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Experimental and Clinical Advances in Skin Grafting
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Experimental and Clinical Advances in Skin Grafting

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Plastic, Reconstructive and Aesthetic Surgery/Aesthetic Medicine".

Deadline for manuscript submissions: 10 August 2024 | Viewed by 10379

Special Issue Editor

Prof. Dr. Pietro G. Di Summa

E-Mail Website
Guest Editor
Associate Professor, Department of Plastic, Reconstructive and Hand Surgery, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
Interests: breast microsurgery; plastic and reconstructive surgery; aesthetic surgery; nerve regeneration; stem-cell research; tissue engineering
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Skin grafting is one of the oldest and most effective ways to treat soft-tissue defects.

In clinical practice, different external factors may lead to surface soft tissue loss, ranging from trauma to chronic ulcers, from oncologic resections to surgical debridements due to infection or burn.

Even if skin grafting needs a healthy vascularised bed to guarantee its take, in the last few years we have observed a constant improvement in skin repair and regeneration techniques.

Dermal substitutes represent a strong novelty, able to improve the wound-healing process, decreasing scarring and allowing skin grafting on previously “off-limits” structures (e.g., tendons), with an increased use even in complex lower limb trauma.

Burn surgery, where skin grafting is the surgical core, has been revolutionised by tissue engineering innovations, using cell therapy to improve skin graft take or even avoiding its use.

Clinical and preclinical research have also seen the raise of xenografts. Animal-derived skin is finding new indications, from chronic ulcers to burns.

This Special Issue aims to highlight both basic science and clinical advancements in one of the most common, but at the same absolutely critical, procedures in plastic surgery, that is, skin grafting.

Prof. Dr. Pietro G. Di Summa
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • skin graft
  • burns
  • chronic ulcers
  • dermal substitute
  • tissue engineering
  • regenerative cell therapy
  • wound healing

Published Papers (7 papers)

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Editorial

Jump to: Research, Review, Other

3 pages, 190 KiB  
Editorial
Special Issue “Experimental and Clinical Advances in Skin Grafting”
by Joachim N. Meuli and Pietro G. di Summa
J. Clin. Med. 2023, 12(10), 3540; https://doi.org/10.3390/jcm12103540 - 18 May 2023
Viewed by 879
Abstract
Skin grafting is one of the oldest ways to treat soft-tissue defects [...] Full article
(This article belongs to the Special Issue Experimental and Clinical Advances in Skin Grafting)

