elastin and Burns

Management of full-thickness facial burns remains one of the greatest challenges. Controversy exists among surgeons regarding the use of early excision for facial burns. Unfortunately, delayed excision of deeper burns often results in more scarring and subsequent reconstruction becomes more difficult. A collagen-elastin matrix is used to improve the quality of the reconstructed skin, to reduce scarring and to prevent wound contraction. It serves as a foundation for split thickness skin graft and enhances short and long-term results.. We report the usage of a collagen-elastin matrix during single-step wound closure technique of severe full-thickness facial burns in 15 children with large burned body surface area, and also we review the literature about pediatric facial burns.. There were 15 pediatric patients with severe facial burns, 8 girls and 7 boys ranging in age from 10 months to 12 years, mean age 7 years and 6 months old. The facial burn surface area (FBSA) among the patients includes seven patients with 100%, five with 75%, and three with 50%. The average total body surface area (TBSA) for the patients was 72%, ranging between 50 and 90%. 5 of the patients' admissions were late, more than four days after burns while the rest of the patients were admitted within the first four days (acute admission time). The burns were caused by flame in eight of the patients, bomb blast in four, and scalding in three. All patients were treated by the simultaneous application of the collagen-elastin matrix and an unmeshed split thickness skin graft at Turgut Özal Medical Center, Pediatric Burn Center, Malatya, Turkey. After the treatment only two patients needed a second operation for revision of the grafts. All grafts transplanted to the face survived. The average Vancouver scar scales (VSS) were 2.55±1.42, ranging between one and six, in the first 10 of 15 patients at the end of 6 months postoperatively. VSS measurements of the last 5 patients were not taken since the 6 months postoperative period was not over.. In regard to early results, graft quality was close to normal skin in terms of vascularity, elasticity, pliability, texture and color. Esthetic and functional results have been encouraging. This study shows us that the collagen-elastin matrix as a dermal substitute is a useful adjunct, which may result in quick healing with satisfying esthetic and functional results. It also may enhance short and long-term results in after burn facial wound closure in children.

Topics: Body Surface Area; Burns; Child; Child, Preschool; Collagen; Elastin; Esthetics; Facial Injuries; Female; Graft Survival; Humans; Infant; Male; Reoperation; Skin Transplantation; Skin, Artificial; Trauma Severity Indices; Treatment Outcome; Turkey

Severe burn injuries are a major health problem as they can compromise whole body function and result in extensive emotional trauma exacerbated by prolonged hospital stay. Burn injury treatment has improved dramatically to increase the probability of survival, but burn survivors still suffer from excessive scarring and skin contractures, which substantially compromise their health and quality of life. Elastin is historically underrepresented in commercial dermal substitutes, yet deserves consideration because of its fundamental role in skin structure and function. Dermal elastic network is a strong determinant of skin resilience, texture, and quality but is not sufficiently regenerated following burn injury. In addition to its structural and mechanical roles, elastin has inherent cell signaling properties that promote a diverse range of cellular responses including chemotaxis, cell attachment, proliferation, and differentiation. Scaffold elasticity and regeneration of the elastic fiber system is now recognized as integral to the development of functional dermal substitutes. Dermal substitutes are intended to replace damaged dermal tissue in severe burn injuries. Elastin-based dermal substitutes have the potential to decrease wound contraction, improve scar appearance and functionality, and contribute to wound healing outcomes through a combination of elastin's mechanical and cell signaling properties.

Topics: Animals; Burns; Cell Differentiation; Cell Proliferation; Dermis; Elasticity; Elastin; Humans; Skin; Skin, Artificial; Tissue Engineering; Wound Healing

The therapeutic management of the sequelae of deep burns always relies in principle on dermal-epidermal grafts. The latter, the price of which to pay is heavy scarring, cannot always be performed because the surface of skin available may not be sufficient. Research pathways have turned towards the creation of skin substitutes to minimise the scarring and improve the cosmetic quality of the grafts. We review the technical characteristics of collagen matrixes (Intégra(®) - Matriderm(®)) and their method of use.

Topics: Burns; Chondroitin Sulfates; Cicatrix; Collagen; Elastin; Humans; Skin, Artificial; Treatment Outcome; Wound Healing

Dermal substitutes are well established in the reconstructive ladder. MatriDerm® (Dr. Otto Suwelack Skin & Health Care AG, Billerbeck, Germany) is a single-layer dermal substitute composed of a bovine collagen (type I, III, and V) and elastin hydrolysate, that allows for immediate split-thickness skin grafting (SSG). The aim of this study was to histologically characterize the integration of MatriDerm® when used during burns surgery reconstruction. Eight subjects with nine burn scars and one acute burn wound underwent reconstruction with MatriDerm® and an immediate SSG. MatriDerm® integration and skin graft take were assessed with serial biopsies performed at weeks 1, 2, 3, and 4 and months 2, 3, 6, 9, and 12. Biopsies were assessed with standard special stains and immunohistochemistry, and representative slides were imaged with a transmission electron microscope. Patient satisfaction and clinical scar outcome were assessed with the Vancouver Scar Scale and a patient questionnaire. Histological analysis showed similar stages of wound healing as shown in other dermal templates but on a different timescale. There is early evidence of vascularization and an inflammatory infiltrate in the first 2 weeks. MatriDerm® is resorbed earlier than other dermal substitutes, with evidence of resorption at week 3, to be completely replaced by a neodermis at 2 months. The use of MatriDerm® in reconstruction with immediate skin grafting is supported histologically with early evidence of vascularization to support an epidermal autograft. Future histological studies may help further characterize the ideal dermal substitute.

