Till now, though great progress has been made in the treatment of refractory wound, severe challenges are still awaiting to be solved. The strategy of treatment is generally either non-surgical treatment or surgical treatment. Non-surgical treatment includes physical therapy, negative pressure wound therapy, growth factor therapy, stem cell transplantation, gene therapy, application of new biological dressing, application of skin tissue engineering, three-dimensional bio-printing technology, biological therapy, and Chinese herbal medicine therapy. Surgical treatment mainly includes skin graft transplantation and a variety of skin flap transplantation. To my mind, comprehensive therapy with concept of precision treatment strategy should be advocated for treatment of refractory wound.
Biological Dressings ; Bioprinting ; Drugs, Chinese Herbal ; Genetic Therapy ; Humans ; Negative-Pressure Wound Therapy ; Skin ; pathology ; Skin Transplantation ; Stem Cell Transplantation ; Surgical Flaps ; Tissue Engineering ; Wound Healing

PURPOSE: With the advances of knowledge in wound healing process and technology in various fields, dressing material of the split thickness skin graft (STSG) donor site was improved. Recently, biologic dressing materials attracted attention and these are used for wound management. The aim of the study was to compare the efficacy of Xe-derma® (porcine acellular dermal matrix) with Kaloderm® (cultured epithelial autografts) for treatment of the donor site. METHODS: From July 2015 to January 2016, 20 patients who had undergone STSG were enrolled. The grafts harvested with a same manner and the donor sites were managed with Xe-derma® or Kaloderm®. We compared days for re-epithelization, number of dressings, ease of application, ease of wound monitoring, pain level and complications. RESULTS: All patients managed by these dressing materials were well healed without any complications. There is no statistically difference (P=0.830) between the days for re-epithelization of Xe-derma® (11.10±0.944) and Kaloderm® (11.00±1.054). Number of dressings of Xe-derma® (1.2±0.421) was lower than Kaloderm® (2.3±0.483). Ease of application of Kaloderm® (7.40±0.516) was easier than Xe-derma® (6.36±0.343). Ease of wound monitoring of Xe-derma® (7.77±0.856) was easier than Kaloderm® (6.25±0.720). Xe-derma® was more painless in 1 day and 3 days after operation than Kaloderm®. CONCLUSION: Advantageous properties of Xe-derma® are improving wound healing, reducing pain by contact to the wound immediately after application and easy of wound monitoring due to its transparency. Therefore, we expected Xe-derma® can be used for management of various wound.
Bandages ; Biological Dressings* ; Humans ; Skin* ; Tissue Donors* ; Transplants* ; Wound Healing ; Wounds and Injuries

To observe clinical effects of combination of acellular porcine skin with delayed microskin graft on extensively burned patients.
 Methods: Forty extensively burned patients were assigned into a treatment group and a control group. In the treatment group, 20 patients were covered with acellular porcine skin after escharectomy, and the delayed microskin grafting was performed 5 days later. In the control group, 20 patients were covered with allograft skin combined with microskin graft after escharectomy. The cure rate, the graft survival rate, wound healing time and cost per 1% wound were observed.
 Results: The cure rate for the 2 groups was the same (90%), and wound healing time was similar between the two groups (P>0.05). The graft survival rate in the treatment group was higher than that in the control group (P<0.05), and cost per 1% wound in the treatment group was less than that in the control group (P<0.05).
 Conclusion: The combination of acellular porcine skin with delayed microskin graft is an effective method to treat extensively burned patients, and it provides an ideal substitute for allograft skin combined with microskin graft.
Acellular Dermis ; economics ; statistics & numerical data ; Animals ; Biological Dressings ; economics ; statistics & numerical data ; Burns ; therapy ; Cost-Benefit Analysis ; Graft Survival ; Humans ; Skin Transplantation ; economics ; methods ; Swine ; Transplantation, Homologous ; adverse effects ; economics ; methods ; Wound Healing

