The use of cultured epithelial autograft in the treatment of major burn injuries: A critical review of the literature

Wood, Fiona; Kolybaba, M.L.; Allen, Pim

doi:10.1016/j.burns.2006.01.008

Cited by 173 publications

(105 citation statements)

References 60 publications

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“…When the tissue-engineered constructs are grafted, vascularization of the dermal support remains a major challenge, limiting their survival and take rates, even when autologous cellular components are used [44]. In the present report, we observed that the grafted DPC-containing composite skin retained the living epidermis generated in vitro, and the DF-containing ones showed a dermal-epidermal detachment associated with a focal necrosis process.…”

Section: Discussionsupporting

confidence: 56%

Dermal Papilla Cells Improve the Wound Healing Process and Generate Hair Bud-Like Structures in Grafted Skin Substitutes Using Hair Follicle Stem Cells

Leirós

Kusinsky

Drago³

et al. 2014

Stem Cells Translational Medicine

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Tissue-engineered skin represents a useful strategy for the treatment of deep skin injuries and might contribute to the understanding of skin regeneration. The use of dermal papilla cells (DPCs) as a dermal component in a permanent composite skin with human hair follicle stem cells (HFSCs) was evaluated by studying the tissue-engineered skin architecture, stem cell persistence, hair regeneration, and graft-take in nude mice. A porcine acellular dermal matrix was seeded with HFSCs alone and with HFSCs plus human DPCs or dermal fibroblasts (DFs). In vitro, the presence of DPCs induced a more regular and multilayered stratified epidermis with more basal p63-positive cells and invaginations. The DPC-containing constructs more accurately mimicked the skin architecture by properly stratifying the differentiating HFSCs and developing a well-ordered epithelia that contributed to more closely recapitulate an artificial human skin. This acellular dermal matrix previously repopulated in vitro with HFSCs and DFs or DPCs as the dermal component was grafted in nude mice. The presence of DPCs in the composite substitute not only favored early neovascularization, good assimilation and remodeling after grafting but also contributed to the neovascular network maturation, which might reduce the inflammation process, resulting in a better healing process, with less scarring and wound contraction. Interestingly, only DPC-containing constructs showed embryonic hair bud-like structures with cells of human origin, presence of precursor epithelial cells, and expression of a hair differentiation marker. Although preliminary, these findings have demonstrated the importance of the presence of DPCs for proper skin repair.

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Section: Discussionsupporting

confidence: 56%

Dermal Papilla Cells Improve the Wound Healing Process and Generate Hair Bud-Like Structures in Grafted Skin Substitutes Using Hair Follicle Stem Cells

Leirós

Kusinsky

Drago³

et al. 2014

Stem Cells Translational Medicine

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“…Epidermis and keratinocyte suspensions have been assessed as treatment methods for chronic non-healing wounds [22,23]. Keratinocytes grafted on full-thickness wounds have yielded satisfactory results owing to rapid healing [24].…”

Section: Discussionmentioning

confidence: 99%

Microenvironment-induced myofibroblast-like conversion of engrafted keratinocytes

Han

et al. 2014

Sci. China Life Sci.

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Myofibroblasts, recognized classically by -smooth muscle actin (-SMA) expression, play a key role in the wound-healing process, promoting wound closure and matrix deposition. Although a body of evidence shows that keratinocytes explanted onto a wound bed promote closure of a skin injury, the underlying mechanisms are not well understood. The basal layer of epidermis is rich in undifferentiated keratinocytes (UKs). We showed that UKs injected into granulation tissue could switch into -SMA positive cells, and accelerate the rate of skin wound healing. In addition, when the epidermis sheets isolated from foreskin cover up the wound bed or are induced in vitro, keratinocytes located at the basal layers or adjacent sites were observed to convert into myofibroblast-like cells. Thus, UKs have a potential for myofibroblastic transition, which provides a novel mechanism by which keratinocyte explants accelerate skin wound healing. epithelial-mesenchymal transition, epithelial-myofibroblast transition, keratinocyte-myofibroblast transition, myofibroblast, wound healing Citation:Li MR, Ti DD, Han WD, Fu XB. Microenvironment-induced myofibroblast-like conversion of engrafted keratinocytes.

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“…7,14,15 Although dermal substitutes may provide wound coverage and reduce pain, they still require an epidermal component, which is often provided through one or more applications of split-thickness autografts, necessitating multiple surgical procedures that injure the donor site and increase scar morbidity. 16 On the other hand, cultured epithelial autografts without dermal component have shown unreliable take rate possibly owing to lack of adequate vascularization and produce an unstable epidermis that is prone to blistering or minor trauma. 17 Finally, substitutes with autologous keratinocytes and fibroblasts require several weeks of culture for development before transplantation to the wound site.…”

mentioning

confidence: 99%

“…22,23 However, vascularization of the dermal support remains a major challenge limiting the survival and take rate of the multilayered epithelial component. 16,17,24 Therefore, successful wound regeneration requires (1) fast wound coverage; (2) quick vascularization of the neodermis; and (3) full restoration of the epidermis with minimum culture time and no need for split-thickness autografts. In principle these requirements can be met by a two-step approach.…”

mentioning

confidence: 99%

Vascularization of the Dermal Support Enhances Wound Re-Epithelialization by In Situ Delivery of Epidermal Keratinocytes

Lugo

Lei

Andreadis

2011

Tissue Engineering Part A

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Despite significant advances in management of severe wounds such as burns and chronic ulcers, autologous split-thickness skin grafts are still the gold standard of care. The main problems with this approach include pain and discomfort associated with harvesting autologous tissue, limited availability of donor sites, and the need for multiple surgeries. Although tissue engineering has great potential to provide alternative approaches for tissue regeneration, several problems have hampered progress in translating technological advances to clinical reality. Specifically, engineering of skin substitutes requires long culture times and delayed vascularization after implantation compromises graft survival. To address these issues we developed a novel two-prong strategy for tissue regeneration in vivo: (1) vascularization of acellular dermal scaffolds by infiltration of angiogenic factors; and (2) generation of stratified epidermis by in situ delivery of epidermal keratinocytes onto the prevascularized dermal support. Using athymic mouse as a model system, we found that incorporation of angiogenic factors within acellular human dermis enhanced the density and diameter of infiltrating host blood vessels. Increased vascularization correlated with enhanced proliferation and stratification of the neoepidermis originating from the fibrin-keratinocyte cell suspension. This strategy promoted tissue regeneration in vivo with no need for engineering skin substitutes; therefore, it may be useful for treatment of major wounds when skin donor sites are scarce and rapid wound coverage is required.

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The use of cultured epithelial autograft in the treatment of major burn injuries: A critical review of the literature

Cited by 173 publications

References 60 publications

Dermal Papilla Cells Improve the Wound Healing Process and Generate Hair Bud-Like Structures in Grafted Skin Substitutes Using Hair Follicle Stem Cells

Dermal Papilla Cells Improve the Wound Healing Process and Generate Hair Bud-Like Structures in Grafted Skin Substitutes Using Hair Follicle Stem Cells

Microenvironment-induced myofibroblast-like conversion of engrafted keratinocytes

Vascularization of the Dermal Support Enhances Wound Re-Epithelialization by In Situ Delivery of Epidermal Keratinocytes

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