Use of Mechanical Stretching to Treat Skin Graft Contracture

2020 ◽  
Vol 41 (4) ◽  
pp. 892-899
Author(s):  
Jinfeng Zhou ◽  
Youcai Zhao ◽  
Wengbo Yang ◽  
Qianming Du ◽  
Jun Yin ◽  
...  
Keyword(s):  
Skin Graft ◽  
Smooth Muscle Actin ◽  
Picric Acid ◽  
Skin Grafting ◽  
Control Group ◽  
Skin Grafts ◽  
Alpha Smooth Muscle Actin ◽  
Treatment Measures ◽  
And Function ◽  
Mechanical Stretching

Abstract After transplantation, skin grafts contract to different degrees, thus affecting the appearance and function of the skin graft sites. The exact mechanism of contracture after skin grafting remains unclear, and reliable treatment measures are lacking; therefore, new treatment methods must be identified. Many types of centripetal contraction forces affect skin graft operation, thus leading to centripetal contracture. Therefore, antagonizing the centripetal contraction of skin grafts may be a feasible method to intervene in skin contracture. Here, the authors propose the first reported mechanical stretching method to address contracture after skin grafting. A full-thickness skin graft model was established on the backs of SD rats. The skin in the experimental group was stretched unilaterally or bidirectionally with a self-made elastic stretching device, whereas the skin was non-stretched in the control group. The rats were sacrificed 2 weeks after stretching. The area, length, and width of the skin were measured. The grafts were cut and fixed with formalin. Routine paraffin sections were stained with hematoxylin-eosin, picric acid-Sirius red, Victoria blue, and anti-alpha-smooth muscle actin (SMA). Mechanical stretching made the graft lengthen in the direction of the stress and had an important influence on collagen deposition and alpha-SMA expression in the graft. This method warrants further in-depth study to provide a basis for clinical application.

Cold Plasma Treatment Promotes Full-thickness Healing of Skin Wounds in Murine Models

2021 ◽  
pp. 153473462110021
Author(s):  
Joon M. Jung ◽  
Hae K. Yoon ◽  
Chang J. Jung ◽  
Soo Y. Jo ◽  
Sang G. Hwang ◽  
...  
Keyword(s):  
Wound Healing ◽  
Plasma Treatment ◽  
Cold Plasma ◽  
Smooth Muscle Actin ◽  
Treated Group ◽  
Control Group ◽  
Alpha Smooth Muscle Actin ◽  
Skin Wound Healing

Cold plasma can be beneficial for promoting skin wound healing and has a high potential of being effectively used in treating various wounds. Our aim was to verify the effect of cold plasma in accelerating wound healing and investigate its underlying mechanism in vitro and in vivo. For the in vivo experiments, 2 full-thickness dermal wounds were created in each mouse (n = 30). While one wound was exposed to 2 daily plasma treatments for 3 min, the other wound served as a control. The wounds were evaluated by imaging and histological analyses at 4, 7, and 11 days post the wound infliction process. Immunohistochemical studies were also performed at the same time points. In vitro proliferation and scratch assay using HaCaT keratinocytes and fibroblasts were performed. The expression levels of wound healing–related genes were analyzed by real-time polymerase chain reaction and western blot analysis. On day 7, the wound healing rates were 53.94% and 63.58% for the control group and the plasma-treated group, respectively. On day 11, these rates were 76.05% and 93.44% for the control and plasma-treated groups, respectively, and the difference between them was significant ( P = .039). Histological analysis demonstrated that plasma treatment promotes the formation of epidermal keratin and granular layers. Immunohistochemical studies also revealed that collagen 1, collagen 3, and alpha-smooth muscle actin appeared more abundantly in the plasma-treated group than in the control group. In vitro, the proliferation of keratinocytes was promoted by plasma exposure. Scratch assay showed that fibroblast exposure to plasma increased their migration. The expression levels of collagen 1, collagen 3, and alpha-smooth muscle actin were elevated upon plasma treatment. In conclusion, cold plasma can accelerate skin wound healing and is well tolerated.

