Neoskin development in the fetus with the use of a three-layer graft: an animal model for in utero closure of large skin defects

Abstract

Our study shows that neoskin can develop in the fetus using a 3-layer graft, including epidermal growth beneath the silicone layer of the bilaminar skin graft. These findings suggest that the fetus is able to reepithelialise even large skin defects. Further experience is necessary to assess the quality of this repair.

Comparison between two surgical techniques for prenatal correction of meningomyelocele in sheep

“…A possible explanation for these findings would be significant differences between fetal and neonatal healing. However, if this was true, these findings would indicate "worse healing" during the fetal period, which is probably not the case, as it is known that the fetus "heals with no scar formation" (25) . Another hypothesis that may explain that difference may be that suturing the dura mater causes the adhesion between the meninges and the nervous tissue.…”

“…A previous study carried out by our group (25) , using a skin graft to close a skin defect large enough to not allow its suture, showed that the fetus "found its way" between the two artificial skin layers, and a new epidermis was formed above the dermal matrix. Since this type of regeneration was never demonstrated in adults before, we hypothesized that the excellent fetal healing was responsible for this difference.…”

Cryopreserved human umbilical cord versus biocellulose film for prenatal spina bifida repair in a physiologic rat model

“…Furthermore, regardless of the timing of repair, a significant number of SB repair patients demonstrate radiological evidence of spinal cord tethering with 30% to 40% requiring further surgical intervention for this complication . To optimize surgical outcomes, there is a need for ongoing research to identify a regenerative patch material that could be applied over the SB defect to improve outcomes for the fetus by minimizing the inflammation and scarring that is associated with conventional repair . Such a material would also help in the repair of myeloschisis SB defects, where primary closure of the skin is difficult .…”

“…6,7 To optimize surgical outcomes, there is a need for ongoing research to identify a regenerative patch material that could be applied over the SB defect to improve outcomes for the fetus by minimizing the inflammation and scarring that is associated with conventional repair. 8,9 Such a material would also help in the repair of myeloschisis SB defects, where primary closure of the skin is difficult. 10 An appropriate patch also opens up the possibility of a single-port laparoscopic approach to SB repair at an earlier gestational age than the current prenatal repair through a maternal hysterotomy.…”

Fetoscopic repair of spina bifida: safer and better?

“…After addressing in animal models several of the challenges mentioned above (i.e. the need to develop an endoscopically applicable watertight technique and the need to reduce the likelihood of cord tethering), our group conducted a phase‐I trial of the fetoscopic repair of OSB, using our skin‐over‐biocellulose technique: the CECAM (Cirurgia Endoscópica para Correção Antenatal da Meningomielocele em humanos) trial. Patient inclusion and exclusion criteria were very similar to those of the MOMS trial.…”