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Wound Healing After Fractional Skin Harvesting. Dermatol Surg 2022; 48:1083-1088. [PMID: 36036977 DOI: 10.1097/dss.0000000000003552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Autologous fractional full-thickness skin grafting is a method of harvesting full-thickness skin with reduced donor site morbidity compared with conventional skin grafting. OBJECTIVE To demonstrate that full-thickness skin microbiopsies can be harvested with minimal scarring or complications. MATERIALS AND METHODS In a nonrandomized, self-controlled, pilot trial, subjects (n = 8) underwent tissue harvesting of full-thickness skin columns of 200, 400, 500, 600, 800 μm, 1, and 2 mm diameters. The extent of scarring was measured by using the Patient and Observer Scar Assessment Scale and blinded evaluation of photographs at 6 weeks postprocedure. Pain visual analog scale (VAS) and side effects were recorded. RESULTS When present, scars were first observed after 2 to 4 weeks, much more often for wounds >400 μm (p < .001). Blinded dermatologists increasingly identified clinical scarring on photographs with larger harvested microcolumn diameters (p < .001). Median VAS pain score was 0 (range 0-4). All subjects rated the procedure safe and tolerable. CONCLUSION Harvesting full-thickness skin microcolumns is well-tolerated over a wide range of column diameters. At diameters of less than 500 μm, side effects including scarring are minimal.
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Ibarra-Silva E, Raff AB, Cardenas A, Franco W. Point-of-care detection of neutrophils in live skin microsamples using chemiluminescence. JOURNAL OF BIOPHOTONICS 2020; 13:e201960170. [PMID: 32048794 DOI: 10.1002/jbio.201960170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/09/2020] [Accepted: 01/28/2020] [Indexed: 06/10/2023]
Abstract
Many skin diseases are defined by the presence of neutrophils, which are among the first cells to respond to infection and inflammation. Currently, neutrophil identification in the skin is costly and slow. The objectives of the present work are to investigate the feasibility of detecting the presence of neutrophils in live skin microsamples using chemiluminescence and develop a device and procedures that will enable preclinical and clinical investigations. Our approach consists of collecting skin microsamples and exposing them to reagents that activate neutrophils and amplify the light emission produced by chemiluminescence. Experiments using live pig skin with and without inflammation show that it is feasible to detect the presence of neutrophils in the skin. The proposed method is minimally invasive, simple, fast, and does not require user specialization. The developed system is compact in size with a small footprint, which makes it portable and suitable for point-of-care diagnostics.
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Affiliation(s)
- Esmeralda Ibarra-Silva
- Departamento de Ingeniería Mecánica, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Adam B Raff
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Antonio Cardenas
- Departamento de Ingeniería Mecánica, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | - Walfre Franco
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
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Tam J, Purschke M, Fuchs C, Wang Y, Anderson RR. Skin Microcolumns as a Source of Paracrine Signaling Factors. Adv Wound Care (New Rochelle) 2020; 9:174-183. [PMID: 32117581 PMCID: PMC7047113 DOI: 10.1089/wound.2019.1045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/17/2019] [Indexed: 01/08/2023] Open
Abstract
Objective: We recently developed the approach of using “microcolumns” of autologous full-thickness skin tissue for wound repair. The small size of these micro skin tissue columns (MSTCs, ∼0.5 mm in diameter) allows donor sites to heal quickly without scarring. Treatment with MSTCs significantly accelerate wound healing, and suppled various skin cell types and skin structures to replenish the wound volume. This technology is now starting clinical use. In this study, we investigate whether MSTCs may also influence wound healing by releasing soluble signaling factors. Approach: Freshly harvested MSTCs were incubated in culture medium for 24 h. The conditioned medium was collected and tested for its effects on migration and proliferation of human dermal fibroblasts, and its ability to induce tube formation by human umbilical vein endothelial cells (HUVECs). Proteins released into the conditioned medium were characterized by multiplex enzyme-linked immunosorbent assay (ELISA), and compared with medium conditioned by an equivalent mass of intact full-thickness skin. Results: MSTC-conditioned medium increased fibroblast migration and proliferation, as well as HUVEC tube formation. MSTCs released many soluble factors known to play prominent roles in wound healing. A subset of proteins showed significantly different release profiles compared with intact full-thickness skin. Innovation: The technology for harvesting and using MSTCs to augment wound healing was recently developed as an alternative to conventional autologous skin grafting. This study shows that MSTCs could also function as “cytokine factories.” Conclusion: In addition to supplying autologous cells to repopulate the wound volume, MSTCs can also function as a source of growth factors and cytokines to further enhance wound healing.
