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Berkane Y, Oubari H, van Dieren L, Charlès L, Lupon E, McCarthy M, Cetrulo CL, Bertheuil N, Uygun BE, Smadja DM, Lellouch AG. Tissue engineering strategies for breast reconstruction: a literature review of current advances and future directions. ANNALS OF TRANSLATIONAL MEDICINE 2024; 12:15. [PMID: 38304901 PMCID: PMC10777243 DOI: 10.21037/atm-23-1724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/15/2023] [Indexed: 02/03/2024]
Abstract
Background and Objective Mastectomy is a primary treatment for breast cancer patients, and both autologous and implant-based reconstructive techniques have shown excellent results. In recent years, advancements in bioengineering have led to a proliferation of innovative approaches to breast reconstruction. This article comprehensively explores the promising perspectives offered by bioengineering and tissue engineering in the field of breast reconstruction. Methods A literature review was conducted between April and June 2023 on PubMed and Google Scholar Databases. All English and French articles related to bioengineering applied to the field of breast reconstruction were included. We used the Evidence-Based Veterinary Medicine Association (EBVM) Toolkit 14 checklist for narrative reviews as a quality assurance measure and the Scale for the Assessment of Narrative Review Articles (SANRA) tool to self-assess our methodology. Key Content and Findings Over 130 references related to breast bioengineering were included. The analysis revealed four key applications: enhancing the quality of the skin envelope, improving the viability of fat grafting, creating breast shape and volume via bio-printing, and optimizing nipple reconstruction through engineering techniques. The primary identified approaches revolved around establishing structural support and enhancing cellular viability. Structural techniques predominantly involved the implementation of 3D printed, decellularized, or biocompatible material scaffolds. Meanwhile, promoting cellular content trophicity primarily focused on harnessing the regenerative potential of adipose-derived stem cells (ADSCs) and increasing the tissue's survivability and cell trophicity. Conclusions Tissue and bioengineering hold immense promise in the field of breast reconstruction, offering a diverse array of approaches. By combining existing techniques with novel advancements, they have the potential to significantly enhance the therapeutic options available to plastic and reconstructive surgeons.
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Affiliation(s)
- Yanis Berkane
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Shriners Children’s Boston, Boston, MA, USA
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Rennes, University of Rennes, Rennes, France
- Unité Mixte de Recherche UMR 1236 Suivi Immunologique des Thérapeutiques Innovantes, INSERM and University of Rennes, Rennes, France
| | - Haizam Oubari
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Shriners Children’s Boston, Boston, MA, USA
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Grenoble University Hospital Center, Grenoble, France
| | - Loïc van Dieren
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Plastic Surgery, University of Antwerp, Wilrijk, Belgium
| | - Laura Charlès
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Shriners Children’s Boston, Boston, MA, USA
| | - Elise Lupon
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Plastic and Reconstructive Surgery, Pasteur 2 Hospital, University Côte d’Azur, Sophia Antipolis, Nice, France
| | - Michelle McCarthy
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Shriners Children’s Boston, Boston, MA, USA
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Curtis L. Cetrulo
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Shriners Children’s Boston, Boston, MA, USA
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Rennes, University of Rennes, Rennes, France
- Unité Mixte de Recherche UMR 1236 Suivi Immunologique des Thérapeutiques Innovantes, INSERM and University of Rennes, Rennes, France
| | - Basak E. Uygun
- Shriners Children’s Boston, Boston, MA, USA
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David M. Smadja
- Unité Mixte de Recherche UMR-S 1140 Innovative Therapies in Haemostasis, INSERM and University of Paris, Paris, France
- Department of Hematology, European Georges Pompidou Hospital, Paris, France
| | - Alexandre G. Lellouch
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Shriners Children’s Boston, Boston, MA, USA
- Unité Mixte de Recherche UMR-S 1140 Innovative Therapies in Haemostasis, INSERM and University of Paris, Paris, France
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Berkane Y, Kostyra DM, Chrelias T, Randolph MA, Lellouch AG, Cetrulo CL, Uygun K, Uygun BE, Bertheuil N, Duisit J. The Autonomization Principle in Vascularized Flaps: An Alternative Strategy for Composite Tissue Scaffold In Vivo Revascularization. Bioengineering (Basel) 2023; 10:1440. [PMID: 38136031 PMCID: PMC10740989 DOI: 10.3390/bioengineering10121440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/28/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Autonomization is a physiological process allowing a flap to develop neo-vascularization from the reconstructed wound bed. This phenomenon has been used since the early application of flap surgeries but still remains poorly understood. Reconstructive strategies have greatly evolved since, and fasciocutaneous flaps have progressively replaced muscle-based reconstructions, ensuring better functional outcomes with great reliability. However, plastic surgeons still encounter challenges in complex cases where conventional flap reconstruction reaches its limitations. Furthermore, emerging bioengineering applications, such as decellularized scaffolds allowing a complex extracellular matrix to be repopulated with autologous cells, also face the complexity of revascularization. The objective of this article is to gather evidence of autonomization phenomena. A systematic review of flap autonomization is then performed to document the minimum delay allowing this process. Finally, past and potential applications in bio- and tissue-engineering approaches are discussed, highlighting the potential for in vivo revascularization of acellular scaffolds.