Topics: Animals; Burns; Cattle; Cicatrix; Collagen; Collagen Type I; Elastin; Humans; Skin Transplantation; Skin, Artificial

Major challenges facing clinicians treating burn wounds are the lack of integration of treatment to wound, inadequate mechanical properties of treatments, and high infection rates which ultimately lead to poor wound resolution. Electrospun chitosan membranes (ESCM) are gaining popularity for use in tissue engineering applications due to their drug loading ability, biocompatibility, biomimetic fibrous structure, and antimicrobial characteristics. This work aims to modify ESCMs for improved performance in burn wound applications by incorporating elastin and magnesium-phosphate particles (MgP) to improve mechanical and bioactive properties. The following ESCMs were made to evaluate the individual components' effects; (C: chitosan, CE: chitosan-elastin, CMg: chitosan-MgP, and CEMg: chitosan-elastin-MgP). Membrane properties analyzed were fiber size and structure, hydrophilic properties, elastin incorporation, MgP incorporation and in vitro release, mechanical properties, degradation profiles, and in vitro cytocompatibility with NIH3T3 fibroblasts. The addition of both elastin and MgP increased the average fiber diameter of CE (~400 nm), CMg (~360 nm), and CEMg (565 nm) compared to C (255 nm). Water contact angle analysis showed elastin incorporated membranes (CE and CEMg) had increased hydrophilicity (~50°) compared to the other groups (C and CMg, ~110°). The results from the degradation study showed mass retention of ~50% for C and CMg groups, compared to ~ 30% seen in CE and CEMg after 4 weeks in a lysozyme/PBS solution. CMg and CEMg exhibited burst-release behavior of ~6 µg/ml or 0.25 mM magnesium within 72 h. In vitro analysis with NIH3T3 fibroblasts showed CE and CEMg groups had superior cytocompatibility compared to C and CMg. This work has demonstrated the successful incorporation of elastin and MgP into ESCMs and allows for future studies on burn wound applications.

Topics: Animals; Anti-Infective Agents; Burns; Chitosan; Elastin; Magnesium; Mice; Muramidase; Nanofibers; NIH 3T3 Cells; Phosphates; Wound Healing

The advent of dermal regeneration templates has fostered major advances in the treatment of acute burns and their sequelae, in the last three decades. Both data on morphological aspects of the newly-formed tissue, and clinical trials comparing different templates, are few. The goal of this study was to prospectively analyze the outcome of randomized patients treated with two of the existing templates, followed by thin skin autograft. They are both 2 mm-thick bovine collagen templates (Matriderm® and Integra®), the latter includes a superficial silicone layer. Surgery was performed on patients with impaired mobility resulting from burn sequelae (n = 12 per template) in a two-step procedure. Negative pressure therapy was applied after surgery; patients were monitored for 12 months. No intra or postoperative complications were observed. Data on scar skin quality (Vancouver scar scale), rate of mobility recovery, and graft contraction were recorded; as well as morphological analyses at light microscopical level. Improvement in mobility and skin quality were demonstrated along with graft contraction, in all patients. The double layer template showed the best performance in retraction rate, skin quality and mobility recovery. The subepidermal newly-formed connective tissue showed no histoarchitectural differences between the templates. The double layer template was not absorbed up to 12 months after placement.

Topics: Adolescent; Adult; Burns; Chondroitin Sulfates; Cicatrix; Collagen; Contracture; Elastin; Female; Guided Tissue Regeneration; Humans; Longitudinal Studies; Male; Middle Aged; Negative-Pressure Wound Therapy; Plastic Surgery Procedures; Postoperative Complications; Skin; Skin Transplantation; Transplantation, Autologous; Young Adult

The quality of resulting scar tissue plays an important role in patients return to normal life and full functioning in society. The use of artificial skin substitutes in clinical practice improves functional and cosmetic outcomes. This is true for any patient, and not only those suffering from burns.. The collagen elastin dermal substitute Matriderm® allows for immediate application of a dermal substitute together with a skin graft. The authors present a group of 10 patients representing their first experience in utilizing Matriderm® as a dermal substitute in the treatment of skin losses due to various etiologies.. The average healing time in the group was 19.6 days. Healing took place without serious infectious complications and with good functional results.. Matriderm® can be utilized as an alternative to the most commonly used dermal substitute so far, Integra®, in the treatment of acute skin loss due to various etiologies and in reconstructive surgery.

Topics: Burn Units; Burns; Collagen; Elastin; Humans; Skin Transplantation; Skin, Artificial

The use of split-thickness skin autografts (STSA) with dermal substitutes is the gold standard treatment for third-degree burn patients. In this article, we tested whether cryopreserved amniotic membranes could be beneficial to the current treatments for full-thickness burns. Swines were subjected to standardised full-thickness burn injuries, and then were randomly assigned to treatments: (a) STSA alone; (b) STSA associated with the dermal substitute, Matriderm; (c) STSA plus human amniotic membrane (HAM); and (d) STSA associated with Matriderm plus HAM. Clinical and histological assessments were performed over time. We also reported the clinical use of HAM in one patient. The addition of HAM to classic treatments reduced scar contraction. In the presence of HAM, skin wound healing displayed high elasticity and histological examination showed a dense network of long elastic fibres. The presence of HAM increased dermal neovascularization, but no effect was observed on the recruitment of inflammatory cells to the wound. Moreover, the use of HAM with classical treatments in one human patient revealed a clear benefit in terms of elasticity. These results give initial evidence to consider the clinical application of HAM to avoid post-burn contractures and therefore facilitate functional recovery after deep burn injury.

