineering, RWTH Aachen University Hospital , Aachen, Germany
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Chrapusta A, Nessler MB, Drukala J, Bartoszewicz M, Mądry R. A comparative analysis of advanced techniques for skin reconstruction with autologous keratinocyte culture in severely burned children: own experience. Postepy Dermatol Alergol 2014; 31:164-9. [PMID: 25097488 PMCID: PMC4112268 DOI: 10.5114/pdia.2014.43190] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 02/28/2014] [Accepted: 03/14/2014] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION The local treatment in burns larger than 50% of total body surface area is still the great challenge for surgeons. AIM This paper presents a review of different solutions for deep burn wound healing in children and the early outcomes of treatment with combined autologous cell culture technique. MATERIAL AND METHODS For this study, 20 children aged between 4 and 12 years with 55-65% of TBSA III grade burn injury were analyzed. A skin sample, 1 cm × 1 cm in size, for keratinocyte cultivation, was taken on the day of the burn. After necrotic tissue excision, the covering of the burned area with an isolated meshed skin graft was carried out between day 4 and 7. After 7 days of keratinocyte cultivation, the mentioned areas were covered with cells from the culture. We divided the burned regions, according to the way of wound closure, into 3 groups each consisting of 15 treated regions of the body. We used meshed split thickness skin grafts (SSG group), cultured autologous keratinocytes (CAC group), and both techniques applied in one stage (SSG + CAC group). RESULTS In the SSG group, the mean time for complete closure of wounds was 12.7 days. Wounds treated with CAC only needed a non-significantly longer time to heal - 14.2 days (p = 0.056) when compared to SSG. The shortest time to heal was observed in the group treated with SSG + CAC - 8.5 days, and it was significantly shorter when compared to the SSG and CAC groups (p < 0.001). CONCLUSIONS This study suggests that cultured keratinocytes obtained after short-time multiplication, combined with meshed autologous split thickness skin grafts, constitute the optimal wound closure in burned children.
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Affiliation(s)
- Anna Chrapusta
- Malopolska Center for Burn and Plastic Surgery, Ludwik Rydygier Memorial Specialized Hospital, Krakow, Poland. Head of Center: Anna Chrapusta MD, PhD
| | - Michał B. Nessler
- Malopolska Center for Burn and Plastic Surgery, Ludwik Rydygier Memorial Specialized Hospital, Krakow, Poland. Head of Center: Anna Chrapusta MD, PhD
| | - Justyna Drukala
- Laboratory of Cell and Tissue Engineering, Department of Cell Biology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland. Head of Department: Prof. Zbigniew Madeja PhD, DSc
| | - Marzenna Bartoszewicz
- Department of Microbiology, Medical University of Wroclaw, Poland. Head of Department: Assoc. Prof. Grażyna Gościniak PhD
| | - Ryszard Mądry
- The Eastern Center for Burn and Reconstructive Surgery, Łęczna, Poland. Head of Center: Prof. Jerzy Strużyna MD, PhD
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Lagus H, Sarlomo-Rikala M, Böhling T, Vuola J. Prospective study on burns treated with Integra®, a cellulose sponge and split thickness skin graft: comparative clinical and histological study--randomized controlled trial. Burns 2013; 39:1577-87. [PMID: 23880091 DOI: 10.1016/j.burns.2013.04.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 04/18/2013] [Accepted: 04/19/2013] [Indexed: 01/23/2023]
Abstract
BACKGROUND The aim of this study was to compare three different methods to cover excised burn wounds in a randomized controlled trial. METHODS Fascially excised burn wounds, measuring 10 cm × 5 cm, were covered with Integra(®), split thickness skin graft (STSG), and a viscose cellulose sponge Cellonex™ in each of ten adult patients. Integra(®) and Cellonex™ treated areas were covered with thin STSG on day 14. Biopsies were taken 3, 7, 14, and 21 days, 3 months, and 12 months after surgery, and samples were subjected to a range of immunohistochemical stains, in addition to hematoxylin and eosin (HE). Scar assessment was performed 3 and 12 months post-operatively with the Vancouver Scar Scale (VSS). RESULTS Inflammation was not substantial in any of the study areas, but Cellonex™ had the most neutrophils, histiocytes, and lymphocytes with significant differences on days 7 and 14. Complete vascularization of Integra(®) seemed to occur later compared to the other materials. STSG had the most myofibroblasts on day 14 (p = 0.012). In VSS the quality of the scar improved in all materials from 3 to 12 months. CONCLUSIONS The final results for all treatments after 12 months demonstrate equal clinical appearance, as well as histological and immunohistochemical findings.
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Affiliation(s)
- Heli Lagus
- Department of Surgery, Hyvinkää Hospital, Hyvinkää, Finland.
