title: Neoskin development in the fetus with the use of a three-layer graft: an animal model for in utero closure of large skin defects.
abstract: OBJECTIVE
  To assess the ability of a three-layer graft in the closuse of large fetal skin defects.
  
  
  METHODS
  Ovine fetuses underwent a large (4 × 3 cm) full-thickness skin defect over the lumbar region at 105 days' gestation (term = 140 days). A bilaminar artificial skin was placed over a cellulose interface to cover the defect (3-layer graft). The skin was partially reapproximated with a continuous nylon suture. Pregnancy was allowed to continue and the surgical site was submitted to histopathological analysis at different post-operative intervals.
  
  
  RESULTS
  Seven fetuses underwent surgery. One maternal/fetal death occurred, and the remaining 6 fetuses were analyzed. Artificial skin adherence to the wound edges was observed in cases that remained in utero for at least 15 days. Neoskin was present beneath the silicone layer of the bilaminar artificial skin.
  
  
  CONCLUSIONS
  Our study shows that neoskin can develop in the fetus using a 3-layer graft, including epidermal growth beneath the silicone layer of the bilaminar skin graft. These findings suggest that the fetus is able to reepithelialise even large skin defects. Further experience is necessary to assess the quality of this repair.
authors.affiliation: Maternal-fetal specialist, Pathology Department, Faculty of Medicine, University of São Paulo (USP), São Paulo, Brazil. wdpedreira@uol.com.br
authors.forename: Denise Araújo Lapa
authors.initials: DA
authors.lastname: Pedreira
authors.forename: Ruben A
authors.initials: RA
authors.lastname: Quintero
authors.forename: Gregório Lorenzo
authors.initials: GL
authors.lastname: Acácio
authors.forename: Elia Tamaso Espin Garcia
authors.initials: ET
authors.lastname: Caldini
authors.forename: Paulo Hilário Nascimento
authors.initials: PH
authors.lastname: Saldiva
mesh_terms: D000818:Animals; D005260:Female; D005332:Fetoscopy; D023421:Models, Animal; D011247:Pregnancy; D012756:Sheep; D012867:Skin / Q000473:pathology; D016038:Skin Transplantation / Q000379:methods*; D017768:Skin, Artificial; D016137:Spina Bifida Cystica / Q000473:pathology / Q000628:therapy*