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Affiliation(s)
- Yanis Berkane
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, Rennes University, 16 Boulevard de Bulgarie, 35000 Rennes, France (T.C.); (N.B.)
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA 02114, USA; (M.A.R.); (A.G.L.); (C.L.C.J.)
- Shriners Children’s Boston, 51 Blossom Street, Boston, MA 02114, USA; (K.U.); basa (B.E.U.)
- SITI Laboratory, UMR1236, INSERM, Rennes University, 2 Rue Henri le Guillou, 35000 Rennes, France
| | - David M. Kostyra
- Plastic Surgery Research Laboratory, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA 02114, USA;
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA 02114, USA
| | - Theodoros Chrelias
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, Rennes University, 16 Boulevard de Bulgarie, 35000 Rennes, France (T.C.); (N.B.)
| | - Mark A. Randolph
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA 02114, USA; (M.A.R.); (A.G.L.); (C.L.C.J.)
- Shriners Children’s Boston, 51 Blossom Street, Boston, MA 02114, USA; (K.U.); basa (B.E.U.)
- Plastic Surgery Research Laboratory, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA 02114, USA;
| | - Alexandre G. Lellouch
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA 02114, USA; (M.A.R.); (A.G.L.); (C.L.C.J.)
- Shriners Children’s Boston, 51 Blossom Street, Boston, MA 02114, USA; (K.U.); basa (B.E.U.)
| | - Curtis L. Cetrulo
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA 02114, USA; (M.A.R.); (A.G.L.); (C.L.C.J.)
- Shriners Children’s Boston, 51 Blossom Street, Boston, MA 02114, USA; (K.U.); basa (B.E.U.)
| | - Korkut Uygun
- Shriners Children’s Boston, 51 Blossom Street, Boston, MA 02114, USA; (K.U.); basa (B.E.U.)
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA 02114, USA
| | - Basak E. Uygun
- Shriners Children’s Boston, 51 Blossom Street, Boston, MA 02114, USA; (K.U.); basa (B.E.U.)
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, MA 02114, USA
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, Rennes University, 16 Boulevard de Bulgarie, 35000 Rennes, France (T.C.); (N.B.)
- SITI Laboratory, UMR1236, INSERM, Rennes University, 2 Rue Henri le Guillou, 35000 Rennes, France
| | - Jérôme Duisit
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rennes University Hospital Center, Rennes University, 16 Boulevard de Bulgarie, 35000 Rennes, France (T.C.); (N.B.)
- IRIS Sud Hospitals, Rue Baron Lambert 38, 1040 Etterbeek, Belgium
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Chiu A, Sharma D, Zhao F. Tissue Engineering-Based Strategies for Diabetic Foot Ulcer Management. Adv Wound Care (New Rochelle) 2023; 12:145-167. [PMID: 34939837 PMCID: PMC9810358 DOI: 10.1089/wound.2021.0081] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/26/2021] [Indexed: 01/13/2023] Open
Abstract
Significance: Diabetic foot ulcers (DFU) are a mounting problem with the increasingly frail population. Injuries that would otherwise heal are kept open by risk factors such as diabetes, obesity, and age-related conditions, which interferes with the natural wound healing processes. Recent Advances: This review summarizes recent advancements in the field of tissue engineering for the treatment of DFUs. FDA-approved approaches, including signaling-based therapies, stem cell therapies, and skin substitutes are summarized and cutting-edge experimental technologies that have the potential to manage chronic wounds, such as skin printing, skin organogenesis, skin self-assembly, and prevascularization, are discussed. Critical Issues: The standard of care for chronic wounds involves wound debridement, wound dressings, and resolving the underlying cause such as lowering the glycemic index and reducing wound pressure. Current DFU treatments are limited by low wound closure rates and poor regrown skin quality. New adjuvant therapies that facilitate wound closure in place of or in conjunction with standard care are critically needed. Future Directions: Tissue engineering strategies are limited by the plasticity of adult human cells. In addition to traditional techniques, genetic modification, although currently an emerging technology, has the potential to unlock human regeneration and can be incorporated in future therapeutics.
