Artificial dermis is a kind of tissue engineering dermal substitute and is used to repair dermal defects caused by a variety of reasons. This article describes the characteristics and the mechanism of repair and reconstruction of bilayer artificial dermis. Based on domestic experience of clinical applications and relative literature of bilayer artificial dermis, more than 50 domestic experts in related field reached a consensus on indications, contraindications, operation procedures in clinical application, cautions, and treatment and prevention of complications of bilayer artificial dermis, providing reference for clinical application.
Consensus ; Dermis ; pathology ; Skin Transplantation ; methods ; Skin, Artificial ; Tissue Engineering

After healing of burn wound, skin of scar, transplanted skin grafts, and healed donor site wound suffer from temporary or permanent loss of function of sebaceous glands and dysfunction of skin surface lipid film formation, resulting in desiccation, desquamation, and sensitiveness of the skin, making areas of newly formed skin unsatisfactory. Therefore a good rehabilitation may fail. In this paper, the composition, physiochemical properties, and reconstruction of skin surface lipid film are discussed.
Cicatrix ; Lipids ; physiology ; Skin ; pathology ; Skin Transplantation ; Wound Healing

OBJECTIVE: To identify the pathological character of denatured dermis,and its turnover after autologous skin transplant. METHODS: Deep partial thickness burn wounds whose diameter was 2.5 cm were produced on the back of Sprague-Dawley (SD) rats. After simple debriding,xenogenic skin was transplanted. Superficial tangential excision was performed on the burn wounds on 48 hours postburn with the preservation of denatured dermis. Split thickness autologous skin was grafted on the wounds immediately. Tissue samples of whole layer of the skin were harvested from the grafted sites at different time points after the skin grafting. Pathological observation on the denatured skin and the transplanted skin was carried out with HE and Massonos trichrome blue. RESULTS: The superficial cells of the denatured dermis necrotized largely with few cells alive,collagen denatured,and many inflammatory cells infiltrating. Necrosis tissue and inflammatory cells could be found in the denatured skin in the early period after the skin transplant. There were infiltrated inflammatory cells in the transplanted skin 3 days after the skin transplant. On the 10th day,the necrotized tissue diminished markedly,and red cells were found in its upper stratum. On the 21st day, the morphology and structure of the transplanted skin were similar to those of the normal skin. CONCLUSION The retained denatured dermis has little effect on the survival of the transplanted skin. The necrosis components can be absorbed and replaced by the tissue alive after the autologous skin is transplanted.
Animals ; Burns ; pathology ; surgery ; Dermis ; transplantation ; Female ; Male ; Rats ; Rats, Sprague-Dawley ; Skin ; pathology ; Skin Transplantation ; methods ; Transplantation, Autologous

OBJECTIVETo observe the survival of hand allograft under the state of immunosuppression and the pathological changes of rejection in the recovery process.

METHODSThe biopsies of the skin, nerve, muscle, tendon and bone tissue of hand allografts during different stages from 1 day to 7 months after operation were observed using routine histological technique.

RESULTSNo significant changes due to rejection in skin, nerve, muscle and bone tissue were observed. But different degrees of weak rejective changes were found on the wall of blood vessels; in the muscle and nerve the reactions were markedly stronger than those found in skin tissues.

CONCLUSIONSThe rejection in deep tissues should be monitored in controlling the rejection of hand allograft.

Adult ; Biopsy ; Graft Rejection ; pathology ; Hand Transplantation ; Humans ; Immunosuppression ; Male ; Skin ; immunology ; pathology ; Transplantation, Homologous

OBJECTIVETo construct composite skin containing living cells and to observe its significance in the repair of full skin loss in mice.

METHODSThe dermal substitute was formed by culturing heterogeneous fibroblasts on the acellular chondrocyte collagen scaffold for 3 days, and then cultured on the epithelial membrane for another 10 days, to form the composite skin containing living cells. The composite skin was grafted onto full layer skin defect. The growth condition was observed and biopsies were harvested for histologic examination.

