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Journal of Burn Care & Research :... Jan 2023The self-assembled skin substitute (SASS) is an autologous bilayered skin substitute designed by our academic laboratory, the Laboratoire d'Organogenèse Expérimentale... (Review)
Review
The self-assembled skin substitute (SASS) is an autologous bilayered skin substitute designed by our academic laboratory, the Laboratoire d'Organogenèse Expérimentale (LOEX) to offer definitive treatment for patients lacking donor sites (unwounded skin) to cover their burn wounds. This product shows skin-like attributes, such as an autologous dermal and epidermal layer, and is easily manipulable by the surgeon. Its development stems from the need for skin replacement in high total body surface area burned survivors presenting few donor sites for standard split-thickness skin grafting. This review aims to present the history, successes, challenges, and current therapeutic indications of this skin substitute. We review the product's development history, before discussing current production techniques, as well as clinical use. The progression observed since the initial SASS production technique described in 1999, up to the most recent technique expresses significant advances made in the technical aspect of our product, such as the reduction of the production time. We then explore the efficacy and benefits of SASS over existing skin substitutes and discuss the outcomes of a recent study focusing on the successful treatment of 14 patients. Moreover, an ongoing cross-Canada study is further assessing the product's safety and efficacy. The limitations and technical challenges of SASS are also discussed.
Topics: Humans; Skin, Artificial; Burns; Skin; Skin Transplantation; Epidermis
PubMed: 36567476
DOI: 10.1093/jbcr/irac074 -
Open Veterinary Journal Oct 2023The recovery of auto skin graft is a dynamic and complex process that requires a suitable environment for vascularization as nutrition delivery to cells and donor skin...
BACKGROUND
The recovery of auto skin graft is a dynamic and complex process that requires a suitable environment for vascularization as nutrition delivery to cells and donor skin reception.
AIMS
This research aimed to determine the effect of Tilapia skin dressing on the recovery of auto skin graft treatment on domestic cats through subjective and objective observation.
METHODS
Six male Indonesian local cats aged 1-2 years old weighing 3-4 kg were separated into two groups. The surgical procedure was performed in a sterile and aseptic environment. The first surgery created wound defects on the forelimb area 2 × 2 cm in size to whole groups. The wounds were left for 4 days and then treated with the following treatments; Group I (G-I) was treated with Tilapia skin dressing, and Group II (G-II) was treated with moist dressing Sofra-tulle. The dressing of the two groups was replaced every 3 days and evaluated subjectively and objectively.
RESULTS
Subjective observation showed that skin was reddish (day 3), the bleeding test showed bleeding immediately occurred after incision, and pain response was observed on day 6 post-surgery on both treatment groups showed significantly differences with 95% confidence level ( < 0.05). Objective observation in the form of NaCl 0.9% absorption and medicine effect on auto skin graft did not show a significant difference between the two treatment groups ( > 0.05).
CONCLUSION
Auto skin graft treatment by moist dressing showed better healing, but Tilapia skin dressing can be an alternative choice during auto skin graft treatment.
Topics: Male; Cats; Animals; Skin Transplantation; Tilapia; Bandages; Wound Healing; Administration, Cutaneous
PubMed: 38027407
DOI: 10.5455/OVJ.2023.v13.i10.14 -
Revue Medicale Suisse Mar 2022Chronic ulcers are a common but important dermatological problem and a major source of expense in the western countries. Skin graft is a surgical procedure in which skin... (Review)
Review
Chronic ulcers are a common but important dermatological problem and a major source of expense in the western countries. Skin graft is a surgical procedure in which skin or skin substitute is transplanted in order to close a wound. This article aims to review the different categories of grafts, their indications for the healing of chronic ulcers of the lower limbs, emphasizing the position of punch grafts in the treatment arsenal.
Topics: Humans; Leg Ulcer; Skin Diseases; Skin Transplantation; Ulcer; Wound Healing
PubMed: 35353456
DOI: 10.53738/REVMED.2022.18.775.604 -
Journal of Wound Care Jul 2021
Topics: Humans; Leg Injuries; Skin Transplantation
PubMed: 34256603
DOI: 10.12968/jowc.2021.30.7.516 -
Journal of Visualized Experiments : JoVE Jan 2008As one of the most stringent and least technically challenging models, skin transplantation is a standard method to assay host T cell responses to MHC-disparate donor...
As one of the most stringent and least technically challenging models, skin transplantation is a standard method to assay host T cell responses to MHC-disparate donor antigens. The aim of this video-article is to provide the viewer with a step-by-step visual demonstration of skin transplantation using the mouse model. The protocol is divided into 5 main components: 1) harvesting donor skin; 2) preparing recipient for transplant; 3) skin transplant; 4) bandage removal and monitoring graft rejection; 5) helpful hints. Once proficient, the procedure itself should take <10 min to perform.
Topics: Animals; Antigens; Histocompatibility Antigens; Mice; Mice, Inbred BALB C; Mice, Inbred C57BL; Skin Transplantation; T-Lymphocytes; Transplantation Immunology; Transplantation, Homologous
PubMed: 19066559
DOI: 10.3791/634 -
Burns : Journal of the International... Nov 2022Globally, burn injuries are the 3rd principal cause of death due to injury among children aged 1-9 years. Yet, the management of paediatric burns is always challenging;... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Globally, burn injuries are the 3rd principal cause of death due to injury among children aged 1-9 years. Yet, the management of paediatric burns is always challenging; due to limited donor sites and the cosmetic appearance that will affect the child later in life, either at the donor or the recipient site. Skin grafts may need to be expanded to minimise donor skin size or in patients with limited donor sites. Multiple techniques were described for graft expansion, mainly the mesher and the Meek technique.
PATIENTS AND METHODS
A prospective comparative randomised study was done from January 2019 to June 2020 on 40 paediatric burn patients with deep dermal and full-thickness burns. Patients were divided into two groups, Meek and meshed groups. The skin graft take, epithelialization time, total time of the surgery and the aesthetic outcomes (using the POSAS - Patient and observer scar assessment scale) in each group were evaluated at three months postoperatively.
RESULTS
The percentage of take in the Meek group (84.25%) was significantly better than with the meshed group (71.5%) (P = 0.006). Epithelialization time was better for the Meek group (27.11 days) compared to the meshed group (33.5 days) (P = 0.176). In addition, infection rates were lower in the Meek group (25%) than the meshed group (40%) (P = 0.311). Subjectively POSAS scar assessment scale exhibited better results for the Meek group with a mean score of 3.17 & for the meshed group was 4.2 (P = 0.048). The observer's overall score was as well better for the Meek group with a mean overall opinion score of 2.89 & for the meshed group was 4.1 (P = 0.003). The operative time was longer with the Meek technique than the traditional mesher (P < 0.001).
CONCLUSION
The Meek technique for expanding the skin grafts is useful in covering burn wounds with greater expansion rate, more accessible application, better graft take & a better scar appearance than the traditional mesher. Still, the Meek technique has a considerable learning curve, longer procedure time & is more expensive.
Topics: Humans; Child; Skin Transplantation; Burns; Cicatrix; Prospective Studies; Skin
PubMed: 35248428
DOI: 10.1016/j.burns.2022.01.016 -
Transplant International : Official... Feb 2008In 1943, Gibson and Medawar opened the modern era of transplantation research with a paper on the problem of skin allograft rejection. Ten years later Billingham, Brent... (Review)
Review
In 1943, Gibson and Medawar opened the modern era of transplantation research with a paper on the problem of skin allograft rejection. Ten years later Billingham, Brent and Medawar demonstrated that it was possible to induce selective immune acceptance of skin grafts in mice, a state of tolerance. After over six decades, however, the precise mechanism of skin allograft rejection remains still ill-defined. Furthermore, it has not been possible to achieve reliably clinical tolerance allowing the widespread application of skin allotransplantation techniques. The first successful applications of skin allotransplantation have included the hand and face. However, complications from the chronic immunosuppression regimens limit the application of these techniques. Induction of tolerance to skin (and the other tissues in the allograft) would be the most effective way to overcome all these difficulties, but this is yet to be achieved reliably, stimulating some to look for other ways to surmount the current limitations. This paper summarizes alternatives to enlarge the scope of skin allotransplantation techniques, current understanding of mechanisms of skin rejection, and the utility and limitations of animal models used to study skin rejection and tolerance induction. Finally, manipulation strategies to achieve skin tolerance are outlined.
Topics: Animals; Graft Rejection; Humans; Immune Tolerance; Models, Animal; Skin Transplantation; Transplantation, Homologous
PubMed: 17903184
DOI: 10.1111/j.1432-2277.2007.00559.x -
Wounds : a Compendium of Clinical... Jun 2022Dermal regeneration matrices (DRMs) represent a significant advance in wound treatment, but their use remains limited because of high associated costs. Used correctly,...
INTRODUCTION
Dermal regeneration matrices (DRMs) represent a significant advance in wound treatment, but their use remains limited because of high associated costs. Used correctly, DRMs help improve aesthetic and functional results of skin-grafted areas.
OBJECTIVE
This case series reports the use of a DRM of 1-mm and 2-mm thickness in the management of acute complex wounds.
MATERIALS AND METHODS
This is a retrospective analysis of a cohort of patients treated between 2015 and 2018. Complex wounds were defined as those with extensive loss of skin and subcutaneous tissue, or as those in critical areas, that required sequential and specialized treatment. Management of acute wounds involved debridement of devitalized tissue, wound bed preparation, DRM implantation, and split-thickness skin grafting (STSG). Negative pressure wound therapy (NPWT) was used in all cases preoperatively, after DRM implantation, and after STSG. Results of integration of DRM and skin grafts were subjectively evaluated. The Vancouver Scar Scale was used to evaluate results 12 months postoperatively.
RESULTS
Traumatic injuries were the most common etiology, and the extension of the treated wounds varied between 4 cm × 5 cm to 42 cm × 28 cm, in the greatest dimensions. A 2-mm-thick matrix was used in 14 cases, with skin grafting after 7 to 9 days. In 6 cases, a 1-mm-thick matrix was used, immediately followed by skin grafting. Negative pressure wound therapy was used in all cases. Dermal regeneration matrices and skin graft integration rates of almost 100% were achieved in all cases. No complications occurred.