Using fibrin sealant for skin graft fixation to avoid sedation in children with burns: a prospective study

2020 ◽  
Vol 29 (11) ◽  
pp. 642-648
Author(s):  
Kelly AA Kwa ◽  
Anouk Pijpe ◽  
Dirk de Korte ◽  
Annabel Snoeks ◽  
Roelf S Breederveld ◽  
...  
Keyword(s):  
Fibrin Sealant ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
Wound Complications ◽  
Control Group ◽  
Skin Grafts ◽  
Skin Staples ◽  
Graft Take ◽  
Significant Difference ◽  
Sealant Group

Objective: To investigate whether a fibrin sealant, Fitrix (Sanquin Blood Supply Foundation, The Netherlands), for fixation of skin grafts in children with burn wounds is less invasive and equally effective in comparison with skin staples. Method: A single-centre prospective observational cohort study was conducted. Children requiring skin grafting after burns were included and received the fibrin sealant. This group was compared with a retrospective control group of children whose skin grafts were fixed with skin staples. Study outcomes were graft take, graft dislocation, other wound complications, healing and need for sedation. Results: In the fibrin sealant and the control groups, 17 and 27 patients were included, respectively. The percentage of total body surface area (%TBSA) grafted was smaller (p=0.028) in the fibrin sealant group (median 1.0, interquartile range (IQR) 1.5 versus 2.0, IQR 2.5). There was no significant difference in graft take or wound healing. There were two graft dislocations in the fibrin sealant group and none in the control group. Other complications included a patient with graft failure in the fibrin sealant group, and another patient with a vanishing graft and wound infection in the control group. There were fewer sedations in the fibrin sealant group compared with the control group (one versus 20, p<0.0001). Conclusion: The fibrin sealant used in this study was non-inferior for the fixation of skin grafts in comparison with skin staples, and avoided sedation procedures.

643 The Use of Topical Exogenous Nutrient Supplementation to Improve Graft Take on an Avascular Wound Bed

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S167-S168
Author(s):  
Laura Cooper ◽  
Phillip Kemp Bohan ◽  
Anders H Carlsson ◽  
Rodney K Chan ◽  
Tyler Everett
Keyword(s):  
Graft Survival ◽  
Skin Graft ◽  
Skin Grafting ◽  
Dermal Substitute ◽  
Skin Grafts ◽  
Pressure Therapy ◽  
Nutrient Supplementation ◽  
Successful Model ◽  
Dermal Substitutes ◽  
Graft Take

Abstract Introduction Skin graft survival relies on imbibition, inosculation, and revascularization from the wound bed. When a wound bed is poorly vascularized, as in the case of exposed fascia, tendon or bone, skin grafting may be delayed until the wound bed improves. We propose that topical nutrient supplementation may be able to increase take of skin grafts applied over an avascular wound bed. Methods Twenty full-thickness 5cm-diameter wounds were created on the dorsum of anesthetized swine and a dermal substitute (0.4mm, 0.8mm, 1.2mm, or 1.6mm thick) was placed on each wound. Negative pressure therapy with and without intermittent (3x per day) saline instillation was applied. Wounds were analyzed using a non-contact 3D camera at day 7 and day 14. Results Dermal substitutes of 0.8mm, 1.2mm, and 1.6mm thicknesses inhibited graft take significantly (p&lt; 0.01, p=0.02, p&lt; 0.01, respectively) for all wounds treated with wound vac alone. Addition of the normal saline instill showed a significant improvement in graft take (p=0.03) over wound vac alone for the wounds treated with the 0.8mm dermal substitute. Wounds covered with 1.2mm and 1.6mm dermal substitute continued to show significantly decreased graft take (p=0.03 and p=0.02, respectively). Wounds with 0.4mm dermal substitute showed similar graft take to control for both the wound vac and wound vac + instill treatments. Conclusions Dermal substitutes ≥0.8mm create a successful model of an avascular wound bed. Vac + instill treatment overcame the impedance of an avascular wound bed only for the 0.8mm dermal substitute thickness. This thickness of dermal substitute creates an ideal avascular wound bed model from which to conduct further studies incorporating topical nutrients instilled directly onto skin grafts placed onto avascular wound beds. Applicability of Research to Practice Single-stage skin grafting procedures onto avascular wound beds may become feasible with topical nutrient supplementation providing the environment to maintain graft survival until the wound bed is able to support the skin graft.

scholarly journals Skin Graft

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Ruka Shimizu ◽  
Kazuo Kishi
Keyword(s):  
Plastic Surgery ◽  
Skin Graft ◽  
Skin Grafting ◽  
Present Review ◽  
Skin Grafts ◽  
Skin Flaps ◽  
Muscle Flaps ◽  
Scar Contracture ◽  
Contracture Release ◽  
Complex Wounds