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Affiliation(s)
- Joshua Tam
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Martin Purschke
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Christiane Fuchs
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Ying Wang
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - R. Rox Anderson
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
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Abstract
Conventional skin and blood sampling techniques for disease diagnosis, though effective, are often highly invasive and some even suffer from variations in analysis. With the improvements in molecular detection, the amount of starting sample quantity needed has significantly reduced in some diagnostic procedures, and this has led to an increased interest in microsampling techniques for disease biomarker detection. The miniaturization of sampling platforms driven by microsampling has the potential to shift disease diagnosis and monitoring closer to the point of care. The faster turnaround time for actionable results has improved patient care. The variations in sample quantification and analysis remain a challenge in the microsampling field. The future of microsampling looks promising. Emerging techniques are being clinically tested and monitored by regulatory bodies. This process is leading to safer and more reliable diagnostic platforms. This review discusses the advantages and disadvantages of current skin and blood microsampling techniques.
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Affiliation(s)
- Benson U W Lei
- Future Industries Institute, University of South Australia, Mawson Lakes Campus, Building MM - MM2-01F, GPO Box 2471, Mawson Lakes Blvd, Mawson Lakes, Adelaide, SA, 5095, Australia.,Dermatology Research Centre, Faculty of Medicine, The University of Queensland, St. Lucia, Australia
| | - Tarl W Prow
- Future Industries Institute, University of South Australia, Mawson Lakes Campus, Building MM - MM2-01F, GPO Box 2471, Mawson Lakes Blvd, Mawson Lakes, Adelaide, SA, 5095, Australia. .,Dermatology Research Centre, Faculty of Medicine, The University of Queensland, St. Lucia, Australia.
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Rettinger CL, Fletcher JL, Carlsson AH, Chan RK. Accelerated epithelialization and improved wound healing metrics in porcine full‐thickness wounds transplanted with full‐thickness skin micrografts. Wound Repair Regen 2017; 25:816-827. [DOI: 10.1111/wrr.12585] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 09/09/2017] [Indexed: 01/04/2023]
Affiliation(s)
- Christina L. Rettinger
- Dental and Craniofacial Trauma Research Directorate, United States Army Institute of Surgical ResearchFort Sam Houston Texas
| | - John L. Fletcher
- Dental and Craniofacial Trauma Research Directorate, United States Army Institute of Surgical ResearchFort Sam Houston Texas
| | - Anders H. Carlsson
- Dental and Craniofacial Trauma Research Directorate, United States Army Institute of Surgical ResearchFort Sam Houston Texas
| | - Rodney K. Chan
- Dental and Craniofacial Trauma Research Directorate, United States Army Institute of Surgical ResearchFort Sam Houston Texas
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Tam J, Wang Y, Vuong LN, Fisher JM, Farinelli WA, Anderson RR. Reconstitution of full-thickness skin by microcolumn grafting. J Tissue Eng Regen Med 2016; 11:2796-2805. [PMID: 27296503 PMCID: PMC5697650 DOI: 10.1002/term.2174] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/11/2016] [Accepted: 02/15/2016] [Indexed: 12/23/2022]
Abstract
In addition to providing a physical barrier, skin also serves a diverse range of physiological functions through different specialized resident cell types/structures, including melanocytes (pigmentation and protection against ultraviolet radiation), Langerhans cells (adaptive immunity), fibroblasts (maintaining extracellular matrix, paracrine regulation of keratinocytes), sweat glands (thermoregulation) and hair follicles (hair growth, sensation and a stem cell reservoir). Restoration of these functional elements has been a long-standing challenge in efforts to engineer skin tissue, while autologous skin grafting is limited by the scarcity of donor site skin and morbidity caused by skin harvesting. We demonstrate an alternative approach of harvesting and then implanting μm-scale, full-thickness columns of human skin tissue, which can be removed from a donor site with minimal morbidity and no scarring. Fresh human skin microcolumns were used to reconstitute skin in wounds on immunodeficient mice. The restored skin recapitulated many key features of normal human skin tissue, including epidermal architecture, diverse skin cell populations, adnexal structures and sweat production in response to cholinergic stimulation. These promising preclinical results suggest that harvesting and grafting of microcolumns may be useful for reconstituting fully functional skin in human wounds, without donor site morbidity. © 2016 The Authors Journal of Tissue Engineering and Regenerative Medicine Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Joshua Tam
