Meshed Skin Graft Research Articles

336 Outcomes Following Use of Negative-Pressure Wound Therapy Over Autologous Meshed and Non-Meshed Skin Grafts

336 Outcomes Following Use of Negative-Pressure Wound Therapy Over Autologous Meshed and Non-Meshed Skin Grafts

360 In Vivo Characterization of Burn Wound and Skin Graft Healing in a Porcine Model using Spatial Frequency Domain Imaging

Spatial frequency domain imaging (SFDI) is a wide-field optical imaging technique enabling non-invasive quantitative determination of sub-surface tissue properties. It provides structural information via the reduced scattering coefficient and chromophore concentrations (e.g. oxy- and de-oxyhemoglobin). We investigated SFDI for assessing healing progression in a porcine model of burn wounds treated with split-thickness skin grafts. Anesthetized Yorkshire pigs received deep partial thickness burns to their dorsum. Four days afterwards the wounds were debrided and autologous meshed split-thickness skin grafts were then applied. The wounds were imaged periodically over 60 days using SFDI at 9 wavelengths and their optical properties were determined. Concurrently, biopsies were taken for histological evaluation and comparison with the SFDI data. Additionally, one burn wound was debrided but received no treatment. Images and biopsies were also taken from regions of healthy skin as controls. All experiments followed protocols reviewed and approved by the Institutional Animal Care and Use Committee. The split-thickness skin grafts exhibited a decrease in scattering after grafting that recovered to values close to that of uninjured skin in 60 days, whereas the scattering of the debrided wound with no graft did not recover to baseline (Figure 1). These changes in scattering correlated with structural changes during healing that were evident in histology. Furthermore, the recovery in scattering for the grafts was less at longer wavelengths that penetrate deeper, indicating less complete healing at greater depths, which also agreed with histology. SFDI is capable of characterizing healing in porcine models of burn wounds and skin grafts. Changes in optical properties measured by SFDI tracked structural changes observed in histology. SFDI provides quantitative information on the subsurface properties of tissue without the need for invasive biopsies. SFDI can non-invasively evaluate wound healing therapies/strategies for burns. This can aid the development of new treatments that can ultimately shorten recovery times and improve outcomes.

Assessment of outcome of using amniotic membrane enriched with stem cells in scar formation and wound healing in patients with burn wounds

Background: In recent decades, various techniques include flaps and grafts have been deployed to heal deep burn wounds. All efforts tend to use a method which will cause faster epithelization and fewer scars. Amniotic membrane and stem-cells are shown to have unique properties in epithelization and wound healing for depth wounds. Objective: There are many studies in which the prevalence of using fresh amniotic membrane has been discussed as a biological dressing. In this study, we used frozen amniotic membrane enriched with stem-cells to evaluate the outcomes of this biological combination on epithelization rate, wound healing and scar formation in third-degree burn wounds.Method: In this study, we evaluated outcomes of using amniotic membrane enriched with stem-cells in the repair process of third-degree burn for 180 days after the reconstructive surgery. We divided the burn area into two sections of control (skin mesh graft only) and case (skin mesh graft with the dressing of amniotic membrane enriched with stem-cells). All patients were followed-up for 180-days to analyze the risk of infection, scar formation, and pain score during this period.Results: Our findings showed that there is a significant difference between pain score in case and control group only during the first 7-days of follow-up. The mean Vancouver scar scale score in case group is less than it in the control group and has a statistically significant relationship with it. Prevalence of infection in case and control group showed no statistically significant difference and yet, there was a significant difference between satisfaction in both groups.Conclusion: Using frozen amnion, in addition, to maintain the properties of fresh amnion, may reduce the risk of infection transfer. Also because of the unique properties of stem cells in reepithelization and wound healing, using amniotic membrane enriched with stem-cells may be an ideal dressing to treat depth wounds.Â

One-year outcome after repair of giant incisional hernia using synthetic mesh or full-thickness skin graft: a randomised controlled trial

PurposeRepair of giant incisional hernia often requires complex surgery and the results of conventional methods using synthetic mesh as reinforcement are unsatisfactory, with high recurrence and complication rates. Our hypothesis was that full-thickness skin graft (FTSG) provides an alternative reinforcement material for giant incisional hernia repair and that outcome is improved. The aim of this study was to compare FTSG with conventional materials currently used as reinforcement in the repair of giant incisional hernia.MethodsA prospective randomised controlled trial was conducted, comparing FTSG with synthetic mesh as reinforcement in the repair of giant (> 10 cm minimum width) incisional hernia. One-year follow-up included a blinded clinical examination by a surgeon and objective measurements of abdominal muscle strength using the Biodex-4 system.Results52 patients were enrolled in the study: 24 received FTSG and 28 synthetic mesh. Four recurrences (7.7%) were found at 1-year follow-up, two in each group. There were no significant differences regarding pain, patient satisfaction or aesthetic outcome between the groups. Strength in the abdominal wall was not generally improved in the study population and there was no significant difference between the groups.ConclusionThe outcome of repair of giant incisional hernia using FTSG as reinforcement is comparable with repair using synthetic mesh. This suggests that FTSG may have a future place in giant incisional hernia repair.

Erectile dysfunction after urethroplasty.

IntroductionThe aim of this study was to analyze the influence of urethroplasty on sexual function.Material and methodsWe analyzed 75 operations: 41 anastomotic, 13 labial graft, 6 thigh skin mesh graft, and 15 penile skin flap urethroplasties. The severity of erectile dysfunction was assessed in the International Index of Erectile Function (IIEF5) questionnaire, preoperatively and at least 3 months after the surgery. The appearance of possible penile deformities was also evaluated postoperatively.ResultsThe etiology and location of the stricture had no impact on the erectile dysfunction in men with untreated urethral stricture. The difference in mean IIEF5 score before and after the first urethroplasty was not statistically significant (12.58 ±9.01 and 10.88 ±9.28; t(42) = 1.25, p = 0.220). The length of the stricture had no impact on the preoperative and postoperative IIEF5 score. Stricture in penile urethra caused a risk of postoperative penile curvature (p = 0.023).ConclusionsPatients with urethral stricture have a higher rate of erectile dysfunction than healthy men. Proper therapy should not negatively affect erectile function in a significant way, regardless of the length or location of the stricture, though it may have some influence on the penile anatomy.

Fibrin as a Tissue Adhesive and Scaffold with an Angiogenic Agent (FGF-1) to Enhance Burn Graft Healing In Vivo and Clinically.

There is a need for a strategy to reduce scarring in meshed skin graft healing leading to a better cosmetic result without a significant increase in cost. The strategy in this paper is to increase the closure rate of a meshed skin graft to reduce scarring, which should also decrease the infection rate. Specifically, we used fibrin glue to attach all parts of the graft to the wound bed and added in an angiogenic growth factor and made the fibrin porous to further help the growth of blood vessels from the wound bed into the graft. There was a 10-day animal study and a one-month clinical study. Neither making the fibrin porous or adding an angiogenic agent (i.e., fibroblast growth factor-1 (FGF-1)) seemed to make a significant improvement in vivo or clinically. The use of fibrin on a meshed skin graft appears to speed up the regenerative healing rate leading to less scarring in the holes in the mesh. It appears to shorten the healing time by five days and keep the tissue stiffness close to normal levels vs. the doubling of the stiffness by the controls. A larger clinical study, however, is needed to definitively prove this benefit as well as the mechanism for this improvement.

Experience in the clinical use of allogeneic fibroblasts in patients with severe burns

Purpose. To evaluate the results of the application of allogenic fibroblasts in patients with extensive thermal burns.
 Methods. The study included 34 patients with burns over 20% TBSA, treated in the burn ICU. In accordance with the indications for transplantation of fibroblasts, all patients were divided into 4 groups: stimulation of regeneration of superficial burns (n = 10), stimulation of regeneration after meshed skin graft (n = 14), reduction of healing time for donor wounds (n = 6) and acceleration growth of granulations after the escharectomy (n = 4).
 Results. A positive effect of fibroblast transplantation was found in 7 (70%) patients of the first group, 13 (93%) of the patients in the second group, 2 (33%) of the third group and 2 (50%) in the fourth study group.
 Conclusion. The maximum positive effect of transplantation of human dermal fibroblasts can be observed when performing the meshed skin graft and treating the superficial burns.

