Comparison of porcine and human acellular dermal matrix outcomes in wound healing: a deep dive into the evidence

Advanced Secondary Intention Healing for Complex Soft-Tissue Defects Using Reprocessed Micronized Acellular Dermal Matrix

Secondary intention healing offers an alternative when surgical options are infeasible. This study analyzed the effect of micronized acellular dermal matrices (mADMs; CGderm Matrix®, CG Bio, Seoul, Republic of Korea) on secondary intention healing in patients with complex soft-tissue defects and assessed mADMs' efficacy in promoting secondary healing and improving clinical outcomes in these challenging cases. This retrospective study included 26 patients treated with sheet-type reprocessed mADMs between August 2022 and December 2022 at Soonchunhyang University Cheonan Hospital. Patients with full-thickness skin defects classified as complex wounds were included. Data on demographics, wound characteristics, and treatment outcomes were collected and analyzed. Wound area was measured using ImageJ software, and statistical analyses were conducted using SPSS. The application of mADMs resulted in a median wound area reduction of 81.35%, demonstrating its significant efficacy in wound healing. Most patients presented with compromised vascular supply, significant tissue loss, or infections that precluded conventional surgical interventions. No significant correlations were observed between patient variables and wound-healing outcomes, indicating the complex nature of wound healing. mADMs effectively promote secondary intention healing by providing a supportive extracellular matrix scaffold that enhances epithelialization and angiogenesis. Their rapid absorption, ease of handling, and ability to improve wound tensile strength make them particularly suitable for complex wounds.

Decellularized Matrices for the Treatment of Tissue Defects: from Matrix Origin to Immunological Mechanisms

Decellularized matrix transplantation has emerged as a promising therapeutic approach for repairing tissue defects, with numerous studies assessing its safety and efficacy in both animal models and clinical settings. The host immune response elicited by decellularized matrix grafts of natural biological origin plays a crucial role in determining the success of tissue repair, influenced by matrix heterogeneity and the inflammatory microenvironment of the wound. However, the specific immunologic mechanisms underlying the interaction between decellularized matrix grafts and the host immune system remain elusive. This article reviews the sources of decellularized matrices, available decellularization techniques, and residual immunogenic components. It focuses on the host immune response following decellularized matrix transplantation, with emphasis on the key mechanisms of Toll-like receptor, T-cell receptor, and TGF-β/SMAD signaling in the stages of post-transplantation immunorecognition, immunomodulation, and tissue repair, respectively. Furthermore, it highlights the innovative roles of TLR10 and miR-29a-3p in improving transplantation outcomes. An in-depth understanding of the molecular mechanisms underlying the host immune response after decellularized matrix transplantation provides new directions for the repair of tissue defects.

Clinical study on the role of platelet-rich plasma in human acellular dermal matrix with razor autologous skin graft repair of giant congenital pigmented nevus in children

BACKGROUND

NA OBJECTIVE: Evaluate the safety and feasibility of platelet-rich plasma (PRP) in the treatment of giant congenital melanocytic nevi (GCMN) in children with human acellular dermal matrix (HADM) transplantation.

PATIENTS AND METHODS

A total of 22 children with GCMN were included in the study. They were divided into an experimental and a control group. The experimental group used the method of HADM with Razor Autologous Skin Graft combined with PRP to repair skin and soft tissue defects after giant nevus resection (Group A, n = 11). The control group was treated with HADM with Razor Autologous Skin Graft (Group B, n = 11) only. To compare the survival rate of skin grafts, we used the Vancouver Scar Scale (VSS) for the postoperative skin graft area and the Patient and Observer Scar Assessment Scale (POSAS) to compare the two groups of patients.

RESULTS

There was no statistically significant difference in age, gender, location of giant nevi, and pathological classification between Group A and Group (P > 0.05). The survival rate of skin grafting and the VSS and POSAS scores of scar tissue in group A were superior to those of group B (P < 0.05).

CONCLUSIONS

PRP has improved the survival rate of composite skin grafting in children with GCMN, and long-term satisfactory prognosis of scar healing. Therefore, we consider this treatment method a valuable contribution to clinical practice.

