Use of Mechanical Stretching to Treat Skin Graft Contracture

2020 ◽  
Vol 41 (4) ◽  
pp. 892-899
Author(s):  
Jinfeng Zhou ◽  
Youcai Zhao ◽  
Wengbo Yang ◽  
Qianming Du ◽  
Jun Yin ◽  
...  

Abstract After transplantation, skin grafts contract to different degrees, thus affecting the appearance and function of the skin graft sites. The exact mechanism of contracture after skin grafting remains unclear, and reliable treatment measures are lacking; therefore, new treatment methods must be identified. Many types of centripetal contraction forces affect skin graft operation, thus leading to centripetal contracture. Therefore, antagonizing the centripetal contraction of skin grafts may be a feasible method to intervene in skin contracture. Here, the authors propose the first reported mechanical stretching method to address contracture after skin grafting. A full-thickness skin graft model was established on the backs of SD rats. The skin in the experimental group was stretched unilaterally or bidirectionally with a self-made elastic stretching device, whereas the skin was non-stretched in the control group. The rats were sacrificed 2 weeks after stretching. The area, length, and width of the skin were measured. The grafts were cut and fixed with formalin. Routine paraffin sections were stained with hematoxylin-eosin, picric acid-Sirius red, Victoria blue, and anti-alpha-smooth muscle actin (SMA). Mechanical stretching made the graft lengthen in the direction of the stress and had an important influence on collagen deposition and alpha-SMA expression in the graft. This method warrants further in-depth study to provide a basis for clinical application.

Author(s):  
Joon M. Jung ◽  
Hae K. Yoon ◽  
Chang J. Jung ◽  
Soo Y. Jo ◽  
Sang G. Hwang ◽  
...  

Cold plasma can be beneficial for promoting skin wound healing and has a high potential of being effectively used in treating various wounds. Our aim was to verify the effect of cold plasma in accelerating wound healing and investigate its underlying mechanism in vitro and in vivo. For the in vivo experiments, 2 full-thickness dermal wounds were created in each mouse (n = 30). While one wound was exposed to 2 daily plasma treatments for 3 min, the other wound served as a control. The wounds were evaluated by imaging and histological analyses at 4, 7, and 11 days post the wound infliction process. Immunohistochemical studies were also performed at the same time points. In vitro proliferation and scratch assay using HaCaT keratinocytes and fibroblasts were performed. The expression levels of wound healing–related genes were analyzed by real-time polymerase chain reaction and western blot analysis. On day 7, the wound healing rates were 53.94% and 63.58% for the control group and the plasma-treated group, respectively. On day 11, these rates were 76.05% and 93.44% for the control and plasma-treated groups, respectively, and the difference between them was significant ( P = .039). Histological analysis demonstrated that plasma treatment promotes the formation of epidermal keratin and granular layers. Immunohistochemical studies also revealed that collagen 1, collagen 3, and alpha-smooth muscle actin appeared more abundantly in the plasma-treated group than in the control group. In vitro, the proliferation of keratinocytes was promoted by plasma exposure. Scratch assay showed that fibroblast exposure to plasma increased their migration. The expression levels of collagen 1, collagen 3, and alpha-smooth muscle actin were elevated upon plasma treatment. In conclusion, cold plasma can accelerate skin wound healing and is well tolerated.


2020 ◽  
Vol 29 (11) ◽  
pp. 642-648
Author(s):  
Kelly AA Kwa ◽  
Anouk Pijpe ◽  
Dirk de Korte ◽  
Annabel Snoeks ◽  
Roelf S Breederveld ◽  
...  

Objective: To investigate whether a fibrin sealant, Fitrix (Sanquin Blood Supply Foundation, The Netherlands), for fixation of skin grafts in children with burn wounds is less invasive and equally effective in comparison with skin staples. Method: A single-centre prospective observational cohort study was conducted. Children requiring skin grafting after burns were included and received the fibrin sealant. This group was compared with a retrospective control group of children whose skin grafts were fixed with skin staples. Study outcomes were graft take, graft dislocation, other wound complications, healing and need for sedation. Results: In the fibrin sealant and the control groups, 17 and 27 patients were included, respectively. The percentage of total body surface area (%TBSA) grafted was smaller (p=0.028) in the fibrin sealant group (median 1.0, interquartile range (IQR) 1.5 versus 2.0, IQR 2.5). There was no significant difference in graft take or wound healing. There were two graft dislocations in the fibrin sealant group and none in the control group. Other complications included a patient with graft failure in the fibrin sealant group, and another patient with a vanishing graft and wound infection in the control group. There were fewer sedations in the fibrin sealant group compared with the control group (one versus 20, p<0.0001). Conclusion: The fibrin sealant used in this study was non-inferior for the fixation of skin grafts in comparison with skin staples, and avoided sedation procedures.