Topics: Adult; Amnion; Animals; Burns; Cicatrix; Collagen; Cryopreservation; Dermis; Elasticity; Elastin; Fibroblasts; Humans; Male; Models, Animal; Neovascularization, Physiologic; Skin, Artificial; Swine; Wound Healing

The consequences of deep burns to the hands and face are the most challenging we encounter in modern reconstructive surgery. In many cases, the simple autotransplantation of full-thickness defects with split-thickness skin grafts is now considered inadequate or outdated. For this and many other reasons, the use of dermal substitution is on the rise as it provides improved cosmetic effects and skin compliance, reduces contractility and greatly approximates the histological image to normal, healthy skin. For the purpose of this article, we present a dermal substitution, Matriderm ® , in the case of extensive thermal trauma in a 6-year-old boy. Key words:dermal substitution, burns, Matriderm ® , cutometry.

Topics: Administration, Topical; Burns; Child; Collagen; Elasticity; Elastin; Humans; Male; Skin, Artificial

Extensive burn may cause acute resistance to insulin, which accentuates hypermetabolism, impairs glucose metabolism, immune dysfunction and risks of sepsis. To minimize these effects, insulin is used as a treatment. The purpose was to analyze the collagen-elastic arrangement effects of insulin on the burned skin. Wistar rats were assigned in groups: control (C); control with insulin (C + I); scald burn injury (SBI); and SBI with insulin (SBI+ I). SBI were submitted to 45% total body surface area burn and the insulin-treated groups received insulin (5 UI/Kg/day) for 4 or 14 days (d). Insulin levels, glucose tolerance test and HOMA index were determined. The skin sections were analyzed for histophatological and morphoquantitative data. Histopathological findings showed increased reepithelization of SBI+ I and formation of a new muscle layer after 14 days. In the collagen-elastic arrangement, insulin for 4 days increased the volume fraction (Vv) of thin collagen and elastic fibers. After 14 days, independently of injury, insulin decreased the elastic fibers. Insulin was able to reverse damages in the collagen-elastic rearrangement and stimulate reepithelization after 4 days. Untreated scald-burned animals showed higher Vv of thick collagen after 4 days, while those treated had a higher Vv of thin collagen. The Vv of elastic fibers was increased in SBI+ I for 4 days. In conclusion, insulin treatment was able to stimulate reepithelization. It also reversed the damages to the collagen-elastic arrangement in the scald-burned group, improving the organization of thin collagen and increasing the Vv of elastic fibers in the injured group treated with insulin for a short time, that is, for 4 days.

Topics: Animals; Area Under Curve; Body Weight; Burns; Collagen; Drinking Behavior; Elastin; Feeding Behavior; Glucose; Insulin; Male; Rats, Wistar; Re-Epithelialization; Skin

Facial burns remain a complex reconstructive challenge. Achieving the plastic surgical goals of restoring form and function is difficult in these cases, with poor cosmetic results, reduced facial animation, and oral and ocular contractures a common result. In recent years, the use of dermal substitutes in combination with skin grafts has shown promising results in complex burn reconstruction. A 3-year-old girl was admitted to our pediatric tertiary referral center with 60% TBSA full-thickness burns, involving all skin above the waist including the face and neck. She underwent staged debridement of burnt tissue and temporary coverage with cadaveric skin over a 2-week period. Facial reconstruction was achieved by placement of Matriderm acellular dermal matrix covered with sheet split skin grafts, both in aesthetic subunits, at 2 weeks post-burn. Graft take on day 5 was 95%, with the small area of loss successfully regrafted. Twelve-month follow-up demonstrates great aesthetic results in terms of texture and color, as well as normal ocular and near-normal oral function. Use of Matriderm beneath split skin grafts demonstrates promising results for both aesthetic outcome and functional skin movement in burn reconstruction. Our results provide early evidence in favor of this new technique in full-thickness facial burns in pediatric patients.

Topics: Burns; Child, Preschool; Collagen; Debridement; Elastin; Esthetics; Facial Injuries; Female; Humans; Plastic Surgery Procedures; Skin Transplantation

The effect of the "Patient and Observer Scar Assessment Scale" (POSAS) and "Vancouver Scar Scale" (VSS) on patients' quality of life and their correlation with objective scar assessment tools, such as the Cutometer®, is not fully elucidated. In addition, long-term results of the dermal substitute Matriderm® used in combination with split-thickness skin grafting (STSG) remain unclear. We evaluated burn scars of 45 patients at least 2 years postburn injury using the Cutometer® MPA 580, the VSS, and the POSAS with three additional questions regarding quality of life and correlated the results. Study groups were: 1) scars following conservative treatment, 2) scars following STSG, and 3) scars following STSG in combination with Matriderm®. Cutometer® measurements demonstrated better elastic qualities in the Matriderm® group compared with the STSG group. VSS and extended POSAS were rated best for the conservative group, followed by the STSG group and the Matriderm® group. There was a significant correlation between POSAS and VSS, quality of life and the objective Cutometer® measurements. Conservatively treated superficial dermal burns do not reach the elastic qualities of healthy skin, and the use of Matriderm® significantly improves the long-term elastic qualities of STSG in deep dermal and full-thickness burns 2 years post injury. Results from the VSS and the POSAS correlate with restrictions in the quality of life of patients and also with objective Cutometer® measurements and are therefore useful tools in scar evaluation following burn injury.