RESULTSBoth fibroblasts and stratified epithelium grew well in the collagen scaffold. The composite skin adhered tightly to wounds of the mice, with obvious vascularization one week after grafting. The grafts began to merge with the wound margin at 6 post operation weeks without obvious signs of rejection.

CONCLUSIONFull skin loss could be repaired by composite skin formed by acellular chondrocyte collagen scaffold as a skin substitute.

Animals ; Collagen ; Humans ; Mice ; Skin ; pathology ; Skin Transplantation ; methods ; Skin, Artificial ; Tissue Engineering

A great achievement has been made on burn pathology research in China since 1958. These advances include: pathological changes in burn wound, the healing process of burn wound and its mechanism modulated by growth factors especially bFGF, intermingled transplantation of allo-skin or xeno-skin with auto-skin for coverage of extensive third degree burns, characteristic postburn inflammatory reaction, pathological changes and evolution in various internal organs, multiple organ dysfunction syndrome (MODS), pathological changes in phosphorus burn, pathological changes in endotoxemia in burn, the role of vascular endothelial cell in pathogenesis of postburn visceral organ dysfunction as well as steam and smoke inhalation injury.
Burns ; pathology ; China ; Humans ; Skin Transplantation ; Wound Healing

Acne is a common chronic inflammatory disease of the skin that often occurs on the face, and acne scars are often secondary to the healing process of acne, which often leads to impaired appearance and psychological disorders of patients. The current treatment for acne scars is extremely difficult. With the development of regenerative medicine, stem cell transplantation has become a new treatment for acne scars. In recent years, it has been reported that stem cells and their derivatives can effectively antagonize the formation of acne scars. Therefore, this paper briefly reviews the basic and clinical researches on the treatment of acne scars with various mesenchymal stem cells and their derivatives, aiming to provide theoretical basis and reference for the stem cell therapy of acne scars.
Acne Vulgaris/pathology* ; Cicatrix/pathology* ; Humans ; Mesenchymal Stem Cells ; Skin/pathology* ; Stem Cell Transplantation

Adult ; Biopsy ; Cryptococcosis ; complications ; pathology ; Female ; Humans ; Kidney Transplantation ; adverse effects ; Skin ; pathology ; Skin Diseases ; etiology ; pathology

OBJECTIVETo observe the injury on micro-skin induced by a self designed micro-skin machine.

METHODSMicro-skin was produced either with the machine or by hand. Cells at the edge of micro-skin were observed by transmission electron microscope. succinic dehydrogenase activity in supernatant of cultivated cells was analyzed, and the cell proliferation of micro-skin was assessed by (3)H-TdR. Twenty patients were enrolled in the study for the observation of the wound healing time between the two groups of micro-skin after being grafted.

RESULTSTransmission electron microscope examination revealed that the cellular injury at the edge of the micro-skin in machine-made group was mild compared with that in man-made group. (3)H-TdR rate was elevated but the activity of succinic dehydrogenase in the supernatant of cultured cells decreased in supernatant of cultured cells of machine produced micro-skin. Wound healing time was shortened in machine made group. (P < 0.05).

CONCLUSIONThe cellular injury at the edge of micro-skin in the machine made group was mild when compared with that in the man-made group with cell proliferation accelerated and wound healing time shortened.

Burns ; surgery ; Cell Division ; Epithelium ; pathology ; Humans ; Microscopy, Electron ; Skin ; ultrastructure ; Skin Transplantation ; methods ; Wound Healing

OBJECTIVETo investigate the effects of unified surgical scheme for wounds on the outcome of patients with extensive deep partial-thickness to full-thickness (briefly referred to as deep) burn.