PURPOSE: In the past days, the majority of 2nd degree burns were treated conservatively, and deep 2nd degree burns were usually covered by skin grafts. However, conservative treatment spends a long time in complete healing and accompanies severe pain and discomfort. Additionally, covering the wound with skin graft causes recipient site scarring and donor site morbidity. Since keratinocyte graft was introduced, nowadays it is widely used in burn wound. These treatment methods are proved to be clinically successful by many clinical and experimental studies. However, there are several disadvantages such as inconvenient using methods and limited usage in several cases. For that reason, at 2004, alloplastic material was first introduced to come over these problems of keratinocyte graft. There had been no precious reports comparing theses two methods, so we planned to focus on differences of two methods in our institute. METHODS: From March 2013 to september 2014, among the 47 patients with burn wound (2nd degree - partial 3rd degree) underwent biologic dressing with cultured keratinocyte allograft (Kaloderm(R) (Tegoscience, Korea)) alloplastic material (Suprathel(R) (Polymedics Innovations GmbH, Germany). The outcomes were assessed using time for epithelization, TBSA (%), Vancouver Scar Scale and complication. RESULTS: All burn wounds were completely epithelized without any complication. The average time for epithelization was 13.4/13.4 days. CONCLUSION: The result of this study suggests that Kaloderm(R) and Suprathel(R) did not show significant difference. Therefore, Suprathel(R) may be considered as an alternative choice for treating 2nd and 3rd degree burns in some clinical settings.
Allografts* ; Biological Dressings ; Burns* ; Cicatrix ; Humans ; Keratinocytes* ; Skin ; Tissue Donors ; Transplants ; Wounds and Injuries

BACKGROUND: To minimize the inflammatory reaction and improve healing, a new modified dermal substitute composed of an atelocollagen, chondroitin-6-sulfate, and amniotic membrane (AM) was applied to full-thickness skin defects in a pig. Atelocollagen was extracted from bovine skin, and two modified dermal substitutes were generated according to the cross-linking type. METHODS: The AM-collagen dermal substitutes were characterized and compared with currently used dermal substitutes in a pig skin defect model. There were five experimental groups: dehydrothermal (DHT) cross-linking atelocollagen with the AM on the top (AM-DHT), DHT and chemical cross-linking atelocollagen with the AM on the top (AM-DHT/chemical), Terudermis, Integra, and AlloDerm. After 3x3 cm full-thickness skin defects on the back of a pig were created, each dermal substitutes dermal substitutes was randomly grafted on the defects. Two weeks after grafting, autologous partial-thickness skin was over-grafted on the neodermis. The take rate of the dermal substitutes, skin, and histological sections were all assessed at 1, 2, and 4 weeks postoperatively. RESULTS: More rapid healing and a higher take rate were evident in the AM-DHT and Terudermis groups. Histological examination revealed fewer inflammatory cells and more fibroblast hyperplasia in these two groups. Four weeks after surgery, the amount of newly formed collagen was significantly more appropriate in the AM-DHT group. CONCLUSIONS: These observations provide supporting evidence that a newly developed amniotic-collagen dermal substitute may inhibit inflammatory reactions and promote wound healing.
Amnion ; Biological Dressings ; Chondroitin Sulfates ; Collagen ; Dermis ; Fibroblasts ; Hyperplasia ; Skin ; Skin, Artificial ; Transplants ; Wound Healing

PURPOSE: The biggest problem of wound healing is a possible occurrence of lesion. Especially, in the case of patients who have a skin injury around exposed body parts, if their treatment period drag on for long time, they can suffer from after-effects and the costs can be passed on to a society. Therefore, in this research, we investigated the need to develop the effective medicine and appliances for the patients by examining which therapy methods are being applying to the skin damage and what is the advantage and limit by evaluating the patient's satisfaction level. METHODS: We carried out an online and offline survey targeting medical teams in order to analyze device for wound care. A total of 125 medical teams applied to the research, and investigate the level of customer satisfaction. RESULTS: The moist dressings are the most used method for wound healing. When it comes to the level of customer satisfaction, biological dressing product also has a high satisfaction level. However its high cost tends to limit the use. CONCLUSION: This research reached a conclusion that it is need to develop a low cost and high efficiency wound care product considering the fact that its high cost and low efficiency induced economic problems. Generally, it is needed to develop a product for skin regeneration based on biological technologies, not a product just for damage cure.
Bandages ; Biological Dressings ; Human Body ; Humans ; Methods ; Regeneration ; Skin ; Wound Healing ; Wounds and Injuries*

OBJECTIVETo study the effect of biological protective dressing made from porcine peritoneum in covering wounds with microskin grafts.