Skin graft is one of the most indispensable techniques in plastic surgery and dermatology. Skin grafts are used in a variety of clinical situations, such as traumatic wounds, defects after oncologic resection, burn reconstruction, scar contracture release, congenital skin deficiencies, hair restoration, vitiligo, and nipple-areola reconstruction. Skin grafts are generally avoided in the management of more complex wounds. Conditions with deep spaces and exposed bones normally require the use of skin flaps or muscle flaps. In the present review, we describe how to perform skin grafting successfully, and some variation of skin grafting.

scholarly journals Acceleration of Skin Wound-Healing Reactions by Autologous Micrograft Tissue Suspension

Medicina ◽  
2020 ◽  
Vol 56 (7) ◽  
pp. 321 ◽  
Author(s):  
Shiro Jimi ◽  
Satoshi Takagi ◽  
Francesco De Francesco ◽  
Motoyasu Miyazaki ◽  
Arman Saparov
Keyword(s):  
Wound Healing ◽  
Granulation Tissue ◽  
Smooth Muscle Actin ◽  
Skin Grafting ◽  
Skin Wound ◽  
Control Group ◽  
Distribution Analysis ◽  
Skin Wound Healing ◽  
Tissue Samples ◽  
Tissue Reactions

Background and objectives: Skin grafting is a method usually used in reconstructive surgery to accelerate skin regeneration. This method results frequently in unexpected scar formations. We previously showed that cutaneous wound-healing in normal mice is accelerated by a micrograft (MG) technique. Presently, clinical trials have been performed utilizing this technology; however, the driving mechanisms behind the beneficial effects of this approach remain unclear. In the present study, we focused on five major tissue reactions in wound-healing, namely, regeneration, migration, granulation, neovascularization and contraction. Methods: Morphometrical analysis was performed using tissue samples from the dorsal wounds of mice. Granulation tissue formation, neovascularization and epithelial healing were examined. Results: The wound area correlated well with granulation sizes and neovascularization densities in the granulation tissue. Vascular distribution analysis in the granulation tissue indicated that neovessels extended and reached the subepidermal area in the MG group but was only halfway developed in the control group. Moreover, epithelialization with regeneration and migration was augmented by MG. Myofibroblast is a known machinery for wound contraction that uses α-smooth muscle actin filaments. Their distribution in the granulation tissue was primarily found beneath the regenerated epithelium and was significantly progressed in the MG group. Conclusions: These findings indicated that MG accelerated a series of wound-healing reactions and could be useful for treating intractable wounds in clinical situations.

Enhanced Expression of Heat Shock Protein 47 in Rat Model of Peritoneal Fibrosis

2003 ◽  
Vol 23 (1) ◽  
pp. 14-22 ◽  
Author(s):  
Yoko Mishima ◽  
Masanobu Miyazaki ◽  
Katsushige Abe ◽  
Yoshiyuki Ozono ◽  
Kei Shioshita ◽  
...  
Keyword(s):  
Heat Shock ◽  
Heat Shock Protein ◽  
Experimental Model ◽  
Smooth Muscle Actin ◽  
Control Group ◽  
Peritoneal Fibrosis ◽  
Alpha Smooth Muscle Actin ◽  
Heat Shock Protein 47 ◽  
Peritoneal Tissue ◽  
Enhanced Expression

← Objective Peritoneal fibrosis is one of the serious complications of continuous ambulatory peritoneal dialysis therapy and is characterized by collagen accumulation. Heat shock protein 47 (HSP-47) is a collagen-specific molecular chaperon and is closely associated with collagen synthesis; however, the involvement of HSP-47 in the progression of peritoneal fibrosis is not fully understood. ← Design To examine the serial pathological alterations caused by peritoneal fibrosis, we made an experimental model of peritoneal fibrosis by daily intraperitoneal injection of chlorhexidine gluconate (CG) in rats for 28 days and examined the expression of HSP-47 together with that of types I and III collagen, alpha-smooth muscle actin (αSMA), and ED-1 (a marker for macrophages) using immunohistochemistry. Rats treated with saline containing 15% ethanol were used as the control group. ← Results In the control group, the peritoneal tissue was slightly thickened and HSP-47 was expressed in the peritoneum at day 28. In the CG group, the peritoneal tissue serially became thickened and fibrotic. The expression of HSP-47 was evident in mesothelial cells and submesothelial connective tissue after day 7 of treatment with CG, and increased thereafter. The expression of types I and III collagen and αSMA was proportionally strengthened during our experiments. ED-1–positive cells were present in thickened areas with abundant proliferation of collagen fiber. The number of cells positive for ED-1 increased gradually and reached a maximum at day 21. ← Conclusion Our results indicate that, in a rat experimental model of peritoneal fibrosis, the expression of HSP-47 is associated with the progression of peritoneal fibrosis.