Topics: Adult; Aged; Aged, 80 and over; Burns; Cicatrix; Collagen; Elastin; Female; Humans; Male; Middle Aged; Quality of Life

An enzyme mixture containing bromelain (NexoBrid®) was found to be suitable for enzymatic debridement of burn wounds, as determined by the criteria of patient comfort and pain, selectivity, and efficiency. Nevertheless, daily experience showed that pretreatment of burn wounds with several other clinical agents may inhibit debridement efficiency. Therefore, the current study was performed to identify those agents and evaluate their debridement inhibition capabilities. The impact of several common agents as well pH, on NexoBrid® debridement efficiency was evaluated in vitro. A collagen-based dermal substitute (MatriDerm®) was exposed to NexoBrid® in the presence of different agents of varying concentrations. Digestion was documented. The criteria used for judging digestion were independently classified by 3 investigators at least 3 times in succession. When a low concentration (1.0 mg/ml) of NexoBrid® was used, a ≥ 50% concentration of Prontosan® had an impact on enzymatic activity. Comparable results were obtained when even lower concentrations of Octenisept® (≥ 10%) were used. A 100-µmol/L concentration of copper inhibited the enzymatic activity of both a low (1.0 mg/ml) and high (10 mg/ml) concentration of NexoBrid®. Silver-sulfadiazine at concentrations of 10% and 90% inhibited the activity of 1 mg/ml NexoBrid®. No complete inhibition of NexoBrid® activity occurred at any concentration of iron. We recommend using polyhexanide-containing agents (Prontosan®) to rinse and presoak burn wounds. Pretreatment of burn wounds with agents containing silver and copper should be avoided. Experimentally, we found a partial inhibition of NexoBrid® activity at the distinct pH values of 3 and 11.

Topics: Anti-Infective Agents, Local; Betaine; Biguanides; Bromelains; Burns; Collagen; Debridement; Elastin; Ethanolamines; Imines; Pyridines; Skin, Artificial; Undecylenic Acids

This study investigated the recovery process during which grafted cultured epithelium generated skin elasticity and skin surface microarchitecture. The subjects were 18 patients whose burn scars were excised at a depth not exposing the fat layer and who subsequently received cultured epithelial autografts. A total of 24 samples were obtained from the grafted sites: 6 samples within 6 weeks (stage 1), 5 samples after 6 weeks and within 6 months (stage 2), 6 samples after 6 months and within 18 months (stage 3) and 7 samples beyond 18 months (stage 4) of transplantation. These samples were evaluated by taking replicas of skin surface, and histological changes of fibrillin-1 and elastin. The expression patterns were classified using a grading scale. The grade of skin surface texture was significantly higher at stage 3 and marginally significantly higher at stage 4 compared with stage 1. The grade of fibrillin-1 was marginally significantly higher at stage 3 and significantly higher at stage 4 compared with stage 1. The grade of elastin was marginally significantly higher at stage 4 compared with stage 1. These results showed that it is important for patients to have skin care and avoid external forces for at least 18 months after transplantation.

Topics: Adolescent; Adult; Aged; Burns; Cells, Cultured; Cicatrix; Elasticity; Elastin; Epithelium; Female; Fibrillin-1; Humans; Male; Middle Aged; Skin; Transplantation, Autologous; Treatment Outcome; Wound Healing; Young Adult

Cutaneous burns are often exacerbated by poor perfusion and subsequent necrosis of the microvasculature surrounding the primary injury. Preservation of these vessels can reduce necrotic tissue expansion and increase success rates of skin graft procedures. Recent work has identified a peptide derived from erythropoietin, ARA290, with the ability to mediate tissue protection in a variety of cell types. Here we demonstrate the advantages of fusing ARA290 to an elastin-like polypeptide (ELP) to salvage microvascular endothelial cells in harsh proteolytic conditions following thermal shock. These fusion proteins were expressed recombinantly in bacterial hosts and rapidly purified by inverse transition cycling. They were shown to spontaneously aggregate into particles at subphysiological temperatures. The bifunctional submicron particles were resistant to digestion in enzymes upregulated after burn injury. Furthermore, the data strongly suggest these ARA290-functionalized particles were superior to treatment with the peptide alone in preventing microvascular cell death in these conditions. The results bring to light an efficient and cost-effective strategy for the delivery therapeutic peptides to proteolytically active wound sites.

Topics: Biopolymers; Burns; Cell Line; Cell Survival; Elastin; Erythropoietin; Escherichia coli; Hot Temperature; Humans; Microvessels; Oligopeptides; Proteolysis; Recombinant Fusion Proteins; Skin; Wound Healing

Topics: Accidents, Traffic; Adult; Aged, 80 and over; Burns; Cellulitis; Chondroitin Sulfates; Collagen; Debridement; Diabetic Foot; Elastin; Female; Foot Injuries; Humans; Leg Injuries; Male; Middle Aged; Necrosis; Skin, Artificial

Skin grafts with an artificial dermis have been widely used as a part of the efforts to minimize contractures and reduce donor-site scars. We conducted a prospective randomized clinical trial to study the effect of a dermal substitute by measuring the size of the graft after surgery for months.. The artificial dermis (Matriderm, Dr. Suwelack Skin and Health Care AG, Billerbeck, Germany) was applied in combination with a split-thickness autograft in 40 patients with acute burn wounds or scar reconstruction. Demographic and medical data were collected on each patient. We directly measured the graft size by using a transparent two-ply film (Visitrak Grid, Smith & Nephew Wound Management, Inc, Largo, FL, USA) intraoperatively and 1, 2, 3, and 6 months postoperatively. For effective data comparison, the size of the graft at the time of surgery was taken to be "100%." Then, the size in each phase was estimated in percentage (%).. During the 1st month, the average size was 89%. The figure decreased to 86% and 82% in the 2nd and 3rd months, respectively. In the 6th month, it slightly rebounded to 85% but failed to return to the original state. The size of patients with acute burns was smaller than the size of scar patients as follows: 85-91% in the 2nd month, 81-87% in the 3rd month, and 85-96% in the 6th month.. This study examined the progress of skin grafts through the measurement of graft size in the human body. The grafted skin underwent contracture and remodeling for 3-6 months. In terms of skin contraction, an acute burn was more serious than scar reconstruction. The use of an artificial dermis that contains elastin is very effective from the functional and esthetic perspective by minimizing contractures and enhancing skin elasticity.

