Clinical application of autologous three-cellular cultured skin substitutes based on esterified hyaluronic acid scaffold: our experience.
BACKGROUND
The aim of this work was to present our experience in the use of autologous three-cellular cultured skin substitutes (CSS). This method represents a surgical alternative in the treatment of a variety of pathologies, including burns, ulcers, giant nevi and tumors.


METHODS
CSS were obtained from full-thickness skin biopsies collected after enrolment of 11 patients in a clinical trial protocol approved by the local Institutional Review Boards of the 'La Sapienza' University of Rome and registered in clinicaltrials.gov (ID: NCT00718978). CSS consisted of a structure made by a pluristratified epithelial cell surface with melanocytes (ratio 1/20) and a basement of fibroblasts kept together by an esterified hyaluronic acid scaffold that can be surgically manipulated and is gradually reabsorbed after implantation and substituted by the host connectival stroma.


RESULTS
At the time of withdrawal of medication, the graft take was comparable to that of autografts, whereas in the follow-up visits, loss of the epithelial layer varied markedly (from 5 to 70%) while fibroblast cellular component growth prevailed. In one patient, there was complete dermal-epidermal construct survival.


CONCLUSIONS
Given the anatomical complexity of the skin, we still have a long way to go before we are able to recreate all the cellular and structural characteristics of this organ. Results are, however, gradually improving, as is demonstrated by a successful graft, which was histologically shown to have a three-dimensional structure that maintained its conformation in vivo (epithelium, basement membrane, dermis, subcutis) in one patient. The take of melanocytes improved the final esthetic outcome.
Scuderi
Nicolò
N
Department of Plastic and Reconstructive Surgery, La Sapieza University, Roma, Italy.
Anniboletti
Tommaso
T
Carlesimo
Bruno
B
Onesti
Maria Giuseppina
MG
D000293:Adolescent; D000328:Adult; D001698:Biomedical Engineering; D002648:Child; D002675:Child, Preschool; D062109:Dermatologic Surgical Procedures; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000473:pathology*; D016038:Skin Transplantation / Q000379:methods*; D017768:Skin, Artificial; D046509:Tissue Culture Techniques; D054457:Tissue Scaffolds; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult
D006820:Hyaluronic Acid