Cultured Human Epidermis Combined With Meshed Skin Autografts Accelerates Epithelialization and Granulation Tissue Formation in a Rat Model

Abstract

IntroductionAs the take rate of cultured epidermal autografts in burn wound treatment is variable, widely expanded meshed auto skin grafts are often used in combination with cultured epidermal autograft to increase the take rate and achieve definitive wound coverage. However, a long time (3–4 weeks) required to prepare a cultured epidermis sheet is a disadvantage. Allogeneic cultured epidermis can be prepared in advance and cryopreserved to be used in combination with auto meshed skin grafts for treating third-degree burns. Nevertheless, the human cultured epidermis (hCE) has not been proved to accelerate wound healing after meshed skin grafting. Here, we investigated the effect of hCE on wound healing in a rat model of meshed skin grafting.Materials and MethodsHuman cultured epidermis was prepared from human neonatal foreskin and assessed by the release of growth factors into the culture medium using enzyme-linked immunosorbent assay. Skin wounds were inflicted on male F344 rats and treated by the application of widely meshed (6:1 ratio) autogenous skin grafts with or without hCE (n = 8 rats per group). Wound area, neoepithelium length, granulation tissue formation, and neovascularization were evaluated on day 7 postgrafting.ResultsHuman cultured epidermis secreted IL-1α, Basic fibroblast growth factor, platelet-derived growth factor-AA, TGF-α, TGF-β1, and vascular endothelial growth factor in vitro. In rats, hCE accelerated wound closure (P = 0.003), neoepithelium growth (P = 0.019), and granulation tissue formation (P = 0.043), and increased the number of capillaries (P = 0.0003) and gross neovascularization area (P = 0.008) compared with the control group.ConclusionsThe application of hCE with meshed grafts promoted wound closure, possibly via secretion of growth factors critical for cell proliferation and migration, suggesting that hCE can enhance the healing effect of widely expanded skin autografts.

The Epidemiology and Management of Electrical Burns in Kasr El-Eni Hospital between the Years 2010-2015

“…Lin et al, [13] used fresh AM for coverage for meshed STSG 0f 1:3 expansion ratio, used STSG with variable thickness (0.012 in to O-016 in) and Alexander [1] in his technique (meshed allograft overlaying meshed STSG) used a variable STSG thickness ranged from 0.010 in to 0.014 inch which could make some bias) in contrast to the present study we fixed the thickness (0.014 in). That is agree with Sakamoto et al, [14] who emphasized that the variability in size and shape of used skin grafts made them unsuitable for the accurate evaluation of the wound healing process.…”

Biomechanical modeling of novel high expansion auxetic skin grafts

“…In other clinical studies, Narayan et al 47 observed a significant reduction in healing time with collagen sheet placement over the grafted skin area. In Sakamoto et al, 48 a cultured epidermis combined with a highly expanded skin graft was found to exhibit expedited epithelialization. Buried chip skin grafting technique is another technique which is known to perform better than the split thickness skin grafts in the cases where the healing of the burnt region is poor, such as in perianal area 49 or plantar foot ulcers 50 .…”

Dried human-cultured epidermis accelerates wound healing in a porcine partial-thickness skin defect model

“…The best use of dried CE is in cases where hair follicles or other skin appendages remain in the wound, such as in second-degree burn wounds or donor sites. In addition, dried CE can be used in combination with autologous meshed skin grafts to treat extensive and third-degree burns [ 23 , 24 ]. Dried CE can be a useful modality in the treatment of severe burns, especially during the first three weeks of preparing autologous CE, to promote wound reduction and improve survival and functional prognosis in patients with severe burns.…”