Topics: Adolescent; Adult; Burns; Child; Child, Preschool; Cicatrix; Collagen; Contracture; Elastin; Female; Humans; Infant; Male; Middle Aged; Organ Size; Postoperative Complications; Skin; Skin Transplantation; Skin, Artificial; Treatment Outcome; Young Adult

Tissue engineering plays an important role in the production of skin equivalents for the therapy of chronic and especially burn wounds. Actually, there exists no (cellularized) skin equivalent which might be able to satisfactorily mimic native skin. Here, we utilized a laser-assisted bioprinting (LaBP) technique to create a fully cellularized skin substitute. The unique feature of LaBP is the possibility to position different cell types in an exact three-dimensional (3D) spatial pattern. For the creation of the skin substitutes, we positioned fibroblasts and keratinocytes on top of a stabilizing matrix (Matriderm®). These skin constructs were subsequently tested in vivo, employing the dorsal skin fold chamber in nude mice. The transplants were placed into full-thickness skin wounds and were fully connected to the surrounding tissue when explanted after 11 days. The printed keratinocytes formed a multi-layered epidermis with beginning differentiation and stratum corneum. Proliferation of the keratinocytes was mainly detected in the suprabasal layers. In vitro controls, which were cultivated at the air-liquid-interface, also exhibited proliferative cells, but they were rather located in the whole epidermis. E-cadherin as a hint for adherens junctions and therefore tissue formation could be found in the epidermis in vivo as well as in vitro. In both conditions, the printed fibroblasts partly stayed on top of the underlying Matriderm® where they produced collagen, while part of them migrated into the Matriderm®. In the mice, some blood vessels could be found to grow from the wound bed and the wound edges in direction of the printed cells. In conclusion, we could show the successful 3D printing of a cell construct via LaBP and the subsequent tissue formation in vivo. These findings represent the prerequisite for the creation of a complex tissue like skin, consisting of different cell types in an intricate 3D pattern.

Topics: Animals; Biomarkers; Bioprinting; Burns; Cadherins; Cell Proliferation; Cells, Cultured; Collagen; Elastin; Fibroblasts; Keratinocytes; Lasers; Mice; Mice, Nude; Neovascularization, Physiologic; Skin; Skin, Artificial; Tissue Engineering; Wound Healing

Silk fibroin (SF) and elastin (EL) scaffolds were successfully produced for the first time for the treatment of burn wounds. The self-assembly properties of SF, together with the excellent chemical and mechanical stability and biocompatibility, were combined with elastin protein to produce scaffolds with the ability to mimic the extracellular matrix (ECM). Porous scaffolds were obtained by lyophilization and were further crosslinked with genipin (GE). Genipin crosslinking induces the conformational transition from random coil to β-sheet of SF chains, yielding scaffolds with smaller pore size and reduced swelling ratios, degradation and release rates. All results indicated that the composition of the scaffolds had a significant effect on their physical properties, and that can easily be tuned to obtain scaffolds suitable for biological applications. Wound healing was assessed through the use of human full-thickness skin equivalents (EpidermFT). Standardized burn wounds were induced by a cautery and the best re-epithelialization and the fastest wound closure was obtained in wounds treated with 50SF scaffolds; these contain the highest amount of elastin after 6 days of healing in comparison with other dressings and controls. The cytocompatibility demonstrated with human skin fibroblasts together with the healing improvement make these SF/EL scaffolds suitable for wound dressing applications.

Topics: Animals; Bandages; Bombyx; Burns; Calorimetry, Differential Scanning; Cattle; Cell Death; Cell Line; Cell Survival; Cross-Linking Reagents; Culture Media, Conditioned; DNA; Elastin; Fibroblasts; Fibroins; Gentamicins; Humans; Hydrogen-Ion Concentration; Kinetics; Microscopy, Electron, Scanning; Spectroscopy, Fourier Transform Infrared; Sus scrofa; Tissue Scaffolds; Wound Healing

Reconstruction of full-thickness defects may benefit from integration of dermal substitutes, which serve as a foundation for split-thickness skin grafts, thus enhancing short and long-term results. We present a series of 7 patients who were treated between 2010 and 2012 for complicated full-thickness defects by the second-generation collagen/elastin matrix Matriderm® covered by a split-thickness skin graft. The defects resulted from malignancy resection, trauma, and post-burn scar reconstruction. Overall graft take was excellent and no complications were noted regarding the dermal substitute. Graft quality was close to normal skin in terms of elasticity, pliability, texture, and color. Good contour and cushioning of defects in weight bearing areas was also achieved. Matriderm was found to be a useful adjunct to full-thickness defect reconstruction, especially in difficult areas where the desired result is a scar of the highest quality possible.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Animals; Burns; Cattle; Cicatrix; Collagen; Elasticity; Elastin; Face; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neoplasms; Plastic Surgery Procedures; Skin Transplantation; Skin, Artificial; Treatment Outcome; Wounds and Injuries; Young Adult