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Affiliation(s)
- Alvis Chiu
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas, USA
| | - Dhavan Sharma
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas, USA
| | - Feng Zhao
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas, USA
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Mihalečko J, Boháč M, Danišovič Ľ, Koller J, Varga I, Kuniaková M. Acellular Dermal Matrix in Plastic and Reconstructive Surgery. Physiol Res 2022. [DOI: 10.33549/physiolres.935045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Despite significant advances in medical research, plastic surgeons still face a shortage of suitable patient tissues, and soft tissue reconstruction is no exception. In recent years, there has been a rapid boom in the use of acellular dermal matrix (ADM) in reconstructive and aesthetic surgery. ADM is incorporated into the surrounding tissue and gradually replaced by the host's collagen, thus promoting and supporting the healing process and reducing the formation of scar tissue. The main goal of this article is to provide a brief review of the current literature assessing the clinical applications of ADM across a broad spectrum of applications in plastic and reconstructive surgery.
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Affiliation(s)
| | | | | | | | | | - M Kuniaková
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University in Bratislava, Sasinkova 4, 811 08 Slovakia. E-mail:
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MIHALEČKO J, BOHÁČ M, DANIŠOVIČ Ľ, KOLLER J, VARGA I, KUNIAKOVÁ M. Acellular Dermal Matrix in Plastic and Reconstructive Surgery. Physiol Res 2022; 71:S51-S57. [PMID: 36592440 PMCID: PMC9854008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Despite significant advances in medical research, plastic surgeons still face a shortage of suitable patient tissues, and soft tissue reconstruction is no exception. In recent years, there has been a rapid boom in the use of acellular dermal matrix (ADM) in reconstructive and aesthetic surgery. ADM is incorporated into the surrounding tissue and gradually replaced by the host's collagen, thus promoting and supporting the healing process and reducing the formation of scar tissue. The main goal of this article is to provide a brief review of the current literature assessing the clinical applications of ADM across a broad spectrum of applications in plastic and reconstructive surgery.
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Affiliation(s)
- Ján MIHALEČKO
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovak Republic
| | - Martin BOHÁČ
- 2nd Department of Oncology, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovak Republic,Centre for Tissue Engineering and Regenerative Medicine – Translational Research Unit in the Branch of Regenerative Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
| | - Ľuboš DANIŠOVIČ
- Centre for Tissue Engineering and Regenerative Medicine – Translational Research Unit in the Branch of Regenerative Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic,Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic,National Institute of Rheumatic Diseases, Piestany, Slovak Republic
| | - Ján KOLLER
- Department of Burns and Reconstructive Surgery, Faculty of Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic
| | - Ivan VARGA
- National Institute of Rheumatic Diseases, Piestany, Slovak Republic,Institute of Histology and Embryology, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic
| | - Marcela KUNIAKOVÁ
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, Bratislava, Slovak Republic,National Institute of Rheumatic Diseases, Piestany, Slovak Republic
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Kim BK, Kong DS, Nam DH, Hong SD. Comparison of Graft Materials in Multilayer Reconstruction with Nasoseptal Flap for High-Flow CSF Leak during Endoscopic Skull Base Surgery. J Clin Med 2022; 11:jcm11226711. [PMID: 36431187 PMCID: PMC9697000 DOI: 10.3390/jcm11226711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/10/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Cerebrospinal fluid (CSF) leak is a crucial complication after endoscopic skull base surgery. Therefore, multilayer reconstruction with grafts is as essential as a reconstruction with pedicled flaps. Although widely used, the multilayer technique with autologous fascia lata has drawbacks, such as additional wound and donor site complications. We compared acellular dermal graft and banked homologous fascia lata graft (alternative grafts) with autologous fascia lata graft for high-flow CSF leak repair. We retrospectively enrolled 193 subjects who underwent endoscopic skull base reconstruction with multilayer fascial grafts and nasoseptal flap for high-flow CSF leaks from November 2014 to February 2020 at a single institution. Acellular dermal matrix (ADM), banked homologous fascia lata, and autologous fascia lata were used in 48 (24.9%), 102 (52.8%), and 43 (22.3%) patients, respectively. Postoperative CSF leaks occurred in 23 (11.9%) patients and meningitis in 8 (4.1%). There was no significant difference in postoperative CSF leak (p = 0.36) and meningitis (p = 0.17) across the graft groups. Additionally, we could not find out contributing risk factors for postoperative CSF leak and meningitis. ADM and banked homologous fascia lata are non-inferior to autologous fascia lata for endoscopic skull base reconstruction in water-tight reconstruction or safety without additional donor site morbidities.