Research

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19 pages, 8052 KiB  
Article
The Use of Fish Skin Grafts in Children as a New Treatment of Deep Dermal Burns—Case Series with Follow-Up after 2 Years and Measurement of Elasticity as an Objective Scar Evaluation
by Raphael Staubach, Helen Glosse and Steffan Loff
J. Clin. Med. 2024, 13(8), 2389; https://doi.org/10.3390/jcm13082389 - 19 Apr 2024
Viewed by 434
Abstract
Background: Wound healing in deep dermal burn injuries continues to be a challenge in paediatrics. In the absence quick and spontaneous wound closure, split-thickness skin grafting is often necessary. Since the development of a new type of acellular fish matrix, which is very [...] Read more.
Background: Wound healing in deep dermal burn injuries continues to be a challenge in paediatrics. In the absence quick and spontaneous wound closure, split-thickness skin grafting is often necessary. Since the development of a new type of acellular fish matrix, which is very similar to the human skin matrix, skin closure and wound conditioning can be achieved without split-thickness skin grafting. Methods: The following study shows a case series of 20 children in whom a fish skin graft was used. The aim was to develop an algorithm for selecting and using fish skin and its long-term results after one and two years. Acellular fish skin worked as a granulation base for wound healing and also as a substitute for split-thickness skin grafts. Results: There was no evidence of infection. Skin transplants and, thus, additional operations could be avoided. The follow-up examinations showed an excellent result, both objectively by means of elasticity measurements (DermalabCombo®) and in the subjective assessment of the skin as part of the Patient and Observer Scar Assessment Scale (POSAS). Conclusion: Fish skin grafts are a good alternative to split-thickness skin grafts for deep dermal wounds. These results should be further analysed with a larger number of patients in future publications. Full article
(This article belongs to the Special Issue Experimental and Clinical Advances in Skin Grafting)
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16 pages, 3839 KiB  
Article
FastSkin® Concept: A Novel Treatment for Complex Acute and Chronic Wound Management
by Pietro G. di Summa, Nicola Di Marzio, Paris Jafari, Marisa E. Jaconi and Dobrila Nesic
J. Clin. Med. 2023, 12(20), 6564; https://doi.org/10.3390/jcm12206564 - 16 Oct 2023
Viewed by 1809
Abstract
Successful treatments for acute and chronic skin wounds remain challenging. The goal of this proof-of-concept study was to assess the technical feasibility and safety of a novel wound treatment solution, FastSkin®, in a pig model. FastSkin® was prepared from skin [...] Read more.
Successful treatments for acute and chronic skin wounds remain challenging. The goal of this proof-of-concept study was to assess the technical feasibility and safety of a novel wound treatment solution, FastSkin®, in a pig model. FastSkin® was prepared from skin micrografts patterned in blood using acoustic waves. Upon coagulation, the graft was transferred on a silicone sheet and placed on wounds. Six full-thickness wounds were created at the back of two pigs and treated with either FastSkin®, split-thickness skin graft (positive control), a gauze coverage (negative control, NC1), or blood patterned without micrografts (negative control, NC2). Silicone sheets were removed after 7, 14, and 21 days. Wound healing was monitored for six weeks and evaluated macroscopically for re-epithelialization and morphometrically for residual wound area and wound contraction. Tissue regeneration was assessed with histology after six weeks. Re-epithelialization was faster in wounds covered with FastSkin® treatments compared to NC2 and in NC2 compared to NC1. Importantly, an enhanced collagen organization was observed in FastSkin® in contrast to NC treatments. In summary, two clinically approved skin wound treatments, namely micrografting and blood clot graft, were successfully merged with sound-induced patterning of micrografts to produce an autologous, simple, and biologically active wound treatment concept. Full article
(This article belongs to the Special Issue Experimental and Clinical Advances in Skin Grafting)
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11 pages, 2401 KiB  
Article
Outcome of Facial Burn Injuries Treated by a Nanofibrous Temporary Epidermal Layer
by Mauro Vasella, Jan Cirebea, Epameinondas Gousopoulos, Anna Wang, Riccardo Schweizer, Matthias Waldner, Gerrit Grieb, Philipp Buehler, Jan Alexander Plock and Bong-Sung Kim
J. Clin. Med. 2023, 12(16), 5273; https://doi.org/10.3390/jcm12165273 - 13 Aug 2023
Viewed by 1003
Abstract
Background: The face is commonly affected in thermal injuries, with a demand for proper recognition and the correct choice of treatment to guarantee optimal aesthetic and functional outcomes. It is highly vascularized and often heals conservatively, highlighting the particular relevance of conservative treatment [...] Read more.
Background: The face is commonly affected in thermal injuries, with a demand for proper recognition and the correct choice of treatment to guarantee optimal aesthetic and functional outcomes. It is highly vascularized and often heals conservatively, highlighting the particular relevance of conservative treatment modalities, many of which require daily re-applications or dressing changes, which can be painful and tedious for both the patient and the healthcare providers. Motivated by encouraging results of a novel temporary nanofibrous epidermal layer, we herein present a case series of this technology in a case series of patients suffering from facial burns and treated in our Burn Center. Patients and Methods: Patients with superficial partial-thickness facial burns and mixed pattern burns, which were treated with SpinCare™, an electrospun nanofibrous temporary epidermal layer, between 2019 and 2021, at our institution were analyzed retrospectively. The Manchester scar scale (MSS) and numeric rating scale (NRS) were used for scar, pain, and outcome evaluation at different time points by five independent board-certified plastic surgeons with profound experience in burn surgery. Results: Ten patients (m = 9; f = 1) were treated and evaluated retrospectively. The mean age was 38.8 ± years (SD ± 17.85). The mean healing time was 6.4 days (SD ± 1.56). The mean follow-up was 16.4 months (SD ± 11.33). The mean MSS score was 5.06 (SD ± 1.31), and the mean NRS Score for pain was significantly reduced from initially 7 to 0.875 upon application (mean (pre-application) 7 ± 0.7 and (application) 0.875 ± 1.26; p ≤ 0.0001). Patients reported a NRS score of 10 in terms of functional and cosmetic outcomes at their final follow-up appointment. No adverse effects were observed. Conclusions: The application of a nanofibrous temporary epidermal layer such as SpinCare™ represents a relatively easy-to-use, well-tolerated, and effective alternative for the treatment of partial-thickness facial burns. Full article
(This article belongs to the Special Issue Experimental and Clinical Advances in Skin Grafting)
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12 pages, 3967 KiB  
Article
Skin Bank Establishment in Treatment of Severe Burn Injuries: Overview and Experience with Skin Allografts at the Vienna Burn Center
by Clement J. Staud, Annika Resch, Alexandra Christ, Anton Borger, Maximilian Zaussinger, Maryana Teufelsbauer, Nina Worel and Christine Radtke
J. Clin. Med. 2023, 12(14), 4717; https://doi.org/10.3390/jcm12144717 - 17 Jul 2023
Cited by 2 | Viewed by 1647
Abstract
Depending on their extent, burn injuries require different treatment strategies. In cases of severe large-area trauma, the availability of vital skin for autografting is limited. Donor skin allografts are a well-established but rarely standardized option for temporary wound coverage. Ten patients were eligible [...] Read more.
Depending on their extent, burn injuries require different treatment strategies. In cases of severe large-area trauma, the availability of vital skin for autografting is limited. Donor skin allografts are a well-established but rarely standardized option for temporary wound coverage. Ten patients were eligible for inclusion in this retrospective study. Overall, 202 donor skin grafts obtained from the in-house skin bank were applied in the Department of Plastic and Reconstructive and Aesthetic Surgery, Medical University of Vienna. Between 2017 and 2022, we analysed the results in patient treatment, the selection of skin donors, tissue procurement, tissue processing and storage of allografts, as well as the condition and morphology of the allografts before application. The average Abbreviated Burn Severity Index (ABSI) was 8.5 (range, 5–12), and the mean affected total body surface area (TBSA) was 46.1% (range, 20–80%). In total, allograft application was performed 14 times. In two cases, a total of eight allografts were removed due to local infection, accounting for 3.96% of skin grafts. Six patients survived the acute phase of treatment. Scanning electron microscope images and histology showed no signs of scaffold decomposition and intact tissue layers of the allografts. The skin banking program and the application of skin allografts at the Vienna Burn Center can be considered successful. In severe burn injuries, skin allografts provide time by serving as sufficient wound coverage after early necrosectomy. Having an in-house skin banking program at a dedicated burn centre is particularly advantageous since issues of availability and distribution can be minimized. Skin allografts provide a reliable treatment option in patients with extensive burn injuries. Full article
(This article belongs to the Special Issue Experimental and Clinical Advances in Skin Grafting)
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Review