2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S167-S168
Author(s):  
Laura Cooper ◽  
Phillip Kemp Bohan ◽  
Anders H Carlsson ◽  
Rodney K Chan ◽  
Tyler Everett

Abstract Introduction Skin graft survival relies on imbibition, inosculation, and revascularization from the wound bed. When a wound bed is poorly vascularized, as in the case of exposed fascia, tendon or bone, skin grafting may be delayed until the wound bed improves. We propose that topical nutrient supplementation may be able to increase take of skin grafts applied over an avascular wound bed. Methods Twenty full-thickness 5cm-diameter wounds were created on the dorsum of anesthetized swine and a dermal substitute (0.4mm, 0.8mm, 1.2mm, or 1.6mm thick) was placed on each wound. Negative pressure therapy with and without intermittent (3x per day) saline instillation was applied. Wounds were analyzed using a non-contact 3D camera at day 7 and day 14. Results Dermal substitutes of 0.8mm, 1.2mm, and 1.6mm thicknesses inhibited graft take significantly (p&lt; 0.01, p=0.02, p&lt; 0.01, respectively) for all wounds treated with wound vac alone. Addition of the normal saline instill showed a significant improvement in graft take (p=0.03) over wound vac alone for the wounds treated with the 0.8mm dermal substitute. Wounds covered with 1.2mm and 1.6mm dermal substitute continued to show significantly decreased graft take (p=0.03 and p=0.02, respectively). Wounds with 0.4mm dermal substitute showed similar graft take to control for both the wound vac and wound vac + instill treatments. Conclusions Dermal substitutes ≥0.8mm create a successful model of an avascular wound bed. Vac + instill treatment overcame the impedance of an avascular wound bed only for the 0.8mm dermal substitute thickness. This thickness of dermal substitute creates an ideal avascular wound bed model from which to conduct further studies incorporating topical nutrients instilled directly onto skin grafts placed onto avascular wound beds. Applicability of Research to Practice Single-stage skin grafting procedures onto avascular wound beds may become feasible with topical nutrient supplementation providing the environment to maintain graft survival until the wound bed is able to support the skin graft.


2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Ruka Shimizu ◽  
Kazuo Kishi

Skin graft is one of the most indispensable techniques in plastic surgery and dermatology. Skin grafts are used in a variety of clinical situations, such as traumatic wounds, defects after oncologic resection, burn reconstruction, scar contracture release, congenital skin deficiencies, hair restoration, vitiligo, and nipple-areola reconstruction. Skin grafts are generally avoided in the management of more complex wounds. Conditions with deep spaces and exposed bones normally require the use of skin flaps or muscle flaps. In the present review, we describe how to perform skin grafting successfully, and some variation of skin grafting.


Medicina ◽  
2020 ◽  
Vol 56 (7) ◽  
pp. 321 ◽  
Author(s):  
Shiro Jimi ◽  
Satoshi Takagi ◽  
Francesco De Francesco ◽  
Motoyasu Miyazaki ◽  
Arman Saparov

Background and objectives: Skin grafting is a method usually used in reconstructive surgery to accelerate skin regeneration. This method results frequently in unexpected scar formations. We previously showed that cutaneous wound-healing in normal mice is accelerated by a micrograft (MG) technique. Presently, clinical trials have been performed utilizing this technology; however, the driving mechanisms behind the beneficial effects of this approach remain unclear. In the present study, we focused on five major tissue reactions in wound-healing, namely, regeneration, migration, granulation, neovascularization and contraction. Methods: Morphometrical analysis was performed using tissue samples from the dorsal wounds of mice. Granulation tissue formation, neovascularization and epithelial healing were examined. Results: The wound area correlated well with granulation sizes and neovascularization densities in the granulation tissue. Vascular distribution analysis in the granulation tissue indicated that neovessels extended and reached the subepidermal area in the MG group but was only halfway developed in the control group. Moreover, epithelialization with regeneration and migration was augmented by MG. Myofibroblast is a known machinery for wound contraction that uses α-smooth muscle actin filaments. Their distribution in the granulation tissue was primarily found beneath the regenerated epithelium and was significantly progressed in the MG group. Conclusions: These findings indicated that MG accelerated a series of wound-healing reactions and could be useful for treating intractable wounds in clinical situations.


2003 ◽  
Vol 23 (1) ◽  
pp. 14-22 ◽  
Author(s):  
Yoko Mishima ◽  
Masanobu Miyazaki ◽  
Katsushige Abe ◽  
Yoshiyuki Ozono ◽  
Kei Shioshita ◽  
...  

