Tissue Eng Regen Med.  2018 Oct;15(5):629-638. 10.1007/s13770-018-0154-6.

Full Thickness Skin Expansion ex vivo in a Newly Developed Reactor and Evaluation of Auto-Grafting Efficiency of the Expanded Skin Using Yucatan Pig Model

• Huh MI
• Yi1 SJ
• Lee KP
• Kim HK
• An SH
• Kim DB
• Ryu RH
• Kim JS
• Lim JO

• KMID: 2422676
• DOI: http://doi.org/10.1007/s13770-018-0154-6

Abstract

BACKGROUND
Skin grafts are required in numerous clinical procedures, such as reconstruction after skin removal and correction of contracture or scarring after severe skin loss caused by burns, accidents, and trauma. The current standard for skin defect replacement procedures is the use of autologous skin grafts. However, donor-site tissue availability remains a major obstacle for the successful replacement of skin defects and often limits this option. The aim of this study is to effectively expand full thickness skin to clinically useful size using an automated skin reactor and evaluate auto grafting efficiency of the expanded skin using Yucatan female pigs.
METHODS
We developed an automated bioreactor system with the functions of real-time monitoring and remote-control, optimization of grip, and induction of skin porosity for effective tissue expansion. We evaluated the morphological, ultra-structural, and mechanical properties of the expanded skin before and after expansion using histology, immunohistochemistry, and tensile testing. We further carried out in vivo grafting study using Yucatan pigs to investigate the feasibility of this method in clinical application.
RESULTS
The results showed an average expansion rate of 180%. The histological findings indicated that external expansion stimulated cellular activity in the isolated skin and resulted in successful grafting to the transplanted site. Specifically, hyperplasia did not appear at the auto-grafted site, and grafted skin appeared similar to normal skin. Furthermore, mechanical stimuli resulted in an increase in COL1A2 expression in a suitable environment.
CONCLUSION
These findings provided insight on the potential of this expansion system in promoting dermal extracellular matrix synthesis in vitro. Conclusively, this newly developed smart skin bioreactor enabled effective skin expansion ex vivo and successful grafting in vivo in a pig model.

Keyword

Animal model; Skin transplantation; Tissue expansion devices; Skin bioreactor

MeSH Terms

Bioreactors
Burns
Cicatrix
Contracture
Extracellular Matrix
Female
Hand Strength
Humans
Hyperplasia
Immunohistochemistry
In Vitro Techniques
Methods
Models, Animal
Porosity
Skin Transplantation
Skin*
Swine
Tissue Expansion
Tissue Expansion Devices
Transplants