- Wellman Center for Photomedicine, Massachusetts General HospitalBostonMAUSA
- Department of DermatologyHarvard Medical SchoolBostonMAUSA
| | - Ying Wang
- Wellman Center for Photomedicine, Massachusetts General HospitalBostonMAUSA
- Department of DermatologyHarvard Medical SchoolBostonMAUSA
| | - Linh N. Vuong
- Wellman Center for Photomedicine, Massachusetts General HospitalBostonMAUSA
| | - Jeremy M. Fisher
- Wellman Center for Photomedicine, Massachusetts General HospitalBostonMAUSA
| | | | - R. Rox Anderson
- Wellman Center for Photomedicine, Massachusetts General HospitalBostonMAUSA
- Department of DermatologyHarvard Medical SchoolBostonMAUSA
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Russe E, Purschke M, Farinelli WA, Wang Y, Doukas AG, Limpiangkanan W, Sakamoto FH, Tam J, Wechselberger G, Anderson RR. Micro-fractional, directional skin tightening: A porcine model. Lasers Surg Med 2015; 48:264-9. [PMID: 26627306 DOI: 10.1002/lsm.22444] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Skin changes are among the most visible signs of aging. Fractional ablative lasers improve skin quality by making small skin wounds that heal rapidly without scarring. While they improve skin texture and discoloration, there is minimal effect on skin laxity. This study was performed to assess skin shrinkage performed by removing multiple small full-thickness skin columns with coring needles combined with wound closure. MATERIALS AND METHODS In 5 swine 116 squares (3 cm(2) ) were demarcated for treatment and control sites. In treatment sites 10% of the skin was removed by full-thickness skin coring needles (19 gauge) and afterwards closed and compressed with an elastic adhesive dressing. This procedure was compared to puncturing the skin with standard hypodermic needles (without tissue removal) and subsequent closure with compressive dressing. Area and shape of sites were measured before and 28 days after treatment. RESULTS Test and control sites healed within a week without scarring. Coring with wound closure caused significant shrinkage after 28 days. The treated skin area was reduced by 9% (P < 0.0001) and the direction of shrinkage was influenced by the direction of wound closure. Coring without wound closure and puncturing the skin without tissue removal produced an insignificant 3% decrease in area. CONCLUSION Significant minimally invasive skin tightening in a preferred direction can be achieved by removing skin with coring needles followed by wound closure. The direction of shrinkage is influenced by the direction of micro-hole closure, irrespective of the skin tension lines. This approach may allow reshaping the skin in a desired direction without scarring.
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Affiliation(s)
- Elisabeth Russe
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, Massachusetts 02114
- Department of Plastic and Reconstructive Surgery, Hospital of the Barmherzige Brüder, Teaching Hospital of the Medical University Salzburg, Kajetanerplatz 1, 5020 Salzburg, Austria
| | - Martin Purschke
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, Massachusetts 02114
| | - William A Farinelli
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, Massachusetts 02114
| | - Ying Wang
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, Massachusetts 02114
| | - Apostolos G Doukas
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, Massachusetts 02114
| | - Wikunda Limpiangkanan
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, Massachusetts 02114
| | - Fernanda H Sakamoto
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, Massachusetts 02114
| | - Joshua Tam
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, Massachusetts 02114
| | - Gottfried Wechselberger
- Department of Plastic and Reconstructive Surgery, Hospital of the Barmherzige Brüder, Teaching Hospital of the Medical University Salzburg, Kajetanerplatz 1, 5020 Salzburg, Austria
| | - Richard Rox Anderson
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, 50 Blossom Street, Boston, Massachusetts 02114
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