← Objective Peritoneal fibrosis is one of the serious complications of continuous ambulatory peritoneal dialysis therapy and is characterized by collagen accumulation. Heat shock protein 47 (HSP-47) is a collagen-specific molecular chaperon and is closely associated with collagen synthesis; however, the involvement of HSP-47 in the progression of peritoneal fibrosis is not fully understood. ← Design To examine the serial pathological alterations caused by peritoneal fibrosis, we made an experimental model of peritoneal fibrosis by daily intraperitoneal injection of chlorhexidine gluconate (CG) in rats for 28 days and examined the expression of HSP-47 together with that of types I and III collagen, alpha-smooth muscle actin (αSMA), and ED-1 (a marker for macrophages) using immunohistochemistry. Rats treated with saline containing 15% ethanol were used as the control group. ← Results In the control group, the peritoneal tissue was slightly thickened and HSP-47 was expressed in the peritoneum at day 28. In the CG group, the peritoneal tissue serially became thickened and fibrotic. The expression of HSP-47 was evident in mesothelial cells and submesothelial connective tissue after day 7 of treatment with CG, and increased thereafter. The expression of types I and III collagen and αSMA was proportionally strengthened during our experiments. ED-1–positive cells were present in thickened areas with abundant proliferation of collagen fiber. The number of cells positive for ED-1 increased gradually and reached a maximum at day 21. ← Conclusion Our results indicate that, in a rat experimental model of peritoneal fibrosis, the expression of HSP-47 is associated with the progression of peritoneal fibrosis.


2022 ◽  
Vol 11 ◽  
Author(s):  
Dan Xu ◽  
Jie Zhou ◽  
Hao Mei ◽  
Huan Li ◽  
Wenbo Sun ◽  
...  

BackgroundCerebrospinal fluid (CSF) plays an important role in maintaining tissue homeostasis in the central nervous system. In 2012, the new CSF outflow pathway, “the glymphatic system,” was discovered. The glymphatic system mediates CSF and interstitial fluid exchange through the perivascular pathway, which eliminates harmful solutes in the brain parenchyma. In recent studies, the importance of the glymphatic system has been demonstrated in healthy and neurodegenerative disease brains. However, there is limited research on the function of the CSF in brain tumors. Intracranial hypertension caused by glioma can affect CSF drainage, which impacts the delivery of chemotherapy drugs via intrathecal injection. This study focused on changes in the glymphatic system and the role of aquaporin 4 (AQP4) in glymphatic transport in glioma.MethodsIn glioma-bearing rats, the effect of tracer infusion on the intracranial pressure (ICP) was evaluated using an ICP microsensor. In vivo magnetic resonance imaging and ex vivo bright field were used to monitor CSF tracer distribution after cisterna magna injection. AQP4 expression was quantitatively detected, and AQP4 in the astrocytes around the vessels was observed using immunofluorescence.ResultsThe ICP of the tumor group was higher than that of the control group and the infusion rate of 2 µl/min did not affect ICP. In vivo and ex vivo imaging showed that the circulation of CSF tracers was significantly impaired in the tumor. High-power confocal microscopy revealed that, in the tumor, the surrounding of AQP4 by Evans Blue was decreased. In both tumor and contralateral areas, data indicated that the number of cluster designation 34 (CD34+) alpha-smooth muscle actin (α-SMA−) veins were more than that of CD34+α-SMA+ arteries. Moreover, in the tumor area, AQP4 in the astrocytes around the vessels was decreased.ConclusionsThese findings indicate that the para-arterial influx of subarachnoid CSF is limited in glioma, especially in those with reduced levels of the fundamental protein AQP4. Our results provide evidence toward a potential new treatment method for glioma in the future.


Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2430-2430
Author(s):  
Fabiola V Merriam ◽  
Ian Nicoud ◽  
Filippo Milano ◽  
Jianqiang Li ◽  
Shelly Heimfeld ◽  
...  