High-resolution, high-contrast, three-dimensional images of live cell and tissue architecture can be obtained using second harmonic generation (SHG), which comprises non-absorptive frequency changes in an excitation laser line. SHG does not require any exogenous antibody or fluorophore labeling, and can generate images from unstained sections of several key endogenous biomolecules, in a wide variety of species and from different types of processed tissue. Here, we examined normal control human skin sections and human burn scar tissues using SHG on a multi-photon microscope (MPM). Examination and comparison of normal human skin and burn scar tissue demonstrated a clear arrangement of fibers in the dermis, similar to dermal collagen fiber signals. Fluorescence-staining confirmed the MPM-SHG collagen colocalization with antibody staining for dermal collagen type-I but not fibronectin or elastin. Furthermore, we were able to detect collagen MPM-SHG signal in human frozen sections as well as in unstained paraffin embedded tissue sections that were then compared with hematoxylin and eosin staining in the identical sections. This same approach was also successful in localizing collagen in porcine and ovine skin samples, and may be particularly important when species-specific antibodies may not be available. Collectively, our results demonstrate that MPM SHG-detection is a useful tool for high resolution examination of collagen architecture in both normal and wounded human, porcine and ovine dermal tissue.

Topics: Animals; Burns; Child; Cicatrix; Collagen Type I; Elastin; Epidermis; Female; Fetus; Fibronectins; Humans; Microscopy, Fluorescence, Multiphoton; Sheep; Swine

The gold standard for the coverage of full-thickness skin defects is autologous skin grafts. However, poor skin quality and scar contracture are well-known problems in functional, highly strained regions. The use of dermal substitutes is an appropriate way to minimise scar contraction and, thereby, to optimise the quality of the reconstructed skin. The aim of this study was to evaluate the impact of the collagen-elastin matrix, Matriderm, for the single-step reconstruction of joint-associated defects of the upper extremity. Seventeen patients with full-thickness skin defects of the upper extremity were treated with the dermal substitute, Matriderm, and unmeshed skin graft in the functional critical region of the distal upper extremity in a single-step procedure. The take rate of the matrix-and-skin graft was 96%. Long-term follow-up revealed an overall Vancouver scar scale of 1.7. No limitation concerning hand function was observed; DASH-score analysis revealed excellent hand function in patients with burn injury and patients with a defect due to the harvest of a radial forearm flap achieved satisfying hand function. This matrix represents a viable alternative to other types of defect coverage and should therefore be considered in the treatment of skin injuries, especially in very delicate regions such as the joint regions. The possibility of performing a one-stage procedure is supposed to be a major advantage in comparison to a two-stage procedure.

Topics: Burns; Collagen; Elastin; Female; Hand Injuries; Humans; Male; Middle Aged; Plastic Surgery Procedures; Skin, Artificial; Surgical Flaps; Treatment Outcome; Vacuum; Wrist Injuries

Topics: Achilles Tendon; Adult; Bandages; Burns; Collagen; Debridement; Elastin; Humans; Male; Skin Transplantation

Topics: Achilles Tendon; Burns; Collagen; Debridement; Elastin; Humans; Skin, Artificial; Wound Healing

This study aims to evaluate percutaneous collagen induction (PCI) in post-burn scarring.. Patients with scarring after burn frequently request help in improving the aesthetic appearance of their residual cicatricial deformity. Their scars are generally treated by tissue transfer, W- and Z-plasties, flaps, cortisone injections or ablative procedures that injure or destroy the epidermis and its basement membrane and subsequently lead to fibrosis of the papillary dermis. The ideal treatment would be to preserve the epidermis and promote normal collagen and elastin formation in the dermis.. A total of 16 consecutive patients (average age: 37+/-15.5 years, average body mass index (BMI): 25.7) in Germany with post-burn scarring.. PCI using the Medical Roll-CIT (Vivida, Cape Town, South Africa). This device was designed to multiply-puncture the skin to the level of the dermal scar to institute remodelling. Patients were prepared with topical vitamin A and C cosmetic creams for a minimum of 4 weeks preoperatively to maximise collagen stimulation.. The outcome was measured rating (visual analogue scale (VAS) and Vancouver Scar Scale (VSS)), histological specimen 12 months after intervention.. On average, patients rated their improvement as a mean of 80% better (+/-15.5) than before treatment. Histologic examination revealed considerable increase in collagen and elastin deposition 12 months postoperatively. The epidermis demonstrated 45% thickening of stratum spinosum and normal rete ridges as well as the normalisation of the collagen/elastin matrix in the reticular dermis at 1 year postoperatively.. This pilot study shows that PCI appears to be a safe method for treating post-burn scarring without destroying the epidermis. The procedure can be repeated safely and is also applicable in regions where laser treatments and deep peels are of limited use. However, it is necessary to initiate an efficacy trial to prove the data of this pilot study.

Topics: Administration, Topical; Adult; Ascorbic Acid; Burns; Cicatrix; Cohort Studies; Collagen; Elastin; Epidermis; Female; Humans; Male; Middle Aged; Pain Measurement; Patient Satisfaction; Pilot Projects; Preoperative Care; Punctures; Vitamin A

Topics: Burns; Collagen; Elastin; Face; Facial Expression; Female; Humans; Skin Transplantation; Skin, Artificial; Transplantation, Autologous; Young Adult

The effect of cold low-pressure plasma treatment on neovascularization of a dermis substitute was evaluated in a mouse model.. Collagen-elastin matrices (Matriderm(®)) were used as scaffolds. Low-pressure argon/hydrogene plasma-treated scaffolds were transplanted into the dorsal skinfold chambers of balb/c mice (group 1, n=10). Untreated scaffolds served as controls (group 2, n=10). Intravital fluorescence microscopy was performed within the border zone of the scaffolds on days 1, 5 and 10. Functional vessel density (FVD), vessel diameter, intervascular distance, microvascular permeability, and leukocyte-endothelium interaction were analyzed.. An increase of FVD associated with a reduction of the intervascular distance was observed. Statistical analysis revealed that the functional vessel density in the border zone of the scaffolds was significantly enhanced in the plasma-treated group compared to controls. For group 1, an increase of FVD from 282±8 cm/cm(2) on days 5 to 315±8 cm/cm(2) on day 10 was observed. Whereas values of 254±7 cm/cm(2) on day 5 and 275±13 cm/cm(2) on day 10 have resulted in group 2 (mean±S.E.M., Student's t-test, p<0.05).. The surface treatment by cold low-pressure plasma intensifies the angiogenesis and accelerates the neovascularization of collagen-elastin matrix.