CONCLUSIONS
The results showed use of DRM and NPWT was a good reconstructive option in the management of acute complex wounds that required STSG. With proper patient selection, such treatment is an important tool in the armamentarium of reconstructive procedures.
Topics: Humans; Negative-Pressure Wound Therapy; Plastic Surgery Procedures; Retrospective Studies; Skin Transplantation; Treatment Outcome; Wound Healing
PubMed: 35881424
DOI: 10.25270/wnds/2022.154158 -
BMC Veterinary Research Mar 2022Full thickness skin grafts (FTSGs), although ideal for resurfacing large defects of the distal extremities in veterinary patients, have a high failure rate due to issues...
BACKGROUND
Full thickness skin grafts (FTSGs), although ideal for resurfacing large defects of the distal extremities in veterinary patients, have a high failure rate due to issues of adherence, infection and inadequate revascularisation because of its thickness and high nutritional demand. This study investigated the effect of Nigeria bee honey on FTSG take at the distal extremities of dogs. The study was conducted on 6 adult male Nigerian indigenous dogs using 3 of the 4 limbs of each dog randomly divided into 3 treatment groups: Nigerian bee honey (HON group), platelet-rich plasma (PRP group) and normal saline (CON group). Full-thickness skin wounds (3 cm × 1.5 cm) were created on the lateral aspect of the radioulnar or metatarsal areas and dressed till adequate granulation tissues formed. Donor skins harvested from the lateral thorax of each dog were sutured to the recipient bed following application of the assigned treatment, and evaluated grossly and histologically on days 0, 4, 7, 10, 14, 17, and 21.
RESULTS
A higher percentage (4/6 representing 66.7%) of complete graft take was observed in the HON and PRP groups as compared to 3/6 (50%) in the CON group. The HON group had a greater percentage (5/6 representing 83.3%) of adhered grafts as compared to the PRP (4/6 representing 66.7%) and CON (3/6 representing 50%) groups at day 4. There was a significant decrease (p = 0.022) in percentage necrosis between the CON and HON/PRP groups on day 10, 14 and 17. The percentage open mesh area for the HON group was significantly lesser at day 4, 7 and 10 when compared with CON (p < 0.001) and at day 4 when compared with PRP (p = 0.001). At histology, graft neovascularisation score was highest in the HON group on days 4, 14 and 21.
CONCLUSION
Nigeria bee honey enhanced take of meshed full-thickness skin autografts by promoting adherence to the recipient bed, enhancing fibroblast proliferation and collagen laydown, and accelerating the rate of neovascularisation suggesting promising application as an alternative modality to enhance FTSG take.
Topics: Animals; Autografts; Dogs; Extremities; Honey; Male; Nigeria; Skin; Skin Transplantation
PubMed: 35272682
DOI: 10.1186/s12917-022-03192-w -
Journal of the American Veterinary... Feb 2021To compare outcomes after application of full-thickness, meshed free-skin grafts in single-session versus delayed (staged) procedures after tumor excision from the...
Comparison of outcomes for single-session and delayed full-thickness applications of meshed skin grafts used to close skin defects after excision of tumors on the distal aspects of the limbs in dogs.
OBJECTIVE
To compare outcomes after application of full-thickness, meshed free-skin grafts in single-session versus delayed (staged) procedures after tumor excision from the distal aspects of the limbs in dogs.
ANIMALS
52 client-owned dogs.
PROCEDURES
Medical records were retrospectively reviewed to identify dogs that received full-thickness, meshed free-skin grafts after tumor excision from the distal aspects of the limbs between 2013 and 2018. Signalment; diagnostic test results; comorbidities; procedure type (single session or staged); tumor characteristics; donor site, recipient site, and size of grafts; concurrent procedures; surgeon; antimicrobial administration; external coaptation type; number of bandage applications; percentage graft survival; graft outcome; postoperative complications; and time to complete healing were recorded. Graft outcome was deemed successful if there was full-thickness graft viability over ≥ 75% of the original graft area. Variables were compared between dogs grouped by procedure type.
RESULTS
The number of bandage applications was significantly greater for dogs that had staged versus single-session procedures. Twenty-seven of 30 (90%) and 18 of 22 (82%) skin grafts placed in single-session and staged procedures, respectively, were successful. Percentage graft survival, graft outcome, and complication rate did not differ between groups. All complications were minor. Time to complete healing was significantly longer after staged procedures (median, 51 days) than after single-session procedures (29.5 days).
CONCLUSIONS AND CLINICAL RELEVANCE
Results suggested both procedure types are appropriate for skin graft placement. The shorter healing time and fewer bandage changes associated with single-session skin graft placement may be beneficial after tumor excision. Prospective studies are needed to confirm these findings.
Topics: Animals; Dog Diseases; Dogs; Neoplasms; Prospective Studies; Retrospective Studies; Skin; Skin Transplantation
PubMed: 33539210
DOI: 10.2460/javma.258.4.387