Attenuating Chronic Fibrosis: Decreasing Foreign Body Response with Acellular Dermal Matrix

Surgical implants are increasingly used across multiple medical disciplines, with applications ranging from tissue reconstruction to improving compromised organ and limb function. Despite their significant potential for improving health and quality of life, biomaterial implant function is severely limited by the body's immune response to its presence: this is known as the foreign body response (FBR) and is characterized by chronic inflammation and fibrotic capsule formation. This response can result in life-threatening sequelae such as implant malfunction, superimposed infection, and associated vessel thrombosis, in addition to soft tissue disfigurement. Patients may require frequent medical visits, as well as repeated invasive procedures, increasing the burden on an already strained health care system. Currently, the FBR and the cells and molecular mechanisms that mediate it are poorly understood. With applications across a wide array of surgical specialties, acellular dermal matrix (ADM) has emerged as a potential solution to the fibrotic reaction seen with FBR. Although the mechanisms by which ADM decreases chronic fibrosis remain to be clearly characterized, animal studies across diverse surgical models point to its biomimetic properties that facilitate decreased periprosthetic inflammation and improved host cell incorporation. Impact Statement Foreign body response (FBR) is a significant limitation to the use of implantable biomaterials. Acellular dermal matrix (ADM) has been observed to decrease the fibrotic reaction seen with FBR, although its mechanistic details are poorly understood. This review is dedicated to summarizing the primary literature on the biology of FBR in the context of ADM use, using surgical models in breast reconstruction, abdominal and chest wall repair, and pelvic reconstruction. This article will provide readers with an overarching review of shared mechanisms for ADM across multiple surgical models and diverse anatomical applications.

Decellularization techniques of human foreskin for tissue engineering application

The rapid development of tissue engineering (TE) and regenerative medicine brings an acute need for biocompatible and bioactive biological scaffolds to regenerate or restore damaged tissue. Great attention is focused on the decellularization of tissues or even whole organs, and the subsequent colonization of such decellularized extracellular matrices by recipient cells. The foreskin is an integral, normal part of the external genitalia that forms the anatomical covering of the glans penis and the urinary meatus of all human and non-human primates. It is mucocutaneous tissue that marks the boundary between mucosa and skin. In this work, we compared two innovative decellularization techniques for human foreskins obtained from donors. We compared the efficacy and feasibility of these protocols and the biosafety of prepared acellular dermal matrixes that can serve as a suitable scaffold for TE. The present study confirms the feasibility of foreskin decellularization based on enzymatic or detergent methods. Both techniques conserved the ultrastructure and composition of natural ECM while being DNA-free and non-toxic, making it an excellent scaffold for follow-up research and TE applications.

The effect of intraoperative immersion solutions on acellular dermal matrix: Biofilm formation and mechanical property

BACKGROUND

Acellular dermal matrix (ADM) is generally used on implant-based breast operations; However, it can increase surgical site infection. Many immersion solutions are applied to ADM, however, the most effective solution is unknown. The purpose of this study is to determine the effect of different solutions on the biofilm formation and mechanical properties of ADM.

METHODS

Aseptic porcine-derived ADMs were immersed in 5 different solutions for 30 min; sterile normal saline, 10% povidone-iodine, 0.5% chlorhexidine, antibiotics (cefazolin, gentamicin, and vancomycin), and taurolidine. They are transferred to 10 ml suspension of methicillin-sensitive/resistant Staphylococcus aureus (MSSA/MRSA) or Staphylococcus epidermidis and an overnight culture was performed. After rinsing and sonication to obtain the biofilm on ADM, colony forming unit (CFU) was measured. In addition, the maximum load before ADM deformation and the elongation length of ADM at the start of the maximum load was determined.

RESULTS

Regardless of strains, povidone-iodine, chlorhexidine, and taurolidine group had lower CFUs than the saline group with statistical significance. Meanwhile, the antibiotics group did not show statistical difference from the saline group. Moreover, only taurolidine group showed higher tensile strength (MRSA, p = 0.0003; S. epidermidis, p = 0.0023) and elongation length (MSSA, p = 0.0015) than the saline group. The antibiotics and chlorhexidine group yielded lower tensile strength and elongation length than the povidone-iodine and taurolidine groups.

CONCLUSIONS

It was suggested that the 10% povidone-iodine or taurolidine solution is effective. In contrast, the antibiotics solution could be considered as an effective intraoperative solution.