Topics: Animals; Biocompatible Materials; Burns; Collagen; Disease Models, Animal; Elastin; Mice; Neovascularization, Physiologic; Pressure; Skin; Skin, Artificial; Tissue Engineering; Tissue Scaffolds

Dermal substitutes are used increasingly in deep partial and full-thickness burn wounds in order to enhance elasticity and pliability. In particular, the dorsum of the hand is an area requiring extraordinary mobility for full range of motion. The aim of this comparative study was to evaluate intra-individual outcomes among patients with full-thickness burns of the dorsum of both hands. One hand was treated with split-thickness skin grafts (STSG) alone, and the other with the dermal substitute Matriderm(®) and split-thickness skin grafts.. In this study 36 burn wounds of the complete dorsum of both hands in 18 patients with severe burns (age 45.1±17.4 years, 43.8±11.8% TBSA) were treated with the simultaneous application of Matriderm(®), a bovine based collagen I, III, V and elastin-hydrolysate based dermal substitute, and split-thickness skin grafting (STSG) in the form of sheets on one hand, and STSG in the form of sheets alone on the other hand. The study was designed as a prospective comparative study. Using both objective and subjective assessments, data were collected at one week and 6 months after surgery. The following parameters were included: After one week all wounds were assessed for autograft survival. Skin quality was measured 6 months postoperatively using the Vancouver Burn Skin Score (VBSS). Range of motion was measured by Finger-Tip-Palmar-Crease-Distance (FPD) and Finger-Nail-Table-Distance (FNTD).. Autograft survival was not altered by simultaneous application of the dermal matrix (p>0.05). The VBSS demonstrated a significant increase in skin quality in the group with dermal substitutes (p=0.02) compared to the control group with non-substituted wounds. Range of motion was significantly improved in the group treated with the dermal substitute (p=0.04).. From our results it can be concluded that simultaneous use of Matriderm(®) and STSG is safe and feasible, leading to significantly better results in respect to skin quality of the dorsum of the hand and range of motion of the fingers. Skin elasticity was significantly improved by the collagen/elastin dermal substitute in combination with sheet-autografts.

Topics: Adult; Burns; Collagen; Elastin; Female; Graft Survival; Hand Injuries; Humans; Male; Middle Aged; Prospective Studies; Range of Motion, Articular; Skin; Skin Transplantation; Wound Healing

Restoring function after hand burns is still a great surgical challenge. Reconstitution of elasticity and pliability are of utmost importance for hand function and aesthetics results. Dermal substitutes have been developed and have been used for many years. The dermal substitute Matriderm® is an acellular three-dimensional matrix composed of native structurally intact collagen fibrils coated with elastin obtained from bovine dermis. The possibility of a one-stage procedure is profitable in treatment of hand burns. The authors report the case of a 43-year-old man admitted for severe burn by flames to 18% of his total body surface area with complete full thickness injury of left hand. After debridement incisions in emergency, early excision and skin graft using Matriderm® were performed. Physical therapy was established at Day 10. At six weeks follow-up, full range of motion was achieved and the patient was able to use his hand in daily activities.

Topics: Adult; Burns; Collagen; Elastin; Hand Injuries; Humans; Injury Severity Score; Male; Skin, Artificial

A cell-based wound coverage with keratinocytes and fibroblasts on the basis of a commercially available dermal substitute (Matriderm ((R)), Kollagen/Elastin matrix) was generated, in order to treat wide burn wounds. First the expansion of keratinocytes was optimised and the culturing time was minimised. Raw material was 1-2 cm (2) split skin. Dermis and epidermis were separated by enzymatic treatment with thermolysin. After treatment of both compartments with trypsin and collagenase I, keratinocytes and fibroblasts were isolated and expanded in collagen I coated dishes. After 10 days fibroblasts were seeded on Matriderm ((R)). After cultivation of the fibroblasts-containing matrix for one week keratinocytes were seeded on top. After an additional week of submersed cultivation the matrix was lifted up to the air-liquid interface to initiate epidermal cell differentiation. After 16 days in the air-liquid interphase the matrix was fixed and underwent immunohistochemical and electron microscopic analysis. Histological analysis showed a regularly stratification of the epidermal part. We observed collagen IV, a marker for the basement membrane, between epidermis and dermis. Desmoglein and the differentiation markers involucrine and cytokeratin 10 were found in the suprabasal layers of the epidermis. Electron microscopic analysis showed the basement membrane in the epidermal junction zone as well as cell-cell connections in the form of desmosomes. Late differentiation characteristics, like granular structures and the cornified layer, were found in the stratum granulosum and stratum corneum. Our results demonstrate that a skin equivalent can be generated by using a collagen/elastin matrix, with an expansion rate of 50-100-fold. This skin equivalent may be useful for covering deep wounds.

