Evaluation of Tissue-Engineered Skin (Human Skin Substitute) and Secondary Intention Healing in the Treatment of Full Thickness Wounds after Mohs Micrographic or Excisional Surgery

Abstract

background. Human Skin Substitute (Apligraf, Organogenesis, Inc., Canton, MA) is a bi-layered tissue-engineered living biological dressing developed from neonatal foreskin. It consists of a bovine collagen matrix containing human fibroblasts with an overlying sheet of stratified human epithelium containing living human keratinocytes. Human Skin Substitute (HSS) appears to be immunologically inert, and has shown usefulness in the treatment of chronic and acute wounds. objective. Primary objectives were to evaluate the safety and efficacy of HSS in the treatment of full-thickness wounds in a prospective case series. Secondary objectives were to determine the rate of complete wound reepithelialization, incidence of complete wound healing, pain at wound site, overall cosmetic outcome, and patient satisfaction. methods. Fourteen patients were enrolled in the study, of which 12 were evaluable. HSS was applied in a blinded fashion to 6 of the patients immediately following Mohs or excisional surgery for skin cancer. The remaining 6 patients were allowed to heal by secondary intention. Both groups were evaluated at weekly appointments until complete reepithelialization occurred. During each evaluation, wound quality was assessed through the Vancouver Burn Scar Assessment Scale by the investigator and an independent blinded dermatologist. The investigator, blinded observer, and patient further evaluated the cosmetic outcome of the wound through the use of a Visual Analog Scale over a 6-month period. results. HSS patients and secondary intention patients were equivalent in comorbid factors such as pain, erythema, edema, exudate, infection, or hematoma between the groups. The incidence of complete wound healing at 6 months was 100% for both groups. Both groups also appeared to heal at similar rates, as defined by the complete reepithelialization of the wound. HSS patients ultimately resulted in more pliable and less vascular wounds as defined by the Vancouver Burn Scar Assessment Scale. Patient satisfaction with cosmetic outcome in both groups was positive at 6 months.conclusions. HSS appears to be a safe, well-tolerated biological dressing with equivalent comorbid factors to secondary intention healing. HSS, however, seems to produce a more pliable and less vascular scar than those developed through healing by secondary intention. HSS also appears to produce more satisfactory cosmetic results when compared to secondary intention healing.

Potential of Human Bone Marrow Stromal Cells to Accelerate Wound Healing in Vitro

“…[1][2][3][4] In other attempts to deliver growth factors to wounds, fibroblast implants, which are able to adjust to a wound's environment and provide the desired growth factors and other substances that maybe be lacking in a chronic wound, have been developed as biologic wound dressings. [5][6][7][8] Bone marrow stroma is the source of mesenchymal stem cells that may serve as long-lasting precursors for bone, cartilage, muscle, and connective tissues. 9 -11 Mesenchymal stem cells also have a low immunity-assisted rejection rate, and they have a greater ability to divide without apoptosis than differentiated cells.…”

Cosmetic Improvement in Various Acute Skin Defects Treated With Tissue‐engineered Skin

“…The cell components of the TE-skin, derived from newborn healthy cells, are metabolically active in comparison to adult cells and may be able to provide more growth factors to the wound; TE-skin accelerates healing mainly by stimulating the endogenous repair process. As reported previously, TE-skin can produce such cytokines as interleukins, transforming growth factors, granulocyte macrophage-stimulating factor, platelet-derived growth factor, basic fibroblast growth factor, and matrix metalloproteinases (22)(23)(24). The expression of those cytokines in TE-skin may interact with circumstances adjacent to wounds, and support wound reepithelialization through recognized modes, and stimulate the formation of granulation tissue (25)(26)(27).…”

Improving wound-healing outcomes in diabetic foot ulcers

“…Two main types of living bioengineered skin have been tested and proven effective in the treatment of diabetic neuropathic foot ulcers. Apligraft is a bilayered, living biological dressing developed from human neonatal foreskins and consists of a collagen matrix containing human fibroblasts overlayed with sheets of stratified human epithelium, containing viable human keratinocytes [62]. Dermagraft is a 3D, allogenic, human neonatal dermal fibroblast culture grown on a degradable scaffold and cryopreserved [63].…”