Simultaneous dermal matrix and autologous split‐thickness skin graft transplantation in a porcine wound model: A three‐dimensional histological analysis of revascularization

Abstract

Despite the popularity of a simultaneous application of dermal matrices and split-thickness skin grafts, scarce evidence exists about the process of revascularization involved. In this study, we aimed at analyzing the progression of revascularization by high-resolution episcopic microscopy (HREM) in a porcine excisional wound model. Following the surgical procedure creating 5 × 5 cm(2) full-thickness defects on the back, one area was covered with an autologous split-thickness skin graft alone (control group), the other with a collagen-elastin dermal matrix plus split-thickness skin graft (dermal matrix group). Two skin biopsies per each group and location were performed on day 5, 10, 15, and 28 postoperatively and separately processed for H&E as well as HREM. The dermal layer was thicker in the dermal matrix group vs. control on day 5 and 28. No differences were found for revascularization by conventional histology. In HREM, the dermal matrix did not appear to decelerate the revascularization process. The presence of the dermal matrix could be distinguished until day 15. By day 28, the structure of the dermal matrix could no longer be delineated and was replaced by autologous tissue. As assessed by conventional histology and confirmed by HREM, the revascularization process was comparable in both groups, notably with regard to the vertical ingrowth of sprouting vessels. The presented technique of HREM is a valuable addition for analyzing small vessel sprouting in dermal matrices in the future.

High-resolution Episcopic Microscopy (HREM) - Simple and Robust Protocols for Processing and Visualizing Organic Materials

“…HREM is a highly robust microscopic method that is ideal for visualizing a broad spectrum of organic materials used in biomedicine and industry 18 21 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 . It can be employed as an exclusive imaging modality, as currently used by the Mechanisms of Developmental Disorders (DMDD) program 41 42 43 44 , or as an integrative part of multimodal imaging pipelines 45 .…”

The dermal arteries in the cutaneous angiosome of the descending genicular artery

“…Recently, a three-dimensional (3D) imaging method, high resolution episcopic microscopy (HREM), was developed for visualising embryo morphology (Weninger et al 2006;Geyer et al 2009;Mohun & Weninger, 2012b). In the last few years this method has also been applied for analysing the topology of dermal arteries in humans and biomedical models (Weninger et al 2006;Mohun & Weninger, 2012b;Geyer et al 2013Geyer et al , 2014Geyer et al , 2015Wiedner et al 2014;Wong et al 2016). As a first result, HREM analysis of the thick skin of the human thumb pad challenged the postulate of a superficial dermal arterial plexus.…”

High-Resolution Episcopic Microscopy (HREM): Looking Back on 13 Years of Successful Generation of Digital Volume Data of Organic Material for 3D Visualisation and 3D Display

“…HREM was developed in 2006, and for about a decade, operated on self-assembled apparatuses. Published data does exist for the pig and the mouse, in which vascularisation in wound healing was researched [97,98], and for humans. In humans, HREM was successfully employed to develop a novel concept for dermal vascularisation in thick [99,100] and thin skin [101] and to analyse the topology of arteries and nerves in the auricle [102].…”