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Affiliation(s)
- Byung Kil Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu 41404, Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Do-Hyun Nam
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
- Correspondence:
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7
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Hong SD. Reconstruction Strategy After Endoscopic Skull-Base Surgery. JOURNAL OF RHINOLOGY 2022. [DOI: 10.18787/jr.2021.00401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Endoscopic skull-base surgery (ESBS) is a rapidly growing surgical area that involves collaboration of otolaryngology-head and neck surgeons and neurosurgeons. Various tumor pathologies and extents have been successfully treated with ESBS, and diverse reconstruction methods have been adopted since its introduction. The optimal reconstructive strategy should be based on heterogeneous surgical situations and tumor extent. Nevertheless, there are few current guidelines for selecting reconstructive methods. Therefore, we review diverse options for endoscopic skull-base reconstruction.
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Insights into the use of genetically modified decellularized biomaterials for tissue engineering and regenerative medicine. Adv Drug Deliv Rev 2022; 188:114413. [PMID: 35777666 DOI: 10.1016/j.addr.2022.114413] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/25/2022] [Accepted: 06/25/2022] [Indexed: 11/24/2022]
Abstract
Various modifications have been performed on biomaterials to improve their applications in tissue engineering and regenerative medicine. However, the challenges of immunogenicity and biocompatibility existed since the application of biomaterials. As a method to solve this problem, the decellularization process removes most living cells from biomaterials to minimize their immunogenicity; and preserves the native structures and compositions that favour cell growth and the subsequent construction of functional tissue. On the other hand, genetic modification of biomaterials aims to achieve specific functions (low immunogenicity, osteogenesis, etc.) or analyse the genetic mechanisms underlying some diseases (cardiac dysfunction, liver fibrosis, etc.). The combination of decellularization and gene modification is highly superior to biomaterials; thus, we must obtain a deeper understanding of these novel biomaterials. In this review, we summarize the fabrication approaches and current applications of genetically modified decellularized biomaterials and then discuss their disadvantages and corresponding future perspectives.
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Patel S, Ziai K, Lighthall JG, Walen SG. Biologics and acellular dermal matrices in head and neck reconstruction: A comprehensive review. Am J Otolaryngol 2022; 43:103233. [PMID: 34537508 DOI: 10.1016/j.amjoto.2021.103233] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/09/2021] [Indexed: 11/30/2022]
Abstract
Acellular dermal matrices (ADMs) have been studied extensively in the literature and have gained popularity for various reconstructive and aesthetic purposes. ADMs are composed of a basement membrane and acellular dermal layer of collagen and provide a platform for mucosal epithelization and neovascularization. Combining dermal collagen and essential growth factors allows ADMs to support adequate wound healing and bolster soft-tissue repairs. These dermal matrices can be derived from human cadaveric donor skin (allogenic) or mammalian donor sources (xenogeneic). These dermal substitutes provide the benefit of reducing or eliminating the need for autologous tissue grafts and subsequently minimize donor site morbidity. Many ADMs are currently available in the market, each with variations in processing, manufacturing, storage, preparation, and use. The literature validating ADMs in the head and neck for both cosmetic and reconstructive purposes is evolving rapidly. This review aims to provide an up-to-date and comprehensive overview of the principles of acellular dermal matrices (ADMs), the different types of ADMs, and evaluate common indications, techniques, and outcomes pertaining to select anatomic sites in the head and neck reconstruction.