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12 pages, 12972 KiB  
Review
The Use of Intact Fish Skin Grafts in the Treatment of Necrotizing Fasciitis of the Leg: Early Clinical Experience and Literature Review on Indications for Intact Fish Skin Grafts
by Philip Dueppers, Roland Bozalka, Reinhard Kopp, Anna-Leonie Menges, Benedikt Reutersberg, Claudia Schrimpf, Francisco Jose Moreno Rivero and Alexander Zimmermann
J. Clin. Med. 2023, 12(18), 6001; https://doi.org/10.3390/jcm12186001 - 16 Sep 2023
Cited by 3 | Viewed by 2891
Abstract
Background: Necrotizing fasciitis (NF) is a serious infectious disease that can initially place the patient’s life in danger and, after successful surgical and antibiotic treatment, leaves extensive wounds with sometimes even exposed bones and tendons. Autologous skin grafts are not always possible or [...] Read more.
Background: Necrotizing fasciitis (NF) is a serious infectious disease that can initially place the patient’s life in danger and, after successful surgical and antibiotic treatment, leaves extensive wounds with sometimes even exposed bones and tendons. Autologous skin grafts are not always possible or require adequate wound bed preparation. Novel intact fish skin grafts (iFSGs; Kerecis® Omega3 Wound, Kerecis hf, Isafjördur, Iceland) have already shown their potential to promote granulation in many other wound situations. Faster wound healing rates and better functional and cosmetic outcomes were observed due to their additionally postulated anti-inflammatory and analgesic properties. Therefore, iFSGs may also be essential in treating NF. We present our initial experience with iFSGs in treating leg wounds after NF and review the literature for the current spectrum of clinical use of iFSGs. Case Presentations: We present two male patients (aged 60 and 69 years) with chronic or acute postsurgical extensive leg ulcers six weeks and six days after necrotizing fasciitis, respectively. Both suffered from diabetes mellitus without vascular pathologies of the lower limbs. A single application of one pre-meshed (Kerecis® Graftguide) and one self-meshed 300 cm2 iFSG (Kerecis® Surgiclose) was performed in our operation room after extensive surgical debridement and single circles of negative wound pressure therapy. Application and handling were easy. An excellent wound granulation was observed, even in uncovered tibia bone and tendons, accompanied by pain relief in both patients. Neither complications nor allergic reactions occurred. The patients received autologous skin grafting with excellent functional and cosmetic outcomes. Conclusions: iFSGs have the potential to play a significant role in the future treatment of NF due to the fast promotion of wound granulation and pain relief. Our experience may encourage surgeons to use iFSGs in NF patients, although high-quality, large-sized studies are still required to confirm these results. The observed effects of iFSGs on wounds associated with NF may be transferred to other wound etiologies as well. Full article
(This article belongs to the Special Issue Experimental and Clinical Advances in Skin Grafting)
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Other

