Epidermal graft encourages wound healing by down‐regulation of gap junctional protein and activation of wound bed without graft integration as opposed to split‐thickness skin graft

Abstract Background Wound repair is one of the most complex biological processes of human life. Allogeneic cell-based engineered skin substitutes provide off-the-shelf temporary wound coverage and act as biologically active dressings, releasing growth factors, cytokines and extracellular matrix components essential for proper wound healing. However, they are susceptible to immune rejection and this is their major weakness. Thanks to their low immunogenicity and high effectiveness in regeneration, fetal skin cells represent an attractive alternative to the commonly used autologous and allogeneic skin grafts. Methods/design We developed a new dressing comprising a collagen matrix seeded with a specific ratio of active fetal fibroblasts and keratinocytes. These produce a variety of healing growth factors and cytokines which will increase the speed of wound healing and induce an immunotolerant state, with a slight inflammatory reaction and a reduction in pain. The objective of this study is to demonstrate that the use of this biological dressing for wound healing at the split-thickness skin graft (STSG) donor site, reduces the time to healing, decreases other co-morbidities, such as pain, and improves the appearance of the scar. This investigation will be conducted as part of a randomized study comparing our new biological dressing with a conventional treatment in a single patient, thus avoiding the factors that may influence the healing of a graft donor site. Discussion This clinical trial should enable the development of a new strategy for STSG donor-wound healing based on a regenerative dressing. The pain experienced in the first few days of STSG healing is well known due to the exposure of sensory nerve endings. Reducing this pain will also reduce analgesic drug intake and the duration of sick leave. Our biological dressing will meet the essential need of surgeons to “re-crop” from existing donor sites, e.g., for thermal-burn patients. By accelerating healing, improving the appearance of the scar and reducing pain, we hope to improve the conditions of treatment for skin grafts. Trial registration ClinicalTrials.gov, ID: NCT03334656. Registered on 7 November 2017.

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Biological versus non-biological dressings in the management of split-thickness skin-graft donor sites: a systematic review and meta-analysis

Journal of Wound Care ◽

10.12968/jowc.2020.29.10.604 ◽

2020 ◽

Vol 29 (10) ◽

pp. 604-610

Author(s):

Shafiq Rahman ◽

Benjamin Langridge ◽

Ahmed Al-Hadad ◽

Rehman Ali Khan ◽

Muhammad Hyder Junejo ◽

...

Keyword(s):

Systematic Review ◽

Wound Healing ◽

Skin Graft ◽

Meta Analysis ◽

Healing Time ◽

Conclusive Evidence ◽

Split Thickness Skin Graft ◽

Controlled Trials ◽

Cochrane Central Register ◽

Thickness Skin

Objective: There are currently no definitive guidelines regarding the management of split-thickness skin-graft (STSG) donor sites. The literature reports biological and non-biological dressings as the two main groups; however, there is no conclusive evidence regarding the ideal type. A systematic review and meta-analysis of existing clinical trials was performed to compare biological and non-biological dressings in managing STSG donor sites. Method: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards was used to conduct this study. Electronic databases including MEDLINE, Embase, CINAHL and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched by two authors (SR and BL). Data analysis was performed with RevMan 5.3. Results: In total, 10 studies, consisting of eight randomised controlled trials and two observational assessments, were identified. Wound healing time was faster with biological dressings compared to non-biological dressings (mean difference -5.44 days; p<0.05). A higher epithelialisation rate was also noted for biological dressings. There was no difference in the infection rate between the two study groups (odds ratio [OR] 0.39; 95% confidence interval [CI] 0.15–1.04) or wound exudation (OR 0.31; 95% CI 0.01–8.28). The pain level experienced during dressing changes in both groups was reported to be similar. Conclusion: The rate of epithelialisation and wound healing is greater for STSG donor sites when treated with biological dressings, but they offer no difference in terms of reducing pain, limiting infection or exudation.

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Lipid-Colloid Dressing Shows Improved Reepithelialization, Pain Relief, and Corneal Barrier Function in Split-Thickness Skin-Graft Donor Wound Healing

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734614541544 ◽

2014 ◽

Vol 13 (3) ◽

pp. 220-225 ◽

Cited By ~ 8

Author(s):

Katsuya Tanaka ◽

Sadanori Akita ◽

Hiroshi Yoshimoto ◽

Seiji Houbara ◽

Akiyoshi Hirano

Keyword(s):

Wound Healing ◽

Pain Relief ◽

Skin Graft ◽

Barrier Function ◽

Split Thickness Skin Graft ◽

Thickness Skin ◽

Graft Donor

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The use of autologous platelet-rich plasma gel increases wound healing and reduces scar development in split-thickness skin graft donor sites

Journal of Plastic Surgery and Hand Surgery ◽

10.1080/2000656x.2019.1635489 ◽

2019 ◽

Vol 53 (6) ◽

pp. 356-360 ◽

Cited By ~ 2

Author(s):

Zhuoqun Fang ◽

Xuekang Yang ◽

Gaofeng Wu ◽

Mengdong Liu ◽

Juntao Han ◽

...