METHODSOne hundred and thirty-seven patients with extensive deep burn hospitalized from July 2007 to November 2012 underwent unified surgery according to area of deep wound (unified scheme group, US). Among them, 57 patients with deep wound area less than 51% TBSA received escharectomy or tangential excision by stages followed by autologous mesh skin grafting; 52 patients with deep wound area from 51% to 80% TBSA underwent escharectomy or tangential excision by stages followed by autologous mesh skin grafting and/or small skin grafting, or escharectomy or tangential excision followed by large sheet of allogeneic skin covering plus autologous mesh skin grafting and/or small skin grafting after the removal of allogeneic skin; 28 patients with deep wound area larger than 80% TBSA received escharectomy or tangential excision by stages followed by autologous microskin grafting plus coverage of large sheet of allogeneic skin, or escharectomy or tangential excision followed by small autologous skin grafting and/or intermingled grafting with small autologous and/or allogeneic skin. Another 120 patients with extensive deep burn hospitalized from January 2002 to June 2007 who did not receive unified surgical scheme were included as control group (C). Except for the surgical methods in group US, in 53 patients with deep wound area less than 51% TBSA in group C escharectomy or tangential excision was performed followed by autologous small skin grafting; in 40 patients with deep wound area from 51% to 80% TBSA in group C escharectomy or tangential excision was performed followed by autologous microskin grafting plus large sheet of allogeneic skin covering, or escharectomy or tangential excision followed by large sheet of allogeneic skin embedded with stamp-like autologous skin; in 27 patients with deep wound area larger than 80% TBSA in group C escharectomy or tangential excision was performed followed by covering with large sheet of allogeneic skin embedded with stamp-like autologous skin without intermingled grafting with small autologous and allogeneic skin in group US. In group US, escharectomy of full-thickness wound in extremities was performed with the use of tourniquet in every patient; saline containing adrenaline was subcutaneously injected when performing escharectomy or tangential excision over the trunk and skin excision; normal skin and healed superficial-thickness wound were used as donor sites for several times of skin excision. The baseline condition of patients and their treatment in the aspects of fluid resuscitation, nutrition support, anti-inflammation, and organ function support were similar between the two groups. The mortality and incidence of complications of all patients and wound healing time and times of surgery of healed patients were compared between the two groups. Data were processed with independent sample t test, Mann-Whitney U test, and Fisher's exact test.

RESULTS(1) Both the mortality and the incidence of complications of patients with deep wound area less than 51% TBSA in group US were 0, which were close to those of group C (with P values above 0.05). The number of times of surgery of healed patients with deep wound area less than 51% TBSA in group US was 2.4 ± 0.9, which was obviously fewer than that of group C (3.5 ± 1.8, U=-5.085, P<0.001), but with wound healing time close to that of group C (U=-1.480, P>0.05). (2) Both the mortality and the incidence of complications of patients with deep wound area from 51% to 80% TBSA in group US were 0, which were significantly lower than those of group C [both as 20.0% (8/40), with P values below 0.01]. The number of times of surgery and wound healing time of healed patients with deep wound area from 51% to 80% TBSA in group US were respectively 3.0 ± 1.0 and (43 ± 13) d, which were obviously fewer or shorter than those in group C [4.2 ± 2.3 and (61 ± 34) d, with U values respectively -2.491 and -2.186, P values below 0.05]. (3) Both the mortality and the incidence of complications of patients with deep wound area larger than 80% TBSA in group US were 25.0% (7/28), which were close to those of group C [both as 25.9% (7/27), with P values above 0.05]. The number of times of surgery and wound healing time of healed patients with deep wound area larger than 80% TBSA in group US were close to those of group C (with U values respectively -0.276 and -0.369, P values above 0.05).

CONCLUSIONSUnified surgical scheme can indirectly decrease the mortality and the incidence of complications of burn patients with deep wound area from 51% to 80% TBSA; it can reduce times of surgery of healed patients of this type and shorten their wound healing time.

Burns ; surgery ; Debridement ; methods ; Extremities ; Humans ; Severity of Illness Index ; Skin ; pathology ; Skin Transplantation ; Transplantation, Autologous ; Treatment Outcome ; Wound Healing