Extensive traumatic soft tissue loss: reconstruction in severely injured patients using cultured hyaluronan-based three-dimensional dermal and epidermal autografts.
BACKGROUND
This report demonstrates the potential of two-stage autologous keratodermal grafting as a starting point for noninvasive reconstruction of extensive traumatic soft tissue defects.


METHODS
In three severely injured patients, skin biopsies for cell cultivation were taken. Cultured "neodermis" consisting of cultured autologous fibroblasts grown on biocompatible three-dimensional scaffolds made up of benzyl ester of hyaluronan was grafted on conditioned defect areas. After ingrowth of dermal substitutes, transplantation of cultured autologous keratinocytes on hyaluronan-based laser-perforated membranes was performed. Ten days later, a 0.2-mm thin, 1:6 meshed autograft was overlaid. Clinical follow-up, histologic, and immunohistochemical findings were documented.


RESULTS
Grafting with cultured autologous fibroblasts revealed a suitable dermal tissue replacement. Epithelialization was evident after transplantation of keratinocytes. Final closure of the defects with "normoelastic" tissue properties was achieved after thin mesh-grafting.


CONCLUSIONS
Preliminary findings with the described method seem to be very promising. As in all fields of tissue engineering, long-term studies and further follow-up are required.
Hollander
D A
DA
Department of Trauma and Reconstructive Surgery, Johann Wolfgang Goethe-University, Frankfurt, Germany.
Soranzo
C
C
Falk
S
S
Windolf
J
J
D000276:Adjuvants, Immunologic / Q000494:pharmacology*; D000328:Adult; D000368:Aged; D002648:Child; D046508:Culture Techniques / Q000379:methods; D005260:Female; D005347:Fibroblasts / Q000637:transplantation; D006801:Humans; D006820:Hyaluronic Acid / Q000494:pharmacology*; D007150:Immunohistochemistry; D015603:Keratinocytes / Q000637:transplantation; D008297:Male; D008854:Microscopy, Electron; D019651:Plastic Surgery Procedures; D016038:Skin Transplantation / Q000379:methods*; D017695:Soft Tissue Injuries / Q000601:surgery*; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D000276:Adjuvants, Immunologic; D006820:Hyaluronic Acid