Foreskin-isolated keratinocytes provide successful extemporaneous autologous paediatric skin grafts

Abstract

Severe burns in children are conventionally treated with split-thickness skin autografts or epidermal sheets. However, neither early complete healing nor quality of epithelialization is satisfactory. An alternative approach is to graft isolated keratinocytes. We evaluated paediatric foreskin and auricular skin as donor sources, autologous keratinocyte transplantation, and compared the graft efficiency to the in vitro capacities of isolated keratinocytes to divide and reconstitute epidermal tissue. Keratinocytes were isolated from surgical samples by enzymatic digestion. Living cell recovery, in vitro proliferation and epidermal reconstruction capacities were evaluated. Differentiation status was analysed, using qRT-PCR and immunolabelling. Eleven children were grafted with foreskin-derived (boys) or auricular (girls) keratinocyte suspensions dripped onto deep severe burns. The aesthetic and functional quality of epithelialization was monitored in a standardized way. Foreskin keratinocyte graft in male children provides for the re-epithelialization of partial deep severe burns and accelerates wound healing, thus allowing successful wound closure, and improves the quality of scars. In accordance, in vitro studies have revealed a high yield of living keratinocyte recovery from foreskin and their potential in terms of regeneration and differentiation. We report a successful method for grafting paediatric males presenting large severe burns through direct spreading of autologous foreskin keratinocytes. This alternative method is easy to implement, improves the quality of skin and minimizes associated donor site morbidity. In vitro studies have highlighted the potential of foreskin tissue for graft applications and could help in tissue selection with the prospect of grafting burns for girls.

Cell therapy for severe burn wound healing

“…They gradually lose the capacity in population doublings through differentiation [ 10 – 15 ]. KSC populations with more active, proliferative and regenerative capacities are observed in young people comparing to aged peoples [ 16 ].…”

Opioid receptor delta as a global modulator of skin differentiation and barrier function repair

“…Normal human epidermal keratinocytes (NHEK) were isolated from surgical samples of healthy foreskin from male children admitted for circumcision as previously described . Foreskin tissues were obtained from the departments of paediatric surgery (University‐Hospital of Poitiers).…”

Bioactive Molecules for Skin Repair and Regeneration: Progress and Perspectives

“…Rapid reepithelialization is indispensable for restoring the skin barrier. Keratinocytes can be used as grafts or as a component of other complex matrices to cover the injured sites [22]. Nevertheless, keratinocyte sources are limited.…”