Keyword(s):

Wound Healing ◽

Skin Graft ◽

Platelet Rich Plasma ◽

Split Thickness Skin Graft ◽

Thickness Skin ◽

Graft Donor ◽

Autologous Platelet Rich Plasma ◽

Autologous Platelet

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Application of Honey and Transparent Dressing to Split Thickness Skin Graft Donor Site and Its Effect on Epithelialization Rate

Jurnal Plastik Rekonstruksi ◽

10.14228/jpr.v1i3.73 ◽

1970 ◽

Vol 1 (3) ◽

Author(s):

Teuku A. ◽

Nandita Melati P. ◽

Gentur Sudjatmiko ◽

Asrofi S. ◽

Ishandono D.

Keyword(s):

Clinical Trial ◽

Wound Healing ◽

Skin Graft ◽

Donor Site ◽

Split Thickness Skin Graft ◽

Parallel Design ◽

Thickness Skin ◽

Graft Donor ◽

The Mean ◽

Clinical Photograph

Background: Split thickness skin graft (STSG) is one of the modalities used to close a defect. The donor site can be healed secondarily with tulle grass and moist gauze after 14 days and with transparent dressing will take about 10-13 days. Recently the wound healing by using honey application has been used. Whether or not using honey application with transparent dressing will hasten the epithelialization rate of the STSG donor site is now in question. Method: This research is an open, non-randomized clinical trial with a parallel design and intervention using honey application with transparent dressing. A total of 19 patients (7 female and 8 male) were included in this study. The reapplication of honey was done every two days. The patients was followed up every day, with clinical photograph taken and complaints such as pain, odor and infection noted. Results: The mean epithelialization rate of the donor site treated with honey and transparent dressing was 9,74 (+0,24) days compared to 10,79 (+1,23) days in the transparent-dressing-only group (p=0,00). Conclusion: The application of honey with transparent dressing to cover for STSG donor site led to a faster epithelialization rate, less odor and less pain. Commercial honey was used, and readily available.

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Principles of plastic surgery

10.1093/med/9780198510567.003.0017 ◽

2011 ◽

Author(s):

P. Baguley

Keyword(s):

Wound Healing ◽

Skin Graft ◽

Split Thickness Skin Graft ◽

Skin Flaps ◽

Full Thickness Skin Graft ◽

Local Skin ◽

Secondary Intention ◽

Normal Wound Healing ◽

Reconstructive Ladder ◽

Thickness Skin

Introduction 760Anatomy of the integument 762Normal wound healing 764Abnormal wound healing 766Keloids and hypertrophic scars 768Reconstructive ladder 770Primary and secondary intention healing 772Skin grafts 774Split thickness skin graft 776Full thickness skin graft 780Flaps 782Types of local skin flaps ...

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Evaluation of skin graft take following post-burn raw area in normovolaemic anaemia

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699344 ◽

2009 ◽

Vol 42 (02) ◽

pp. 195-198 ◽

Cited By ~ 3

Author(s):

Pawan Agarwal ◽

Brijesh Prajapati ◽

D. Sharma

Keyword(s):

Wound Healing ◽

Haemoglobin Level ◽

Skin Graft ◽

Control Group ◽

Split Thickness Skin Graft ◽

Graft Take ◽

Thickness Skin ◽

Significant Difference ◽

Oxygen Carrying Capacity ◽

Moderate Anaemia

ABSTRACT Background: Traditional wisdom is that wound healing is directly related to haemoglobin level in the blood; therefore blood transfusion is given in anaemic patients to raise the haemoglobin level for better wound healing. Methods: Evaluation of wound healing in the form of split thickness skin graft take was done in 35 normovolaemic anaemic patients (haemoglobin level of < 10 gm/ dl) and compared with control group (patients with haemoglobin level of 10 or > 10 gm/ dl). Results: There was no statistically significant difference in mean graft take between the two groups. Conclusion: It is not mandatory to keep haemoglobin level at or >10 g/dL or PCV value at or >30% for skin graft take, as mild to moderate anaemia per se does not cause any deleterious effect on wound healing; provided perfusion is maintained by adequate circulatory volume. Prophylactic transfusion to increase the oxygen carrying capacity of the blood for the purpose of wound healing is not indicated in asymptomatic normovolemic anaemic patients (with haemoglobin levels greater than 6g/dL) without significant cardiovascular or pulmonary disease.

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