METHODSTwenty New Zealand rabbits were divided into ten couples according to the random number table. Rabbits in each couple underwent surgery at the same time. A piece of full-thickness skin of 5 cm in diameter was removed symmetrically from the left and right sides of the back of each rabbit, thus forming two wounds with full-thickness skin defect. One fifth of one piece of skin of one rabbit was cut into tiny pieces of 0.2-0.5 mm in size (microskin). Then the microskin pieces were spread on the two wounds of the donor rabbit with the microskin/wound area ratio 1:10. The two wounds of each rabbit covered with microskin were divided into two groups according to the random number table. One wound was covered with biological protective dressing prepared with porcine peritoneum as experiment group, and the other was covered with the rest allograft in full size obtained from the other rabbit of each couple as control group. The general condition of wound was observed at post operation week (POW) 1-4. Wound healing rate was calculated at POW 3 and 4. Wound healing time was recorded. Specimens were harvested from wounds for histological observation at POW 1-4. Data were processed with paired t test.

RESULTS(1) At POW 1, the biological protective dressings were found to attach firmly to the wounds in experiment group without obvious inflammatory response; the allografts survived well on the wounds in control group. At POW 2, the coverings attached well to the wounds of both groups, but became drier and darker as compared with those at POW 1. At POW 3, some wounds of the two groups healed when the coverings desiccated and separated. At POW 4, all the wounds of both groups healed without obvious difference in appearance. (2) The wound healing rates of the experiment and control groups were respectively (92.8 ± 6.2)% and (91.3 ± 7.3)% (t = 0.54, P > 0.05) at POW 3 and (98.1 ± 2.3)% and (97.0 ± 4.6)% (t = 0.38, P > 0.05) at POW 4. (3) The wound healing time was (25.0 ± 3.9) d in experiment group and (24.8 ± 2.3) d in control group. The difference between them was not statistically significant (t = 0.82, P > 0.05). (4) Histological observation showed that wounds of the two groups were all infiltrated by inflammatory cells, and new blood vessels were observed at POW 1 and 2. The survived microskin proliferated under the coverings. At POW 3 and 4, the coverings on the wounds of two groups were gradually degenerated and became necrotic and separated from the wound beds, while the wounds underneath were re-epithelialized.

CONCLUSIONSThe effect of biological protective dressing in covering wounds grafted with microskin is as good as that of the allograft, as they both help the auto-microskin proliferate and repair the wound. It could be considered to be new biological material for clinical application.

Animals ; Biocompatible Materials ; Biological Dressings ; Male ; Peritoneum ; Rabbits ; Skin Transplantation ; methods ; Swine ; Wound Healing