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Affiliation(s)
- Shivam Patel
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Kasra Ziai
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jessyka G Lighthall
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Scott G Walen
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
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Soffer JM, Dowd RS, Sillman J, Heilman C. Diagnosis and operative repair strategy of an underlying tegmen defect presenting with spontaneous otogenic pneumocephalus after Valsalva maneuver. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ji H, Sukarto A, Deegan D, Fan F. Characterization of Inflammatory and Fibrotic Aspects of Tissue Remodeling of Acellular Dermal Matrix in a Nonhuman Primate Model. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3420. [PMID: 33680668 PMCID: PMC7928538 DOI: 10.1097/gox.0000000000003420] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/10/2020] [Indexed: 01/25/2023]
Abstract
Human acellular dermal matrices (hADMs) are applied in various soft tissue reconstructive surgeries as scaffolds to support tissue remodeling and regeneration. To evaluate the clinical efficacy of hADM implants, it is integral that the hADM does not induce a host chronic inflammatory response leading to fibrotic encapsulation of the implant. In this study, we characterized the inflammatory and fibrosis-related tissue remodeling response of 2 commercial hADM products (SimpliDerm and AlloDerm RTU) in a nonhuman primate model using histology and gene expression profiling. METHODS Eighteen African green monkeys with abdominal wall defects were applied to evaluate the performance of SimpliDerm and AlloDerm RTU implants (N = 3) at 2, 4, and 12-weeks post-implantation. Using histology and gene expression profiling, tissue responses such as implant integration, degradation, cell infiltration, immune response, neovascularization, and pro-fibrotic responses over time were evaluated. RESULTS SimpliDerm showed a lower initial inflammatory response and slower implant degradation rate than AlloDerm RTU evidenced by histomorphological analysis. These factors led to a more anti-inflammatory and pro-remodeling microenvironment within SimpliDerm, demonstrated by lower TNFα levels and lower expression levels of pro-fibrotic markers, and promoted tissue repair and regeneration by 3-months post-implantation. CONCLUSIONS Overall, histology and gene expression profiling analyses shown in this study demonstrated an effective model for analyzing hADM performance in terms of host inflammatory and fibrotic response. Further studies are warranted to fully evaluate the utility of this novel hADM in the clinical setting and verify the prognosis of our pre-clinical analysis model.
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Affiliation(s)
- HaYeun Ji
- From the Aziyo Biologics, Inc., Silver Spring, Md
| | - Abby Sukarto
- From the Aziyo Biologics, Inc., Silver Spring, Md
| | | | - Frank Fan
- From the Aziyo Biologics, Inc., Silver Spring, Md
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12
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Oualla-Bachiri W, Fernández-González A, Quiñones-Vico MI, Arias-Santiago S. From Grafts to Human Bioengineered Vascularized Skin Substitutes. Int J Mol Sci 2020; 21:E8197. [PMID: 33147759 PMCID: PMC7662999 DOI: 10.3390/ijms21218197] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 12/18/2022] Open
Abstract
The skin plays an important role in the maintenance of the human's body physiological homeostasis. It acts as a coverage that protects against infective microorganism or biomechanical impacts. Skin is also implied in thermal regulation and fluid balance. However, skin can suffer several damages that impede normal wound-healing responses and lead to chronic wounds. Since the use of autografts, allografts, and xenografts present source limitations and intense rejection associated problems, bioengineered artificial skin substitutes (BASS) have emerged as a promising solution to address these problems. Despite this, currently available skin substitutes have many drawbacks, and an ideal skin substitute has not been developed yet. The advances that have been produced on tissue engineering techniques have enabled improving and developing new arising skin substitutes. The aim of this review is to outline these advances, including commercially available skin substitutes, to finally focus on future tissue engineering perspectives leading to the creation of autologous prevascularized skin equivalents with a hypodermal-like layer to achieve an exemplary skin substitute that fulfills all the biological characteristics of native skin and contributes to wound healing.
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Affiliation(s)
- Wasima Oualla-Bachiri
- Cell Production and Tissue Engineering Unit, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (W.O.-B.); (M.I.Q.-V.); (S.A.-S.)
- Biosanitary Institute of Granada (ibs. GRANADA), 18014 Granada, Spain
- Andalusian Network of Design and Translation of Advanced Therapies, 41092 Sevilla, Spain
| | - Ana Fernández-González
- Cell Production and Tissue Engineering Unit, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (W.O.-B.); (M.I.Q.-V.); (S.A.-S.)
