Autologous full-thickness skin substitute for healing chronic wounds.
BACKGROUND
Chronic wounds represent a major problem to our society. Therefore, advanced wound-healing strategies for the treatment of these wounds are expanding into the field of tissue engineering.


OBJECTIVE
To develop a novel tissue-engineered, autologous, full-thickness skin substitute of entirely human origin and to determine its ability to heal chronic wounds.


METHODS
Skin substitutes (fully differentiated epidermis on fibroblast-populated human dermis) were constructed from 3-mm punch biopsies isolated from patients to be treated. Acellular allodermis was used as a dermal matrix. After a prior 5-day vacuum-assisted closure therapy to prepare the wound bed, skin substitutes were applied in a simple one-step surgical procedure to 19 long-standing recalcitrant leg ulcers (14 patients; ulcer duration 0.5-50 years).


RESULTS
The success rate in culturing biopsies was 97%. The skin substitute visibly resembled an autograft. Eleven of the 19 ulcers (size 1-10 cm2) healed within 8 weeks after a single application of the skin substitute. The other eight larger (60-150 cm2) and/or complicated ulcers healed completely (n = 5) or continued to decrease substantially in size (n = 3) after the 8-week follow-up period. Wound healing occurred by direct take of the skin substitute (n = 12) and/or stimulation of granulation tissue/epithelialization (n = 7). Skin substitutes were very well tolerated and pain relief was immediate after application.


CONCLUSIONS
Application of this novel skin substitute provides a promising new therapy for healing chronic wounds resistant to conventional therapies.
Gibbs
S
S
Department of Dermatology, VU Medical Centre, De Boelelaan, 1081 HV Amsterdam, the Netherlands. sgibbs@vumc.nl
van den Hoogenband
H M
HM
Kirtschig
G
G
Richters
C D
CD
Spiekstra
S W
SW
Breetveld
M
M
Scheper
R J
RJ
de Boer
E M
EM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001485:Basement Membrane / Q000033:anatomy & histology; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007871:Leg Ulcer / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000033:anatomy & histology; D016038:Skin Transplantation / Q000379:methods*; D017768:Skin, Artificial; D023822:Tissue Engineering / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing