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. ...
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 $10.54%{\pm}6.25%$; take rate, $88.89%{\pm}11.39%$; and contraction rate, $4.2%{\pm}2.28%$ 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.
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 $10.54%{\pm}6.25%$; take rate, $88.89%{\pm}11.39%$; and contraction rate, $4.2%{\pm}2.28%$ 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.
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제안 방법
After the skin graft, scar evaluation was performed through visual assessment and by using photos taken by medical specialists with a digital camera. The evaluation was performed on the 5–7th days, 2 weeks, 4 weeks, 3 months, and 6 months following the graft.
Drugs that affect blood coagulation such as, aspirin and anticoagulants, were prohibited 2 weeks prior to admission. An examination in preparation for anesthesia was carried out 2 weeks before the surgery, and clinical photos were obtained to be used for visual assessment after the skin graft. Photos were obtained using equipment that allowed photography under set conditions, and a constant distance and conditions were maintained.
Histological examination using hematoxylin and eosin (H&E) staining and Masson’s trichrome stain was performed on 5×5-mm samples of each patient’s skin after both skin harvest and skin expansion, in order to observe changes before and after the expansion.
In this study, we used the in vitro skin bioreactor for the correction of cicatricial scar contracture caused by burns and traumas. In addition, we evaluated the clinical applicability and safety of the expanded skin.
Patient satisfaction levels were measured using a survey of the patient’s own scar assessment.
Patient satisfaction was evaluated based on the condition of the recipient site, and the feeling of discomfort of the donor at 3 months and 6 months. Satisfaction scores for the donor site were shown to be high, at above 6, while satisfaction scores for the recipient sites were quite low, at 5–6 (Fig.
Patient satisfaction levels were measured using a survey of the patient’s own scar assessment. The donor and recipient sites were assessed separately, and the survey was performed twice at the 3rd and 6th months, using a score from 0 to 10 (Fig. 2).
The evaluation was performed on the 5–7th days, 2 weeks, 4 weeks, 3 months, and 6 months following the graft.
To evaluate the safety and applicability of the procedure, the study was designed using Simon’s Two-stage Clinical Trial, without a control group, based on an optimal design.
Two plastic surgeons evaluated the photos of the recipient site obtained at 3 and 6 months using the Likert 5-point scar scale. The average score was 3.
대상 데이터
Case 1 was a 41-year-old female patient with a cicatricial scar contracture from a burn on the neck. The expansion rate was 19.
Case 2 was a 30-year-old female patient with a cicatricial scar contracture from a burn on the right arm. The expansion rate was 13.
성능/효과
The results showed an average skin expansion rate of 10.54%±6.25% over a period of 11 to 12 days.
후속연구
Furthermore, the take rate and the contraction rate of the expanded skin were established. Although the safety of the in vitro bioreactor was verified, further studies are required to increase the expansion rate.
참고문헌 (4)
1 Neumann CG The expansion of an area of skin by progressive distention of a subcutaneous balloon; use of the method for securing skin for subtotal reconstruction of the ear Plast Reconstr Surg (1946) 1957 19 124 130 13419574
2 Dotan L Icekson M Yanko-Arzi R Pediatric tissue expansion: our experience with 103 expanded flap reconstructive procedures in 41 children Isr Med Assoc J 2009 11 474 479 19891235
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