Histopathology, matrix metalloproteinase-2 and alpha smooth muscle actin expression in Tenon's capsule of eyes with congenital glaucoma

2021 ◽  
pp. 112067212110589
Author(s):  
Khulood Muhammad Sayed ◽  
Nesreen G. Abd elhaliem ◽  
Sherine A. Mohammed ◽  
Alahmady Hammad Alsmman
Keyword(s):  
Smooth Muscle ◽  
Matrix Metalloproteinase ◽  
Smooth Muscle Actin ◽  
Congenital Glaucoma ◽  
Control Group ◽  
Muscle Actin ◽  
Alpha Smooth Muscle Actin ◽  
Tenon’S Capsule ◽  
Percentage Area ◽  
Tenon's Capsule

Purpose To evaluate the ultrastructural features of collagen fibrils, matrix metalloproteinase (MMP) and alpha-smooth muscle actin (α-SMA) expression in the Tenon's capsule of buphthalmic eyes. Methods A prospective comparative case series study was conducted on 35 buphthalmic eyes vs 25 control eyes. Children with congenital glaucoma (CG) who underwent a combined trabeculectomy-trabeculotomy procedure with mitomycin C (CTTM); the Tenon's capsule was obtained during the surgical procedure. The control group included children with strabismus, the Tenon's capsule was obtained in the course of strabismus surgery. Both H&E and Masson's trichrome staining were done. The Metalloprotenease-2 (MMP-2), alpha smooth muscle actin (α-SMA) immunohistochemical staining was performed. Results Mean collagen percentage area by Masson trichrome stain in Tenons capsule was significantly higher in buphthalmic eyes (54.76% ± 0.32 vs 33.71% ± 1.4; P < 0.001). The percentage area of αSMA expression in Tenons capsule was significantly higher in buphthalmic eyes (4.93% ± 0.7 vs 2.00% ± 0.5; P < 0.001). However, MMP2 expression in Tenons capsule of the buphthalmic group was significantly lower than that of the control group (12.88% ± 2.95 vs 27.91% ± 0.2 respectively) P = 0.02. Conclusions Tenon capsule of buphthalmic eyes have their own histopathological features and properties making them more liable for fibrosis with high rate of failure following antiglaucoma surgeries. Such detailed information has not been published before which may aid in the identification of new antifibrotic therapies in management of glaucoma.

Wound healing properties of a fibrin-based dermal replacement scaffold

2021 ◽  
Author(s):  
Stuart Brown ◽  
Farhana Surti ◽  
Paul Sibbons ◽  
Lilian Hook
Keyword(s):  
Wound Healing ◽  
Skin Graft ◽  
Healing Process ◽  
Skin Grafting ◽  
Wound Healing Process ◽  
Cutaneous Injury ◽  
Fibrin Scaffold ◽  
Extent Of Damage ◽  
And Function ◽  
Early Healing

Abstract When serious cutaneous injury occurs, the innate wound healing process attempts to restore the skin’s appearance and function. Wound healing outcome is affected by factors such as contraction, revascularisation, regeneration versus fibrosis and re-epithelialisation and is also strongly influenced by the pattern and extent of damage to the dermal layer. Dermal replacement scaffolds have been designed to substitute for lost tissue, provide a structure to promote dermal regeneration, and aid skin grafting, resulting in a superior healing outcome. In this study the wound healing properties of a novel fibrin-alginate dermal scaffold were assessed in the porcine wound healing model and also compared to two widely used dermal scaffolds and grafting alone. The fibrin-alginate scaffold, unlike the other scaffolds tested, is not used in combination with an overlying skin graft. Fibrin scaffold treated wounds showed increased, sustained superficial blood flow and reduced contraction during early healing while showing comparable wound closure, re-epithelialisation and final wound outcome to other treatments. The increase in early wound vascularisation coupled with a decrease in contraction and no requirement for a skin graft suggest that the fibrin-based scaffold could provide an effective, distinctive treatment option to improve healing outcomes in human patients.

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