PURPOSE: Facial abrasions have been treated by moist occlusive dressing for many years. But previous dressing methods have several disadvantages such as difficulty of fixation due to varied contours, too frequent dressing changes with pain, discomfort due to volume of the dressing materials. The authors applied dried bovine amniotic membrane (Amnisite BA(R)) to facial abrasions as a new therapeutic option and compared its efficacy with previous foam dressing treatments. METHODS: From June 2010 to May 2011, thirty two patients suffering from facial abrasions were included in this study, with a mean age of 32.4. Patients were divided into two groups by patient preference. One group was treated with dried bovine amniotic membrane while the other group was treated with ointment and foam dressings. Subjects were followed by regular outpatient clinic visits until complete epithelization. Healing time, treatment costs, scar formation, skin elasticity and moisture content were evaluated to compare the efficacy of dried bovine amniotic membrane in comparison to foam dressing groups. RESULTS: All of thirty two patients were well healed after appliance of dried bovine amniotic membrane or foam dressing without any complication. The healing time for patients treated with dried bovine amniotic membrane was significantly shorter (P<0.05) and no significant difference between the two groups regarding treatment costs, scar formation, skin elasticity or moisture content was shown. CONCLUSION: Facial abrasion can be effectively treated with dried bovine amniotic membrane with a shortening of epithelization period and similar effectiveness as previous foam dressings. In addition, dried bovine amniotic membranes have several benefits. easy appliance to any parts of face, reducing the frequency of dressing changes, early adaptation to social life and so on, These presented benefits make this material a new standard for treatment of facial abrasion.
Ambulatory Care Facilities ; Amnion ; Bandages ; Biological Dressings ; Cicatrix ; Elasticity ; Health Care Costs ; Humans ; Occlusive Dressings ; Patient Preference ; Skin ; Stress, Psychological ; Treatment Outcome

We report a sebaceous carcinoma confined to the corneoscleral limbus without involvement of the eyelid. A 60-year-old man, who showed multiple masses on the corneaoscleral limbus and limbal ulceration but with normal eyelids, underwent surgical en-bloc excision of the masses. Histopathologic examination revealed a sebaceous carcinoma. Three weeks after excision, multiple pagetoid recurrences were found along the bulbar conjunctiva 2 mm away from the limbus. After the application of topical mitomycin C, the pagetoid spread regressed completely. After a 2 year follow-up, no other local or systemic recurrences were observed. This report shows that the ulcerative mass which is confined to only the corneoscleral limbus may be a sebaceous carcinoma even without eyelid involvement. Topical mitomycin C may be effective for treating pagetoid spread of sebaceous carcinoma of limbal origin.
Adenocarcinoma, Sebaceous/*pathology/surgery ; Biological Dressings ; Diagnosis, Differential ; Eye Neoplasms/*pathology/surgery ; Follow-Up Studies ; Humans ; Limbus Corneae/*pathology ; Male ; Middle Aged ; *Neoplasm Recurrence, Local ; Ophthalmologic Surgical Procedures/methods ; Sebaceous Gland Neoplasms/*pathology/surgery

PURPOSE: Nowadays importance of growth factors in wound healing is being focused. Wound healing can be accelerated by various growth factors. Wound healing cascade consists of inflammatory, proliferative, and remodeling phases. Basic fibroblast growth factor (bFGF) helps proliferation of fibroblast and promotes angiogenesis and formation of granulation tissue through proliferative phase. We investigated the effect of recombinant basic fibroblast growth factor Fiblast(R) (Kaken Pharmaceutical, Japan) on second degree burns. METHODS: 57 patients from July 2009 to September 2009 with second degree burn were treated with bFGF. Average age, sex, cause of burn, depth of burn, location of wound, epithelization period and number of operation were studied. Recombinant bFGF was used with spraying. The bFGT was sprayed and wait for 30 seconds and then foam dressing was applied to wounds. The bFGF administration continued until the wound healed. RESULTS: The average healing time in the bFGF-treated group was 8.4+/-2.2 days (4~14 days). Among 57 patients, 19 patients had superficial second degree burn and the average healing time in the bFGF-treated group was 7.2+/-1.5 days (4~9 days), 30 patients had deep second degree burn and the average healing time in the bFGF-treated group was 11.2+/-1.7 days (9~14 days). 20 patients had deep second degree burn and were clinically considered to get operation during hospital course but eventually 8 of patients (40%) with deep second degree burn treated with bFGF underwent operation. CONCLUSION: The use of bFGF for second-degree burns decreased the wound healing time. Especially the use of bFGF decreased the rate of getting operation in deep second degree burn and increased the convenience of treatment.
Bandages ; Biological Dressings ; Burns ; Fibroblast Growth Factor 2 ; Fibroblasts ; Granulation Tissue ; Humans ; Intercellular Signaling Peptides and Proteins ; Wound Healing