A Multicentre Study: The Use of Micrografts in the Reconstruction of Full-Thickness Posttraumatic Skin Defects of the Limbs—A Whole Innovative Concept in Regenerative Surgery

Abstract

The skin graft is a surgical technique commonly used in the reconstructive surgery of the limbs, in order to repair skin loss, as well as to repair the donor area of the flaps and cover the dermal substitutes after engraftment. The unavoidable side effect of this technique consists of unaesthetic scars. In order to achieve the healing of posttraumatic ulcers by means of tissue regeneration and to avoid excessive scarring, a new innovative technology based on the application of autologous micrografts, obtained by Rigenera technology, was reported. This technology was able to induce tissue repair by highly viable skin micrografts of 80 micron size achieved by a mechanical disaggregation method. The specific cell population of these micrografts includes progenitor cells, which in association with the fragment of the Extracellular Matrix (ECM) and growth factors derived by patients' own tissue initiate biological processes of regeneration enhancing the wound healing process. We have used this technique in 70 cases of traumatic wounds of the lower and upper limbs, characterized by extensive loss of skin substance and soft tissue. In all cases, we have applied the Rigenera protocol using skin micrografts, achieving in 69 cases the complete healing of wounds in a period between 35 and 84 days. For each patient, the reconstructive outcome was evaluated weekly to assess the efficacy of this technique and any arising complication. A visual analogue scale (VAS) was administered to assess the amount of pain felt after the micrografts' application, whereas we evaluated the scars according to the Vancouver scale and the wound prognosis according to Wound Bed Score. We have thus been able to demonstrate that Rigenera procedure is very effective in stimulating skin regeneration, while reducing the outcome scar.

Acceleration of Skin Wound-Healing Reactions by Autologous Micrograft Tissue Suspension

“…This renewal method has been used for different pathologic lesions, such as chronic ulcers [ 2 , 15 , 16 ], exaggerated scars [ 17 ] and wound opening [ 18 ]. Riccio et al (2019) [ 19 ] recently performed a multicenter clinical analysis using a MG technique in complicated traumatic ulcers with large loss of skin and soft tissue in the lower limbs of patients with domestic or work related injuries. The aim of reconstructive treatment is the morphologic and functional restoration.…”

Autologous micrografts and methotrexate in plantar erosive lichen planus: healing and pain control. A case report

“…Referring to all these variables, we had to consider an alternative solution, which would accelerate reepithelization, such as using micro-grafts. In our experience we have already tested their validity in other wound types [ 7 ].…”

“…Cell characterization by flow cytometry analysis shows a heterogeneous pool of cells [ 18 , 19 ]. The specific cell population of these micrografts includes progenitor cells [ 19 ], which in association with the fragment of the Extracellular Matrix (ECM) and growth factors derived by starting tissue, initiate biological processes of cell proliferation and differentiation enhancing the wound healing process [ 7 , 11 ]. Anti-inflammatory effect: this micrograft technique allows to select factors such as TGF-β 1 (which acts both as a promoter of tissue repair and as a suppressor of excessive inflammation) [ 18 , 21 , 22 , 23 , 24 ] and alpha-smooth muscle actin (α-SMA), which plays a central role in the healing process (wound contraction) and which is produced from myofibroblasts, once they have differentiated from fibroblasts upon stimulation of TGF-β 1 present in the ECM [ 11 ].…”

“…Cell characterization by flow cytometry analysis shows a heterogeneous pool of cells [ 18 , 19 ]. The specific cell population of these micrografts includes progenitor cells [ 19 ], which in association with the fragment of the Extracellular Matrix (ECM) and growth factors derived by starting tissue, initiate biological processes of cell proliferation and differentiation enhancing the wound healing process [ 7 , 11 ].…”

Evaluation of Bone Regeneration in Rat Calvaria Using Bone Autologous Micrografts and Xenografts: Histological and Histomorphometric Analysis

“…To date, the Rigenera® micrografting technology has demonstrated its efficacy in different clinical setting. It is widely used with dermal tissue sample for the treatment of complex wounds, such as dehiscences, chronic ulcers, and burns [ 17 , 18 , 19 , 20 , 21 , 22 ]; for dermatological applications, such as hypertrophic scars [ 23 ]; and for the management of androgenetic alopecia [ 24 , 25 ]; with cartilage samples for the management of chondropathy [ 26 , 27 ]; and with bone samples for the treatment of the osteonecrosis of the femoral head [ 28 ].…”