Systematic Review: Adipose-Derived Mesenchymal Stem Cells, Platelet-Rich Plasma and Biomaterials as New Regenerative Strategies in Chronic Skin Wounds and Soft Tissue Defects.

Pietro Gentile,Simone Garcovich

doi:10.3390/ijms22041538

Abstract

The number of clinical trials evaluating adipose-derived mesenchymal stem cells (AD-MSCs), platelet-rich plasma (PRP), and biomaterials efficacy in regenerative plastic surgery has exponentially increased during the last ten years. AD-MSCs are easily accessible from various fat depots and show intrinsic plasticity in giving rise to cell types involved in wound healing and angiogenesis. AD-MSCs have been used in the treatment of soft tissue defects and chronic wounds, employed in conjunction with a fat grafting technique or with dermal substitute scaffolds and platelet-rich plasma. In this systematic review, an overview of the current knowledge on this topic has been provided, based on existing studies and the authors’ experience. A multistep search of the PubMed, MEDLINE, Embase, PreMEDLINE, Ebase, CINAHL, PsycINFO, Clinicaltrials.gov, Scopus database, and Cochrane databases has been performed to identify papers on AD-MSCs, PRP, and biomaterials used in soft tissue defects and chronic wounds. Of the 2136 articles initially identified, 422 articles focusing on regenerative strategies in wound healing were selected and, consequently, only 278 articles apparently related to AD-MSC, PRP, and biomaterials were initially assessed for eligibility. Of these, 85 articles were excluded as pre-clinical, experimental, and in vitro studies. For the above-mentioned reasons, 193 articles were selected; of this amount, 121 letters, expert opinions, commentary, and editorials were removed. The remaining 72 articles, strictly regarding the use of AD-MSCs, PRP, and biomaterials in chronic skin wounds and soft tissue defects, were analyzed. The studies included had to match predetermined criteria according to the patients, intervention, comparator, outcomes, and study design (PICOS) approach. The information analyzed highlights the safety and efficacy of AD-MSCs, PRP, and biomaterials on soft tissue defects and chronic wounds, without major side effects.

Highlights

A scientific, clinical need exists for the development of biotechnologies to improve wound healing (WH), soft tissue defects (STDs), and skin repair (SR) in regenerative plastic surgery (RPS).The number of investigations evaluating the efficacy of autologous platelet-rich plasma (PRP), adult stem cell-based therapy (A-SC-BT), in particular those based on adipose-derived mesenchymal stem cells (AD-MSCs) and biomaterials, have exponentially increased during the last decade (2010–2020).As the largest organ of the body, the skin, acts as an important barrier against the invasion of foreign microorganisms and has the functions of immunity, thermoregulation, and metabolic activities [1]
A total of 422 articles were initially identified and 1714 articles were excluded for several reasons, including duplicates n = 333), not a correct match after the title’s/abstract’s screening n = 301), not human studies n= 276), not related to regenerative strategies (RS) n = 164), not related to PRP, AD-MSCs, and biomaterials n = 442), and not correct match with the topic after full-text reading n = 198)
The 72 articles that strictly related to the use of RS based on AD-MSCs, PRP, and biomaterials in chronic skin wounds (CSW) and STDs were analyzed (Scheme 1)

Summary

Introduction

A scientific, clinical need exists for the development of biotechnologies to improve wound healing (WH), soft tissue defects (STDs), and skin repair (SR) in regenerative plastic surgery (RPS).The number of investigations evaluating the efficacy of autologous platelet-rich plasma (PRP), adult stem cell-based therapy (A-SC-BT), in particular those based on adipose-derived mesenchymal stem cells (AD-MSCs) and biomaterials, have exponentially increased during the last decade (2010–2020).As the largest organ of the body, the skin (consisting of the epidermis, the dermis, and its appendices), acts as an important barrier against the invasion of foreign microorganisms and has the functions of immunity, thermoregulation, and metabolic activities [1]. Autografts, split-thickness skin graft (STSG) or skin flap transplantation, are considered to be important managements for aiding full-thickness skin defects [2,3]. Due to the disadvantages (e.g., complicated operation, severe damage to the donor area, bloated appearance, high failure rate, etc.), skin flap transplantation is not as widely used in clinical practice as skin grafts [4]. Despite the better take-in in the early stage, skin grafts lacking sufficient dermal matrix are often hindered by uncontrollable scar hyperplasia, lower mechanical resistance, and so forth in the later phase, leading to graft failure or severe scar formation, which seriously affects the local appearance and functions [5]. Understanding how to avoid severe scar hyperplasia and contracture in the later phase is a key difficulty that needs to be overcome in skin grafting. Whether the skin graft has sufficient blood supply is the main factor affecting the quality of the skin graft [6]

Methods

Results

Discussion

Conclusion