title: Scarring, stem cells, scaffolds and skin repair.
abstract: The treatment of full thickness skin loss, which can be extensive in the case of large burns, continues to represent a challenging clinical entity. This is due to an on-going inability to produce a suitable tissue engineered substrate that can satisfactorily replicate the epidermal and dermal in vivo niches to fulfil both aesthetic and functional demands. The current gold standard treatment of autologous skin grafting is inadequate because of poor textural durability, scarring and associated contracture, and because of a paucity of donor sites in larger burns. Tissue engineering has seen exponential growth in recent years with a number of 'off-the-shelf' dermal and epidermal substitutes now available. Each has its own limitations. In this review, we examine normal wound repair in relation to stem/progenitor cells that are intimately involved in this process within the dermal niche. Endothelial precursors, in particular, are examined closely and their phenotype, morphology and enrichment from multiple sources are described in an attempt to provide some clarity regarding the controversy surrounding their classification and role in vasculogenesis. We also review the role of the next generation of cellularized scaffolds and smart biomaterials that attempt to improve the revascularisation of artificial grafts, the rate of wound healing and the final cosmetic and functional outcome.
authors.affiliation: Stem Cell Research Laboratory, NHS Blood and Transplant, Oxford, UK.|Department of Plastic and Reconstructive Surgery, Stoke Mandeville Hospital, Aylesbury, UK.|Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.|University College London Centre for Nanotechnology and Regenerative Medicine, Division of Surgery and Interventional Science, Royal Free Hospital, London, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Markeson
authors.affiliation: Department of Plastic and Reconstructive Surgery, Stoke Mandeville Hospital, Aylesbury, UK.|Department of Plastic and Reconstructive Surgery, Frenchay Hospital, Bristol, UK.
authors.forename: Jonathon M
authors.initials: JM
authors.lastname: Pleat
authors.affiliation: Blond McIndoe Research Foundation, Queen Victoria Hospital, East Grinstead, West Sussex, UK.
authors.forename: Justin R
authors.initials: JR
authors.lastname: Sharpe
authors.affiliation: Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK.
authors.forename: Adrian L
authors.initials: AL
authors.lastname: Harris
authors.affiliation: University College London Centre for Nanotechnology and Regenerative Medicine, Division of Surgery and Interventional Science, Royal Free Hospital, London, UK.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Seifalian
authors.affiliation: Stem Cell Research Laboratory, NHS Blood and Transplant, Oxford, UK.|Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Watt
mesh_terms: D000818:Animals; D002921:Cicatrix / Q000473:pathology*; D006801:Humans; D012867:Skin / Q000473:pathology*; D055153:Stem Cell Niche; D013234:Stem Cells / Q000166:cytology*; D054457:Tissue Scaffolds / Q000737:chemistry*; D014945:Wound Healing
keywords: ECFCs; burns; revascularization; scaffolds; skin repair; stem cells