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Allouni A, Papini R, Lewis D. Spray-on-skin cells in burns: a common practice with no agreed protocol. Burns 2013; 39:1391-4. [PMID: 23622870 DOI: 10.1016/j.burns.2013.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 03/23/2013] [Accepted: 03/27/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Cultured epithelial autograft (CEA) has been used for skin coverage after burn wound excision since 1981. It is used in burn units and centres throughout the U.K.; however, there appears to be no agreed standards of practice. We aimed to investigate the experience and current practice with its usage in the management of acute burn injury. METHODS An online survey was sent to twenty-five burns consultants in the U.K., who are members of the British Burn Association. RESULTS We received 14 responses. Rarely have the responders agreed to the same practice in most of the questions. Different choices were given by responders with regards the indications for cell culture, techniques used, primary and secondary dressings used, first wound review timing, and measures used to evaluate outcomes. CONCLUSION In the current economic environment, the NHS needs to rationalize services on the basis of cost effectiveness. CEA is an expensive procedure that requires an adequately sterile laboratory, special equipments and highly experienced dedicated staff. When dealing with expensive management options, it is important to have an agreed protocol that can form the standard that can be referred to when auditing practices and results to improve burn management and patients' care.
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Affiliation(s)
- Ammar Allouni
- Burns and Plastic Department, Queen Elizabeth Hospital Birmingham, Birmingham, West Midlands B15 2TH, UK.
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Abstract
The ultimate goal of the treatment of cutaneous burns and wounds is to restore the damaged skin both structurally and functionally to its original state. Recent research advances have shown the great potential of stem cells in improving the rate and quality of wound healing and regenerating the skin and its appendages. Stem cell-based therapeutic strategies offer new prospects in the medical technology for burns and wounds care. This review seeks to give an updated overview of the applications of stem cell therapy in burns and wound management since our previous review of the “stem cell strategies in burns care”.
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Affiliation(s)
- Lin Huang
- Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, The Chinese University of Hong Kong, Hong Kong
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Minimal contraction for tissue-engineered skin substitutes when matured at the air-liquid interface. J Tissue Eng Regen Med 2012; 7:452-60. [DOI: 10.1002/term.543] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 08/01/2011] [Accepted: 11/03/2011] [Indexed: 11/07/2022]
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Braziulis E, Diezi M, Biedermann T, Pontiggia L, Schmucki M, Hartmann-Fritsch F, Luginbühl J, Schiestl C, Meuli M, Reichmann E. Modified plastic compression of collagen hydrogels provides an ideal matrix for clinically applicable skin substitutes. Tissue Eng Part C Methods 2012; 18:464-74. [PMID: 22195768 DOI: 10.1089/ten.tec.2011.0561] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Tissue engineering of clinically applicable dermo-epidermal skin substitutes is crucially dependent on the three-dimensional extracellular matrix, supporting the biological function of epidermal and dermal cells. This matrix essentially determines the mechanical stability of these substitutes to allow for safe and convenient surgical handling. Collagen type I hydrogels yield excellent biological functionality, but their mechanical weakness and their tendency to contract and degrade does not allow producing clinically applicable transplants of larger sizes. We show here that plastically compressed collagen type I hydrogels can be produced in clinically relevant sizes (7×7 cm), and can be safely and conveniently handled by the surgeon. Most importantly, these dermo-epidermal skin substitutes mature into a near normal skin that can successfully reconstitute full-thickness skin defects in an animal model.
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Affiliation(s)
- Erik Braziulis
- Tissue Biology Research Unit, Department of Surgery, University Children's Hospital, Zürich, Switzerland
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Halmy C, Pesthy P, Nádai Z, Juhász Z. [Use of Integra in a case of extensive upper extremity avulsion]. Orv Hetil 2011; 152:1443-6. [PMID: 21865145 DOI: 10.1556/oh.2011.29190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Authors performed successful skin replacement with Integra, a dermal regeneration template, on a patient with circumferential avulsion injury including the elbow region and the dorsum of the hand. The take rate of Integra was 97%, followed by a 98% take rate of the split thickness mesh graft used for final wound coverage. Treatment modality provided excellent aesthetic and functional results, underlining the role of Integra in cases of extensive traumatic skin and soft tissue deficit, such as the treatment of avulsion injury.
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Affiliation(s)
- Csaba Halmy
- Honvédkórház-Állami Egészségügyi Központ Baleseti Sebészeti Osztály, Plasztikai és Égési Sebészeti Részleg Budapest.
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Mahjour SB, Ghaffarpasand F, Wang H. Hair follicle regeneration in skin grafts: current concepts and future perspectives. TISSUE ENGINEERING PART B-REVIEWS 2011; 18:15-23. [PMID: 21883016 DOI: 10.1089/ten.teb.2011.0064] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The repair and management of full-thickness skin defects resulting from burns and chronic wounds remain a significant unmet clinical challenge. For those skin defects exceeding 50%-60% of total body surface area, it is impractical to treat with autologous skin transplants because of the shortage of donor sites. The possibility of using tissue-engineered skin grafts for full-thickness wound repair is a promising approach. The primary goal of tissue-engineered skin grafts is to restore lost barrier function, but regeneration of appendages, such as hair follicles, has to be yet achieved. The successful regeneration of hair follicles in immunodeficient mice suggests that creating human hair follicles in tissue-engineered skin grafts is feasible. However, many limitations still need to be explored, particularly enriching isolated cells with trichogenic capacity, maintaining this ability during processing, and providing the cells with proper environmental cues. Current advances in hair follicle regeneration, in vitro and in vivo, are concisely summarized in this report, and key requirements to bioengineer a hair follicle are proposed, with emphasis on a three-dimensional approach.
