The complexity of human skin poses a significant challenge for doctors seeking to repair devastating burns. Current methods of burn reconstructive surgery have remained relatively unchanged for nearly 40 years, where rectangular or circular patches are grafted onto the body. These grafts are usually successful for flatter areas of the body, such as the upper back. However, much of the human body has a more complex geometry, and these patches can fall short of effectively covering body parts such as hands or the face. In these situations, many patches have to be used, requiring stitches between each piece, lengthening surgery time, and potentially worsening the aesthetic and functional outcome of the procedure.
A new procedure takes inspiration from the properties of human skin, treating it more like the continuous, fully enclosed organ that it is. The study seeks to create 3D skin constructs that can be seamlessly transplanted as "biological clothing" on any part of the body. Dubbed "wearable edgeless skin constructs (WESCs)," these constructs are meant to better emulate how the skin works on a biophysical level and mimic the cellular and extracellular organization of human skin. They are customizable and can be tailored and printed for a specific burn or wound. Their strength lies in replacing skin in challenging body sites with much less suturing than the traditional method, taking less time to apply in surgery.
Currently, the WESCs have primarily been tested on mouse hindlimbs, where they have shown great promise. By emulating the natural geometry of the skin, the grafts have demonstrated improved deposition and organization of the extracellular matrix (ECM) at the wound site and have notably shown body site-specific variations in cellular and extracellular organization in the 3D-engineered skin itself. Researchers also noticed that the new skin transplants were more resistant to rupture under stress, likely due to the enclosed nature of the constructs.
The research team also compared the success of prevascularized versus nonvascularized WESCs. Conventional skin constructs (CSCs) generally undergo prevascularization, as it improves the success of the graft. However, with the WESCs, researchers demonstrated that all grafts successfully integrated with the host regardless of their prevascularization status. Regardless, they found that they could easily incorporate a vascular network into the WESCs, which is considered an essential feature for graft integration.
Although WESCs still have a long road of research ahead of them, they show immense promise in improving the field of burn reconstructive surgery. By customizing "biological clothing" for individual patients' wounds, surgeons can seamlessly integrate the graft onto areas of the body with complex geometry using only one continuous construct. Requiring fewer sutures, the graft's functional and aesthetic properties will improve patient outcomes. Additionally, by emulating the skin's natural properties, the engineered skin responds more appropriately to the body part it is grafted onto, improving dermal composition and organization at the site. This unique new technique seeks to push the boundaries of what is possible in burn reconstruction and inspires future researchers to approach old problems in new and innovative ways.
Thank you for reading,
Ashby
Source:
Alberto Pappalardo, David Alvarez Cespedes, Shuyang Fang, Abigail R. Herschman, Eun Young Jeon, Kristin M. Myers, Jeffrey W. Kysar, and Hasan Erbil Abaci. “Engineering edgeless human skin with enhanced biomechanical properties.” Science Advances 9, no. 4 (27 January 2023). doi: 10.1126/sciadv.ade2514
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