Applicability and safety of in vitro skin expansion using a skin bioreactor: a clinical trial.
BACKGROUND
Tissue expansion is an effective and valuable technique for the reconstruction of large skin lesions and scars. This study aimed to evaluate the applicability and safety of a newly designed skin expanding bioreactor system for maximizing the graft area and minimizing the donor site area.


METHODS
A computer-controlled biaxial skin bioreactor system was used to expand skin in two directions while the culture media was changed daily. The aim was to achieve an expansion speed that enabled the skin to reach twice its original area in two weeks or less. Skin expansion and subsequent grafting were performed for 10 patients, and each patient was followed for 6 months postoperatively for clinical evaluation. Scar evaluation was performed through visual assessment and by using photos.


RESULTS
The average skin expansion rate was 10.54%±6.25%; take rate, 88.89%±11.39%; and contraction rate, 4.2%±2.28% after 6 months. Evaluation of the donor and recipient sites by medical specialists resulted in an average score of 3.5 (out of a potential maximum of 5) at 3 months, and 3.9 at 6 months. The average score for patient satisfaction of the donor site was 6.2 (out of a potential maximum of 10), and an average score of 5.2 was noted for the recipient site. Histological examination performed before and after the skin expansion revealed an increase in porosity of the dermal layer.


CONCLUSIONS
This study confirmed the safety and applicability of the in vitro skin bioreactor, and further studies are needed to develop methods for increasing the skin expansion rate.
Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Korea.
Cheol
C
Jeong
Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Korea.
Ho Yun
HY
Chung
Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Hyun Ju
HJ
Lim
Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Korea.
Jeong Woo
JW
Lee
Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Korea.
Kang Young
KY
Choi
Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Korea.
Jung Dug
JD
Yang
Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Korea.
Byung Chae
BC
Cho
Biomedical Research Institute, Joint Institute for Regenerative Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea.
Jeong Ok
JO
Lim
Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
James J
JJ
Yoo
Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Sang Jin
SJ
Lee
Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Anthony J
AJ
Atala
Cicatrix; Skin transplantation; Tissue expander devices