Topics: Basement Membrane; Burns; Collagen; Collagen Type IV; Desmogleins; Elastin; Epidermis; Fibroblasts; Humans; Keratinocytes; Microscopy, Electron; Microscopy, Fluorescence; Protein Precursors; Skin; Skin, Artificial; Tissue Engineering

Restoring function after hand burns plays a major role in the restitution of a quality of life. Thereby the reconstructed pliability of the grafted areas is of utmost importance for good hand function. The collagen elastin matrix Matriderm was evaluated as a dermal substitute for the treatment of severe hand burns. In a series of 10 patients, mean age 43 years, TBSA 22.8%, an early debridement and immediate grafting with the matrix and unmeshed skin graft was carried out in a one-stage procedure. In the early postoperative follow up an overall take rate of 97% was observed. In contrast to conventional skin grafts, the color of the skin grafts over the matrix appeared pale in the first few days, but after 2 weeks no difference was observed. After three months, pliability of the grafted area was excellent, (mean VSS 3.2+/-1.2). Full range of motion was achieved in all hands, no blisters and no unstable or hypertrophic scars occurred. Matriderm has proved to be a dermal substitute suitable for the treatment of hand burns. We therefore consider Matriderm as a promising dermal substitute for the treatment of severe hand burns.

Topics: Adult; Burns; Collagen; Elastin; Female; Graft Survival; Hand Injuries; Humans; Male; Middle Aged; Skin, Artificial; Treatment Outcome

The best alternative to a split-thickness graft for the wound coverage of patients with extensive burns should be in vitro reconstructed autologous skin made of both dermis and epidermis and devoid of exogenous extracellular matrix proteins and synthetic material. We have designed such a reconstructed human skin (rHS) and present here its first in vivo grafting on athymic mice.. The rHS was made by culturing newborn or adult keratinocytes on superimposed fibrous sheets obtained after culturing human fibroblasts with ascorbic acid. Ten days after keratinocyte seeding, reconstructed skins were either cultured at the air-liquid interface or grafted on athymic mice. We present the macroscopic, histologic, and phenotypic properties of such tissues in vitro and in vivo after grafting on nude mice.. After maturation in vitro, the reconstructed skin exhibited a well-developed human epidermis that expressed differentiated markers and basement membrane proteins. Four days after grafting, a complete take of all grafts was obtained. Histological analysis revealed that the newly generated epidermis of newborn rHS was thicker than that of adult rHS after 4 days but similar 21 days after grafting. The basement membrane components (bullous pemphigoid antigens, laminin, and type IV and VII collagens) were detected at the dermo-epidermal junction, showing a continuous line 4 days after grafting. Ultrastructural studies revealed that the basement membrane was continuous and well organized 21 days after transplantation. The macroscopic aspect of the reconstructed skin revealed a resistant, supple, and elastic tissue. Elastin staining and elastic fibers were detected as a complex network in the rHS that contributes to the good elasticity of this new reconstructed tissue.. This new rHS model gives supple and easy to handle skins while demonstrating an adequate wound healing on mice. These results are promising for the development of this skin substitute for permanent coverage of burn wounds.

Topics: Animals; Animals, Newborn; Basement Membrane; Burns; Cells, Cultured; Collagen; Dermis; Elasticity; Elastin; Epidermal Cells; Graft Survival; Humans; In Vitro Techniques; Keratinocytes; Mice; Mice, Nude; Microscopy, Electron; Skin Transplantation; Stress, Mechanical; Transplantation, Heterologous; Wound Healing

Urinary excretion of total desmosine was measured by a radioimmunoassay in severely burned adult males, as well as in normal adult males. Total urinary desmosine was significantly elevated in all the samples in the burned patients, who had injuries involving more than 19% of total body surface area. The values of 24-hr urinary desmosine for the burned patients ranged from 250--1,411 nmoles, as compared with 82--142 nmoles for normal controls. These were equivalent to 14--78 mg of elastin degraded for the burned patients and 5--8 mg for normal controls. Urinary desmosine values expressed as nmoles per g of creatinine were also higher than the corresponding normal values, ranging from 110--768 nmoles versus 63 +/- 6 nmoles for normal controls. Urinary excretion of total hydroxyproline in the burned patients was also higher than in normal controls, ranging from 56--471 mg per 24 hrs, or 36 to 413 mg per g of creatinine, vs. 31 +/- 6 mg per 24 hr, or 23 +/- 2 mg per g of creatinine, in burned patients and normal controls, respectively. These values of hydroxyproline were equivalent to 413--3,623 mg of collagen and 238 mg of collagen, respectively. In the burned patients, both urinary desmosine and hydroxyproline values were elevated from day 1 post-burn, and reached peak levels in days 2--12, declining thereafter but remaining higher than values for normal controls through day 60. The metabolism of elastin and collagen in skin of burned patients was probably highly accelerated for a long time, at least through day 60 post-burn.

Topics: Adult; Aged; Amino Acids; Burns; Desmosine; Elastin; Humans; Hydroxyproline; Kinetics; Male; Middle Aged

Topics: Animals; Burns; Cell Membrane; Cell Nucleus; Collagen; Cytoplasm; Cytoplasmic Granules; Elastic Tissue; Elastin; Fibroblasts; Glycosaminoglycans; Guinea Pigs; Microscopy, Electron; Mitochondria; Skin; Staining and Labeling; Thoracic Injuries; Time Factors; Wound Healing

Topics: Acrylic Resins; Animals; Burns; Cattle; Collagen; Connective Tissue; Elastin; Evaluation Studies as Topic; Humans; Mice; Occlusive Dressings; Rabbits; Skin Transplantation; Swine; Tissue Adhesives; Transplantation, Heterologous; Wounds and Injuries