Structural and molecular characteristics of weight‐bearing volar skin can be reconstituted by micro skin tissue column grafting

Abstract

For patients with lower limb amputations, prostheses are immensely helpful for mobility and the ability to perform job‐related or recreational activities. However, the skin covering the amputation stump is typically transposed from adjacent areas of the leg and lacks the weight‐bearing capacity that is only found in the specialized skin covering the palms and soles (a.k.a. volar skin). As a result, the skin tissue in direct contact with the prosthesis frequently breaks down, leading to the development of painful sores and other complications that limit, and often preclude, the use of prostheses. Transplanting volar skin onto amputation stumps could be a solution to these problems, but traditional skin transplantation techniques cause substantial morbidity at the donor site, such as pain and scarring, which are especially problematic for volar skin given the critical functional importance of the volar skin areas. We previously developed the technology to collect and engraft full‐thickness skin tissue while avoiding long‐term donor site morbidity, by harvesting the skin in the form of small (~0.5 mm diameter) cores that we termed “micro skin tissue columns” (MSTCs), so that each donor wound is small enough to heal quickly and without clinically appreciable scarring or other long‐term abnormalities. The goal of this study was to establish whether a similar approach could be used to confer the structural and molecular characteristics of volar skin ectopically to other skin areas. In a human‐to‐mouse xenograft model, we show the long‐term persistence of various human plantar MSTC‐derived cell types in the murine recipient. Then in an autologous porcine model, we harvested MSTCs from the bottom of the foot and transplanted them onto excision wounds on the animals' trunks. The healing processes at both the donor and graft sites were monitored over 8 weeks, and tissue samples were taken to verify volar‐specific characteristics by histology and immunohistochemistry. The volar donor sites were well‐tolerated, healed rapidly, and showed no signs of scarring or any other long‐term defects. The graft sites were able to maintain volar‐specific histologic features and expression of characteristics protein markers, up to the 8‐week duration of this study. These results suggest that MSTC grafting could be a practical approach to obtain autologous donor volar skin tissue, confer volar skin characteristics ectopically to nonvolar skin areas, improve the load‐bearing capacity of amputation stump skin, and ultimately enhance mobility and quality‐of‐life for lower limb amputees.