- Biosanitary Institute of Granada (ibs. GRANADA), 18014 Granada, Spain
- Andalusian Network of Design and Translation of Advanced Therapies, 41092 Sevilla, Spain
| | - María I. Quiñones-Vico
- Cell Production and Tissue Engineering Unit, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (W.O.-B.); (M.I.Q.-V.); (S.A.-S.)
- Biosanitary Institute of Granada (ibs. GRANADA), 18014 Granada, Spain
- Andalusian Network of Design and Translation of Advanced Therapies, 41092 Sevilla, Spain
| | - Salvador Arias-Santiago
- Cell Production and Tissue Engineering Unit, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (W.O.-B.); (M.I.Q.-V.); (S.A.-S.)
- Biosanitary Institute of Granada (ibs. GRANADA), 18014 Granada, Spain
- Andalusian Network of Design and Translation of Advanced Therapies, 41092 Sevilla, Spain
- Dermatology Department, Virgen de las Nieves University Hospital, 18014 Granada, Spain
- Dermatology Department, School of Medicine, Granada University, 18016 Granada, Spain
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Youngerman BE, Kosty JA, Gerges MM, Tabaee A, Kacker A, Anand VK, Schwartz TH. Acellular dermal matrix as an alternative to autologous fascia lata for skull base repair following extended endoscopic endonasal approaches. Acta Neurochir (Wien) 2020; 162:863-873. [PMID: 32048039 DOI: 10.1007/s00701-019-04200-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/24/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Skull base reconstruction after extended endoscopic endonasal approaches (EEAs) can be challenging. In addition to the nasoseptal flap, which has been adopted by most centers, autologous fascia lata is also often utilized. Harvesting of fascia lata requires a separate thigh incision, may prolong recovery, and results in a visible scar. In principal, the use of non-autologous materials would be preferable to avoid a second incision and maintain the minimally invasive nature of the approach, assuming the CSF leak rate is not compromised. OBJECTIVE To assess the efficacy of acellular dermal matrix (ADM) as a non-autologous alternative to autologous fascia lata graft for watertight closure of the cranial base following EEAs. METHODS A retrospective chart review of extended EEAs performed before and after the transition from fascia lata to ADM was performed. Cases were frequency matched for approach, pathology, BMI, use of lumbar drainage, and tumor volume. Power analysis was performed to estimate the sample size needed to demonstrate non-inferiority. RESULTS ADM was used for watertight closure of the cranial base in 19 consecutive extended endoscopic endonasal approaches (16 gasket-seals and 3 buttons) with 1 postoperative CSF leak at the last follow-up (median 5.3, range 1.0-12.6 months). All patients had high-flow intraoperative leaks. The cohort included 8 meningiomas, 8 craniopharyngiomas, 2 chordomas, and 1 pituicytoma ranging in size from 0.2 to 37.2cm3 (median 5.5, IQR 2.8-13.3 cm3). In 19 historical controls who received fascia lata, there were 2 postoperative CSF leaks. CONCLUSIONS Preliminary results suggest that ADM provides a non-inferior non-autologous alternative to fascia lata for watertight gasket-seal and button closures following extended EEAs, potentially reducing or eliminating the need to harvest autologous tissue.
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Affiliation(s)
- Brett E Youngerman
- Department of Neurosurgery, Weill Cornell Medicine, New York Presbyterian Hospital, 525 East 68th St., Box #99, New York, NY, 10065, USA.
| | - Jennifer A Kosty
- Department of Neurosurgery, Ochsner Louisiana State University Shreveport, Shreveport, LA, USA
| | - Mina M Gerges
- Department of Neurosurgery, Weill Cornell Medicine, New York Presbyterian Hospital, 525 East 68th St., Box #99, New York, NY, 10065, USA
- Department of Neurosurgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Abtin Tabaee
- Department of Otolaryngology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Ashutosh Kacker
- Department of Otolaryngology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Vijay K Anand
- Department of Otolaryngology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Theodore H Schwartz
- Department of Neurosurgery, Weill Cornell Medicine, New York Presbyterian Hospital, 525 East 68th St., Box #99, New York, NY, 10065, USA.
- Department of Otolaryngology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA.
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Ahmed OH, Zhang K. Reconstruction Following Endoscopic Endonasal Skull Base Surgery: Options and Technical Considerations. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00276-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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