Abstract Introduction: Our lab has developed novel methods, using an engineered form of the Notch ligand Delta-1, for the ex vivo expansion of cord blood CD34+ hematopoietic stem and progenitor cells (HSPC) for clinical applications. These same methods can be used to expand primary murine HSPC. We have previously demonstrated that transplantation of completely mismatched Notch-expanded lin-/sca-1+/c-kit+ (LSK) cells can prolong survival in mice that received lethal total body irradiation (TBI). The mismatched LSK cells rapidly reconstitute myeloid cells in irradiated recipients that are short-lived, with low-level persistence of lymphoid cells (CD4/CD8) for more than 90 days. This long-term chimerism was directly proportional to the TBI dose, with higher levels of persistent donor engraftment with increasing TBI. We hypothesized that the residual donor lymphoid cells were de novo generated, tolerant by virtue of host education, and might convey immune tolerance. Herein, we now demonstrate the ability of engrafted mismatched Notch-expanded LSK cells to induce immune tolerance toward the same mismatched donor using a skin allograft technique. Methods: Bone marrow LSK cells from Ly5a mice (H-2b, CD45.1) were cultured for 14 days in the presence of engineered Notch ligand, Delta1ext-IgG. The progeny were harvested and cryopreserved and later transplanted into Balb/c (H-2d, CD45.2) mice that were lethally irradiated with 7.5 Gy at a dose of 5x106 cells per mouse. Control animals received 2x105 fresh Balb/c bone marrow cells. 60 days post-transplant, reconstitution and donor chimerism was assessed in the peripheral blood of the recipient mice and bilateral allogeneic and autologous skin grafting was performed. Chimerism ranged from 0 to 12%, with a mean of 3%. Mice were evenly distributed by chimerism into the following 3 groups: mice receiving autologous Balb/c skin graft on the left flank and either a mismatched Ly5a or third-party C3H (H-2k, CD45.2) skin graft on the right flank, or the combination of Ly5a and C3H. Seven days after skin grafting, the dressings were removed and the grafts were scored daily for a period of 30 days. The day of rejection was defined as > 80% of the graft being necrotic, scabbed, or dislodged from the graft bed. Results: Control animals (those reconstituted with Balb/c marrow, Figure 1A, dashed line) had 0% rejection of Balb/c grafts (0/5) and 100% rejection of C3H grafts (6/6) and Ly5a skin grafts (7/7) within the first 10 days. Experimental animals (those reconstituted with expanded Ly5a cells, Figure 1A, solid line) also had 0% rejection of Balb/c skin grafts (0/12). As with Control animals, chimeric mice also had 100% rejection of the C3H grafts (10/10) within the first 10 days after implantation. Interestingly, chimeric animals that received Ly5a skin grafts showed a slower rate of rejection over a period of 30 days; by day 10 only 45.5% had rejected (5/11), another 45.5% rejected between day 10 and 21 (5/11) and 9% (1/11) had complete engraftment of the Ly5a skin without any signs of rejection to present day. Figure 1B shows complete engraftment of Ly5a skin on Balb/c mice that received expanded Ly5a cells. The black arrow shows a contracted scar of the C3H graft rejection and blue arrow shows tolerance to the Ly5a. T test of the graft survival times between mice receiving Balb/c marrow and expanded Ly5a LSK that received Ly5a skin grafts was significant (p=0.05) as was the comparison between Ly5a skin and C3H skin in animals that received expanded Ly5a LSK (p=0.05). Of note, the one animal with no rejection of Ly5a skin had the highest hematopoietic donor chimerism within that group at the time of skin grafting. Conclusion: Preliminary data from these experiments provide strong evidence that Delta1ext-IgG-expanded Ly5a LSK cells, in addition to improving hematopoietic reconstitution, are immunomodulatory and can convey immune tolerance. The results suggest that the level of donor chimerism may correlate with the degree of induced tolerance. Further experiments are being conducted with higher doses of TBI, which we have demonstrated previously result in higher persistent donor chimerism of the expanded Ly5a cells, to investigate the relationship between level of donor engraftment and immune tolerance. The ability to induce immune tolerance could be very important for solid organ transplantation, by enabling the discontinuation of antirejection medicines in transplant recipients. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.


2021 ◽  
Vol 7 ◽  
pp. 205951312110565
Author(s):  
Luxi Sun ◽  
Animesh JK Patel

Background Surgical excision remains the cornerstone of simultaneous diagnosis and treatment of suspicious skin lesions, and the scalp is a high-risk area for skin cancers due to increased cumulative lifetime ultraviolet (UV) exposure. Due to the inelasticity of scalp skin, most excisions with predetermined margins require reconstruction with skin grafting. Methods A retrospective single-centre cohort study was performed of all patients undergoing outpatient local anaesthetic scalp skin excision and skin graft reconstruction in the Plastic Surgery Department at Addenbrookes Hospital over a 20-month period between 1 April 2017 and 1 January 2019. In total, 204 graft cases were collected. Graft reconstruction techniques included both full-thickness and split-thickness skin grafts. Statistical analysis using Z tests were used to determine which skin grafting technique achieved better graft take. Results Split-thickness skin grafts had a statistically significant ( P = 0.01) increased average take (90%) compared to full-thickness skin grafts (72%). Using a foam tie-over dressing on the scalp led to a statistically significant ( P = 0.000036) increase in skin graft take, from 38% to 79%. Conclusion In skin graft reconstruction of scalp defects after skin cancer excision surgery, split skin grafts secured with foam tie-over dressings are associated with superior outcomes compared to full-thickness skin grafts or grafts secured with sutures only.


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