Vasculogenic Chronic Ulcer: Tissue Regeneration with an Innovative Dermal Substitute

Abstract

The healing of venous and arterial ulcers is slow, and in some cases, they may not heal at all. This study aims to demonstrate the clinical advantage of Nevelia®, an innovative collagen dermal template substitute (DS) in venous and arterial chronic ulcers treatment. 35 patients affected by chronic vascular ulcers with a mean area of 35.1 ± 31.8 cm2 were treated with DS followed by autologous dermal epidermal graft (DEG). Follow-up was performed at 7-14-21 and 28 days after DS implant and 7-14-21 and 28 days after DEG. At 28 days after DEG, the mean values of Manchester Scar Scale was of 1.8 ± 0.7 for skin color, 1.6 ± 0.7 for skin contour, 1.7 ± 0.7 for distortion, and 1.7 ± 0.7 for skin texture, whereas skin was matte in 27 patients (77%) and shiny in the remaining eight cases (23%). Histological findings correlate with the clinical result showing a regenerated skin with reactive epidermal hyperplasia and dermal granulation tissue after two weeks (T1), and after three weeks (T2) a re-epithelialization and a formed new tissue architecture analogue to normal skin physiology. These data suggest that Nevelia® could be useful to treat chronic venous and arterial ulcers.

Artificial dermal substitutes for tissue regeneration: comparison of the clinical outcomes and histological findings of two templates

“…Additionally, several biologic and synthetic dermal and epidermal regenerative modalities have recently been investigated to treat fullthickness skin defects and investigate the fundamental characteristics of the biomaterial that closely resembles the natural features of tissue. 3,4,15,16,24,29,30,32 In the present study, we defined tissueengineered skin bio-constructs as DSs that were acellular with xenogeneic synthetic scaffolding and biodegradable material. We observed differences in the composition, structure, and storage adequacy of the two DSs.…”

“… 13 Differences in DSs are likely to affect multiple wound-healing mechanisms, including fibroplasia, because the ECM provides porosity, elasticity, and biocompatibility and may strongly influence cellular migration, proliferation, and differentiation during recovery. 14 – 16 DSs physically differ based on the specific manufacturing methods used. 17 Biomaterials have been extensively investigated for use in skin replacement, and acellular DSs are fundamental to prepare the wound bed and enhance graft integration with the resultant recipient surface.…”

Multipotent adult progenitor cells grown under xenobiotic-free conditions support vascularization during wound healing

“…Hyaluronic acid (HA) or collagen representing important extracellular matrix (ECM) components of the skin are often part of engineered wound dressings or skin substitutes (reviewed by Murray et al [30]). ECMbased dermal substitutes have shown relevance in the treatment of various types of wounds such as chronic ulcers [31], post-traumatic skin injuries [32], but also in regenerative plastic surgery methods (reviewed by Gentile et al [33]) as for instance in scalp repair after tumor resection [34,35]. To stimulate the regenerative capacity of wound dressings, growth factors and cytokines are incorporated, frequently in the form of autologous platelet-rich plasma (PRP), which also has been shown clinical potential for wound healing when used alone [36,37].…”

Systematic Review: Adipose-Derived Mesenchymal Stem Cells, Platelet-Rich Plasma and Biomaterials as New Regenerative Strategies in Chronic Skin Wounds and Soft Tissue Defects

“…De Angelis et al [61] published a recent study in which 35 patients affected by chronic vascular ulcers with a mean area of 35.1 ± 31.8 cm 2 were treated with a dermal substitute (DS) called Nevelia ® , followed by an autologous dermal epidermal graft (DEG). Follow-up was performed at 7, 14, 21, and 28 days after the DS implant and 7, 14, 21, and 28 days after the DEG.…”