Evolution of biomimetic ECM scaffolds from decellularized tissue matrix for tissue engineering: A comprehensive review

Tissue engineering is essentially a technique for imitating nature. Natural tissues are made up of three parts: extracellular matrix (ECM), signaling systems, and cells. Therefore, biomimetic ECM scaffold is one of the best candidates for tissue engineering scaffolds. Among the many scaffold materials of biomimetic ECM structure, decellularized ECM scaffolds (dECMs) obtained from natural ECM after acellular treatment stand out because of their inherent natural components and microenvironment. First, an overview of the family of dECMs is provided. The principle, mechanism, advances, and shortfalls of various decellularization technologies, including physical, chemical, and biochemical methods are then critically discussed. Subsequently, a comprehensive review is provided on recent advances in the versatile applications of dECMs including but not limited to decellularized small intestinal submucosa, dermal matrix, amniotic matrix, tendon, vessel, bladder, heart valves. And detailed examples are also drawn from scientific research and practical work. Furthermore, we outline the underlying development directions of dECMs from the perspective that tissue engineering scaffolds play an important role as an important foothold and fulcrum at the intersection of materials and medicine. As scaffolds that have already found diverse applications, dECMs will continue to present both challenges and exciting opportunities for regenerative medicine and tissue engineering.

Porcine Acellular Dermal Matrix Promotes Migration and Suppresses Inflammation of Keratinocytes by Mediating the AKT Signaling Pathway

Porcine acellular dermal matrix (pADM) is known to accelerate wound healing. However, the underlying molecular mechanism remains unclear. This study aimed to investigate the effects of pADM on wound healing and its underlying mechanisms. HaCaT cells were treated with hydrogen peroxide (H2O2) or pADM, and the appropriate treatment concentration was determined using the cell counting kit-8 and flow cytometry. Cell migration was assessed using a Transwell assay and scratch test. Inflammation was evaluated using enzyme-linked immunosorbent assay. Western blotting was performed to measure the levels of protein kinase B (AKT) pathway-related proteins. The results showed that H2O2 inhibited cell viability and induced apoptosis in a dose-dependent manner. pADM promoted cell migration and decreased the levels of interleukin (IL)-6, IL-8, and tumor necrosis factor-α (TNF-α) in H2O2-treated HaCaT cells. Moreover, pADM rescued the downregulation of phosphorylated (p)-AKT and p-mechanistic target of rapamycin (mTOR) induced by H2O2. LY294002, a phosphatidylinositol 3-kinase (PI3K) inhibitor, abrogated migration and anti-inflammatory response caused by pADM. In conclusion, pADM promotes cell migration and inhibits inflammation by activating the AKT pathway under oxidative stress. These findings support the use of pADM for post-traumatic therapy and reveal a novel underlying mechanism of action.

How Did This Happen? Xenograft Conversion to Dermal Scaffolding after Scalding Grease Burn

Xenograft and other biologic dressings have been an integral part of burn care for many years. Porcine graft is both inexpensive and, for partial thickness burns, provides the additional benefit of avoiding painful dressing changes when compared with topical agents. In this case, we discuss a patient suffering from deep partial thickness burns for whom xenograft was used for initial wound coverage. This porcine graft became unexpectedly incorporated, and the patient ultimately underwent operative debridement and autologous re-grafting. The case demonstrates a gap in the understanding of wound-healing mechanisms around porcine xenografts and raises the potential for future innovation in expedited wound healing using xenografting.

Study of a Hydrophilic Healing-Promoting Porcine Acellular Dermal Matrix

Sodium hyaluronate (SH) is recognized as the strongest natural humectant, since it contains a large number of hydroxyl and carboxyl groups in its structure, and can absorb 1000 times its own weight of water. The porcine acellular dermal matrix (pADM) has been widely used in biological materials for its biological activities, such as promoting cell proliferation and promoting wound healing. Enhancing the hydrophilic and moisturizing properties of the pADM is expected to further improve its ability to promote wound healing. However, there are no strong chemical bonds between SH and pADM. Therefore, SH was oxidized by sodium periodate in this study, and was further used to cross-link it with pADM. The microstructure, hydrophilicity, moisture retention, degradation and cytotoxicity of pADM cross-linked with different oxidation degrees of oxidized sodium hyaluronate (OSH) were studied. The results show that OSH-pADM maintained the secondary structure of natural collagen, as well as the good microporous structure of native pADM after cross-linking. With increasing oxidation degree, the surface hydrophilicity and moisture retention capacities of OSH-pADM increased; among them, OSH-pADM cross-linked with 40% oxidation degree of OSH was found to have the strongest moisture retention capacity. The hygroscopic kinetics at 93% RH were conformed to the second-order hygroscopic kinetics equation, indicating that the hygroscopic process was controlled by chemical factors. The degradation resistance of OSH-pADM also increased with increasing oxidation degree, and the cytotoxicity of OSH-pADM was acceptable. The in vivo full-thickness wound healing experiments showed that OSH-pADM had an obvious ability to promote wound healing. It can be speculated that OSH-pADM, with its good hydrophilic and moisturizing properties, physicochemical properties and biocompatibility, has great potential for facilitating wound repair.