Nessun titolo diapositiva

1
Tissue engineering autologous full-thickness
skin substitute for healing chronic wounds
A. Bellomi , G. Calabrese, A. Cassisa, F.
Colpani, R. Fante, L. Gaetti, G. Granchelli, S.
Negri Servizio Anatomia Patologica Ospedale C.
Poma Mantova
2
Chronic wounds, inclouding venous and
arteriosclerotic leg ulcers, diabetic foot
ulcers, decubitus and trauma induced wounds,
represent a major problem in our society. These
wounds occur with high incidence and exist for
prolonged periods of time and therefore have a
great socioeconomic impact. The problem increases
as the average age of the population increases
and therefore new therapies in wound healing are
continously being sought.
Introduction

• The aim of this study is to develop an
  autologous, full-thickness skin substitute and to
  evaluate its efficiency and applicability in
  closing long-standing ulcers that have proven
  non-responsive to the currently available
  wound-healing therapies (topical therapy,
  antibiotic treatment, surgical debridment,
  external compression).

3
Method

• We included 20 patients with long-standing
  ulcers of which 13 venous and arteriosclerotic
  (65), 3 diabetic (15), 3 trauma-induced and 1
  burn wounds (5). Age of patients varies from 57
  to 91 (average 75). The lesions were present
  since at least two years.
• A single punch biopsy (diameter cm 0,6) or a
  surgical biopsy (cm 1,5x1) obtained from the
  patients upper leg were required. After 3-4
  weeks we obtaneid three autologous products on
  collagen support (Antema soft, Opocrin S.P.A)
  fibroblasts (fig.1), fibroblasts and
  keratinocytes (fig.2 ) and keratinocytes (fig.3).
  
• Sheets of keratinocytes present basal
  melanocytes (fig.4) between keratinocytes and
  fibroblasts we observe basement membrane (fig.5).
• Depending on ulcers depth and dimensions our
  patients underwent multiple applications (at
  least two).
• All procedures were performed with the Ethics
  Committee approval and patient consent.

4
Fig.1 haematoxylin-eosin stain (200x)
5
Fig.2 haematoxylin-eosin stain (400x)
6
Fig.3 haematoxylin-eosin stain (400x)
7
Fig. 4 immunohistochemical detection of
basement membrane - collagen IV- 400 x
8
Fig. 5 immunohistochemical detection of
melanocytes - HMB45 - 200 x
9
Results

• The success rate in culturing biopsies was 100.
  The skin substitute visibly resembled an
  autograft.
• Ten of the 13 (77) chronic venous ulcers (size
  6-300 cmq) healed between 8 and 48 weeks (case 1
  and 2).
• One of the 3 (33) diabetic ulcers (size 3-28
  cmq) healed within 12 weeks.
• Three (100) trauma induced ulcers (size 4-6 cmq)
  healed between 6 and 12 weeks.
• One (100) burn ulcer (size 12 cmq) healed within
  4 weeks.
• Skin substitutes were very well tollerated and
  pain relief was immediate after application.

10
Case n 1 Female 80 years old, with vascular
ulcer since three years non responsive to the
currently available therapies...
11
Case n 1 The same woman after autologous
full-thicness skin substitute application
12
Case n 2 Female 73 years old, with vascular
ulcer since two years non responsive to the
currently available therapies...
13
Case n 2 The same woman after autologous
full-thicness skin substitute application
14
Conclusion

• The application of this noval skin sobstitute
  provides a promising new therapy for healing
  chronic wounds resistant to conventional
  therapies.
• It is also necessary to point out the importance
  of suitable cyto-histological and
  immunohistochemical studies for evaluating the
  correct cell morphology and phenotype.