Chitosan Dermal Substitute and Chitosan Skin Substitute Contribute to Accelerated Full-Thickness Wound Healing in Irradiated Rats

Abstract

Wounds with full-thickness skin loss are commonly managed by skin grafting. In the absence of a graft, reepithelialization is imperfect and leads to increased scar formation. Biomaterials can alter wound healing so that it produces more regenerative tissue and fewer scars. This current study use the new chitosan based biomaterial in full-thickness wound with impaired healing on rat model. Wounds were evaluated after being treated with a chitosan dermal substitute, a chitosan skin substitute, or duoderm CGF. Wounds treated with the chitosan skin substitute showed the most re-epithelialization (33.2 ± 2.8%), longest epithelial tongue (1.62 ± 0.13 mm), and shortest migratory tongue distance (7.11 ± 0.25 mm). The scar size of wounds treated with the chitosan dermal substitute (0.13 ± 0.02 cm) and chitosan skin substitute (0.16 ± 0.05 cm) were significantly decreased (P < 0.05) compared with duoderm (0.45 ± 0.11 cm). Human leukocyte antigen (HLA) expression on days 7, 14, and 21 revealed the presence of human hair follicle stem cells and fibroblasts that were incorporated into and surviving in the irradiated wound. We have proven that a chitosan dermal substitute and chitosan skin substitute are suitable for wound healing in full-thickness wounds that are impaired due to radiation.

Methodologies in creating skin substitutes

“…A significant problem with using collagen as the main component of scaffolds for skin substitutes is it has relatively poor mechanical properties[33]. However, these properties can be improved with various cross-linking methods, typically cross-linking collagen with glycosaminoglycans[34–36], but also with hyaluronic acid[37], fibrin[38], chitosan[30,39,40], gelatin[41,42], elastin[43], pullulan[44–46], alginate[47,48], laminin[49], poly(L-lactic acid) (PLLA)[50], poly(glycolide-co-L-lactide) (PLGA)[51,52], poly(ethylene glycol) (PEG)[53], and polycaprolactone (PCL)[54]. …”

“…A few studies have shown positive wound healing effects from chitosan-based hydrogels[30,39,40]. Chitosan hydrogels have also been used in controlled release drug formulations due to its non-toxicity and structural stability[65].…”

A new rabbit model of impaired wound healing in an X-ray-irradiated field

“…Through our experience in mouse model,[ 10 ] a diameter of 5 mm was considered the maximum. There has been a rat model using 1 x 1 cm wounds on the dorsum, inside a field of “photon beam” irradiation,[ 15 ] however, the “photon beam” described in this study may be an electron beam. As electron beams do not penetrate deeply, the tissue beneath the wound may have been intact.…”

A Concise Review on Tissue Engineered Artificial Skin Grafts for Chronic Wound Treatment: Can We Reconstruct Functional Skin Tissue In Vitro?

“…Table 3 summarizes attempts to generate artificial skin grafts capable of reconstruction of skin appendages, pigmentation, and nerves. Mohd Hilmi et al [107] incorporated human fibroblasts and hair follicle stem cells into the chitosan skin substitute that was subsequently transplanted into a full-thickness wound in an irradiated rat model with impaired healing and hair loss. They observed that the applied cellular skin graft accelerated skin regeneration and was able to supply viable follicle stem cells into the irradiated wound.…”