Reconstruction of extensive soft tissue loss by transplantation of dermal and epidermal equivalents

Abstract

The opportunities of autologous dermal and epidermal grafting as starting point for non-invasive reconstruction of extensive soft tissue defects will be demonstrated and discussed. Skin biopsies for cell cultivation were taken from patients with extensive acute soft tissue defects of different origin. Cultured autologous fibroblasts grown on three dimensional biocompatible scaffolds made up of benzyl ester of hyaluronan were transplanted as "neo-dermis" on debrided and conditioned wound sites. After incorporation of the dermal equivalents grafting of subconfluent proliferative keratinocytes on hyaluronan based laser perforated membranes was performed. Ten days later a 0.2 mm thin, 1 : 6 meshed autograft to create definite biomechanical stability was overlaid. Grafting of in vitro cultured autologous fibroblasts revealed a good vascularized dermal tissue substitute. After keratinocyte-transfer formation of thin epithelium was visible. Final closure of the defects with aesthetic and normo-elastic tissue properties was achieved after thin mesh-grafting. Preliminary results seem to be very promising. Clinical follow-up as well as histological and immunohistochemical outcome in the treatment of five extensive soft-tissue defects are discussed. As in all fields of tissue engineering, long-tem studies and cost-benefit analyses are required.