8 pages, 738 KiB  
Brief Report
Exploring the Place of Fish Skin Grafts with Omega-3 in Pediatric Wound Management
by Ibrahim Cherry, Lana Tarhini, Marie Doan and Anthony De Buys Roessingh
J. Clin. Med. 2024, 13(1), 112; https://doi.org/10.3390/jcm13010112 - 25 Dec 2023
Cited by 1 | Viewed by 859
Abstract
Wound healing in the pediatric population is known to be a challenge and poorly studied. Split-thickness skin grafts, full-thickness skin grafts, and flaps overlap their applications with the growing field of cellular and tissue-based therapies. However, their role in pediatric reconstruction has yet [...] Read more.
Wound healing in the pediatric population is known to be a challenge and poorly studied. Split-thickness skin grafts, full-thickness skin grafts, and flaps overlap their applications with the growing field of cellular and tissue-based therapies. However, their role in pediatric reconstruction has yet to be defined. The Kerecis® Omega-3 wound patch, derived from decellularized codfish skin, has garnered attention due to its preserved microscopic architecture resembling the human extracellular matrix. This acellular dermal matrix acts as a scaffold, fostering dermal cell and capillary adhesion while harnessing omega-3 polyunsaturated fatty acids for granulation acceleration and antimicrobial effects. This study presents a comprehensive review and surgical protocol for utilizing Kerecis® fish skin in pediatric wound care. The research embraces a case series involving five patients with diverse wound locations. The Kerecis® Omega-3 wound patch underwent meticulous application and careful monitoring. The results highlight an average time of 48.6 days for complete epithelialization, yielding favorable outcomes with no hypertrophic scarring and mild retraction. Kerecis® fish skin grafting stands as a tool that not only accelerates healing but also addresses the multifaceted challenges associated with wound management in the pediatric population: the avoidance of donor site morbidity and improved postoperative pain control. Full article
(This article belongs to the Special Issue Experimental and Clinical Advances in Skin Grafting)
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