Differential Capability of Clinically Employed Dermal Regeneration Scaffolds to Support Vascularization for Tissue Bioengineering

The loss of skin integrity has always represented a major challenge for clinicians dealing with dermal defects, such as ulcers (diabetic, vascular and chronic), postoncologic resections (i.e., radical vulvectomy) or dermatologic disorders. The introduction in recent decades of acellular dermal matrices (ADMs) supporting the repair and restoration of skin functionality represented a significant step toward achieving clean wound repair before performing skin grafts. Hard-to-heal ulcers generally depend on local ischemia and nonadequate vascularization. In this context, one possible innovative approach could be the prevascularization of matrices with vessel-forming cells (inosculation). This paper presents a comparative analysis of the most widely used dermal templates, i.e., Integra® Bilayer Matrix Wound Dressing, PELNAC®, PriMatrix® Dermal Repair Scaffold, Endoform® Natural Dermal Template, and Myriad Matrix®, testing their ability to be colonized by human adult dermal microvascular endothelial cells (ADMECs) and to induce and support angiogenesis in vitro and in vivo. By in vitro studies, we demonstrated that Integra® and PELNAC® possess superior pro-adhesive and pro-angiogenetic properties. Animal models allowed us to demonstrate the ability of preseeded ADMECs on Integra® to promote the engraftment, integration and vascularization of ADMs at the site of application.

Optimization of Novel Human Acellular Dermal Dressing Sterilization for Routine Use in Clinical Practice

Gamma rays and electrons with kinetic energy up to 10 MeV are routinely used to sterilize biomaterials. To date, the effects of irradiation upon human acellular dermal matrices (hADMs) remain to be fully elucidated. The optimal irradiation dosage remains a critical parameter affecting the final product structure and, by extension, its therapeutic potential. ADM slides were prepared by various digestion methods. The influence of various doses of radiation sterilization using a high-energy electron beam on the structure of collagen, the formation of free radicals and immune responses to non-irradiated (native) and irradiated hADM was investigated. The study of the structure changes was carried out using the following methods: immunohistology, immunoblotting, and electron paramagnetic resonance (EPR) spectroscopy. It was shown that radiation sterilization did not change the architecture and three-dimensional structure of hADM; however, it significantly influenced the degradation of collagen fibers and induced the production of free radicals in a dose-dependent manner. More importantly, the observed effects did not disrupt the therapeutic potential of the new transplants. Therefore, radiation sterilization at a dose of 35kGy can ensure high sterility of the dressing while maintaining its therapeutic potential.

Adult thermal burns

Adult burn injuries are heterogeneous in their aetiology and in their severity, and in the many ways in which they affect the burns patient. Treatment should be initiated promptly, ensuring that other life-threatening injuries are dealt with, and that expert burn care is delivered to the patient. First aid followed by emergency management of the patient, fluid resuscitation, and specialist wound care ensures the patient is given the very best opportunity for full recovery and survival. The burn wound may be managed non-surgically, but for deeper and more severe injuries, surgical debridement and wound cover with grafts, cell suspensions, dermal matrices, or flaps is required. Areas of special attention include the face, hands, and perineum—all functionally and aesthetically important, and each with specific dressing needs and surgical techniques that optimize good outcomes. Scar management and physiotherapy are crucial components of adult burn care, with many therapies applied concurrently to ensure good functional and aesthetic recovery. For those patients with ongoing scar and contracture difficulties, scar therapies and reconstructive burns surgery offer the chance of better function and appearance even many years after the original burn. The journey to recovery would not be complete, however, without important psychosocial input for the burns patient, as the psychological scars are often just as painful as the physical ones.