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Affiliation(s)
- Seyed Babak Mahjour
- Department of Chemistry, Chemical Biology and Biomedical Engineering, Stevens Institute of Technology, Hoboken, New Jersey 07030, USA
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Considerations in the choice of a skin donor site for harvesting keratinocytes containing a high proportion of stem cells for culture in vitro. Burns 2011; 37:440-7. [DOI: 10.1016/j.burns.2010.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 08/06/2010] [Accepted: 09/03/2010] [Indexed: 11/17/2022]
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Weber AD, Pontiggia L, Biedermann T, Schiestl C, Meuli M, Reichmann E. Determining the origin of cells in tissue engineered skin substitutes: a pilot study employing in situ hybridization. Pediatr Surg Int 2011; 27:255-61. [PMID: 21072665 DOI: 10.1007/s00383-010-2776-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Definitive and high-quality coverage of large and, in particular, massive skin defects remains a significant challenge in burn as well as plastic and reconstructive surgery because of donor site shortage. A novel and promising approach to overcome these problems is tissue engineering of skin. Clearly, before eventual clinical application, engineered skin substitutes of human origin must be grafted and then evaluated in animal models. For the various tests to be conducted it is indispensable to be able to identify human cells as such in culture and also to distinguish between graft and recipient tissue after transplantation. Here we describe a tool to identify human cells in vitro and in vivo. METHODS In situ hybridization allows for the detection and localization of specific DNA or RNA sequences in morphologically preserved cells in culture or tissue sections, respectively. We used digoxigenin-labeled DNA probes corresponding to human-specific Alu repeats in order to identify human keratinocytes grown in culture together with rat cells, and also to label split and full thickness skin grafts of human origin after transplantation on immuno-incompetent rats. RESULTS Digoxigenin-labeled DNA probing resulted in an intensive nuclear staining of human cells, both in culture and after transplantation onto recipient animals, while recipient animal cells (rat cells) did not stain. CONCLUSION In situ hybridization using primate-specific Alu probes reliably allows distinguishing between cells of human and non-human origin both in culture as well as in histological sections. This method is an essential tool for those preclinical experiments (performed on non-primate animals) that must be conducted before novel tissue engineered skin substitutes might be introduced into clinical practice.
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Affiliation(s)
- Andreas Daniel Weber
- Tissue Biology Research Unit, Department of Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, Zurich, Switzerland
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Skingineering I: engineering porcine dermo-epidermal skin analogues for autologous transplantation in a large animal model. Pediatr Surg Int 2011; 27:241-7. [PMID: 21085972 DOI: 10.1007/s00383-010-2777-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Extended full thickness skin defects still represent a considerable therapeutic challenge as ideal strategies for definitive autologous coverage are still not available. Tissue engineering of whole skin represents an equally attractive and ambitious novel approach. We have recently shown that laboratory-grown human skin analogues with near normal skin anatomy can be successfully transplanted on immuno-incompetent rats. The goal of the present study was to engineer autologous porcine skin grafts for transplantation in a large animal model (pig study = intended preclinical study). MATERIALS AND METHODS Skin biopsies were taken from the pig's abdomen. Epidermal keratinocytes and dermal fibroblasts were isolated and then expanded on culture dishes. Subsequently, highly concentrated collagen hydrogels and collagen/fibrin hydrogels respectively, both containing dermal fibroblasts, were prepared. Fibroblast survival, proliferation, and morphology were monitored using fluorescent labelling and laser scanning confocal microscopy. Finally, keratinocytes were seeded onto this dermal construct and allowed to proliferate. The resulting in vitro generated porcine skin substitutes were analysed by H&E staining and immunofluorescence. RESULTS Dermal fibroblast proliferation and survival in pure collagen hydrogels was poor. Also, the cells were mainly round-shaped and they did not develop 3D-networks. In collagen/fibrin hydrogels, dermal fibroblast survival was significantly higher. The cells proliferated well, were spindle-shaped, and formed 3D-networks. When these latter dermal constructs were seeded with keratinocytes, a multilayered and partly stratified epidermis readily developed. CONCLUSION This study provides compelling evidence that pig cell-derived skin analogues with near normal skin anatomy can be engineered in vitro. These tissue-engineered skin substitutes are needed to develop a large animal model to establish standardized autologous transplantation procedures for those studies that must be conducted before "skingineering" can eventually be clinically applied.
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Hu X, Yu W, Sun H, Wang X, Han C. Epidermal cells delivered for cutaneous wound healing. J DERMATOL TREAT 2010; 23:224-37. [DOI: 10.3109/09546634.2010.495741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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