Surgical sponge associated with platelets rich plasma in skin mesh grafts and layer in rabbits (Oryctolagus cuniculus)

ABSTRACT The aim of this study was to evaluate of the efficacy of PRP employment associated with surgical sponges to improve the integration of the graft in the recipient bed. It was held at the Veterinary Hospital UNESP, Campus of Jaboticabal - SP, a study of 64 rabbits, divided into eight groups with eight animals. The groups were divided in control with saline solution 0,9%, control with PRP both without the sponge, surgical sponge with PRP, surgical sponge without PRP, and were used mesh and layer grafts in the respective groups. The data were submitted to statistical analysis (paired t-test, Kruskal-Wallis test, with subsequent use of the multiple comparison tests of Dunn, analysis of variance (F) test, Tukey test, P< 0.05). Edema and exudate with 3 and 3 and 7 days (P= 0,03 e P= 0,0049); coloring on the 14th day (P= 0,0001); cosmetic appearance on the 7th and 14th day (P= 0,0026 and P= 0,0001); mononuclear cells (P= 0,01) and polymorphonuclear (P= 0,01); fibroblast proliferation (P= 0,01); collagenous (P= 0,05); hemorrhage (P-007); necrosis and re-epithelialization (P= 0,2928 and P= 0,1). We concluded that the use of Platelet Rich Plasma Gel on skin grafts associated with a sponge as a compressive dressing promote the skin graft survival without a previous granulation tissue.

Graft orientation influences meshing ratio

ObjectivesThe technique of meshed skin grafting is known since 1960s. It was shown that there is a difference between the declared and real expansion ratio of the skin meshed graft. We hypothesize that the orientation of the Langer’s lines in a split thickness skin graft is a key parameter in the resulting expansion ratio. MethodsThe skin graft meshing process was analyzed in two steps. In the first step, ex vivo uniaxial tests of human skin were performed. This served as an input for the constitutive model used for numerical simulations. In the second step, finite element analyses were performed so that stress distributions and expansion ratios could be determined. ResultsIt was shown that peaks of true stress tended to be concentrated around the vertex of the mesh pattern region for all cases. The declared expansion was impossible to obtain for all expansion ratios having the meshing incision perpendicular to the Langer’s lines. The highest difference between declared and real expansion ratio reaches 37%. ConclusionsWith regard to literature dealing with expansion of skin grafts by meshing, a high scatter amongst data results is observed. This finding was also explained by our research, demonstrating the significance of Langer’s lines and their relative orientation to the direction of meshing.

109 Demonstration of the Safety and Effectiveness of Autologous Skin Cell Suspension Combined with Meshed Skin Grafts for the Reduction of Donor Area in the Treatment of Acute Burns

109 Demonstration of the Safety and Effectiveness of Autologous Skin Cell Suspension Combined with Meshed Skin Grafts for the Reduction of Donor Area in the Treatment of Acute Burns

Meek micrografting history, indications, technique, physiology and experience: a review article.

Traumatic loss of skin, particularly in major burns, requires skin grafting to repair the tissue. For a large burn, where donor sites are limited, the skin graft may need to be expanded. In addition, rapid wound closure is a large factor in successful recovery and is usually achieved by debridement and skin grafting. Micrografting was introduced by Meek and involved dividing the skin into small pieces, allowing for up to a tenfold skin expansion. We conducted a review of the literature, searched via Medline, Pubmed and Embase (from 1958 to June 2017), searching to identify studies and reports of micrografting. We searched using the Medical Subject Headings (MeSH) 'micrograft', 'micrograft technique', 'Meek', 'Meek technique', 'Parker Cicero', 'major burn treatment' and 'mesh skin graft'. We analysed 24 articles in which the description and modifications presented by the micrograft technique were presented, along with evidence that supports or rejects its use. The consensus was for the use of micrografting in burns of >30% total body surface area (TBSA). On poor wound beds, the evaluation of re-epithelialisation had greater success due to low metabolic demands and greater skin coverage compared with control groups (p<0.005). Comparing the 'mesh' with 'Meek' group, the micrograft group had fewer surgeries (10 versus 19.75), shorter average length of hospital stay (51 days versus 120.5 days; p<0.05). Micrografting can be used where there is poor bed vascularity (such as in patients with diabetes), with higher success due to low metabolic demand. This is recommended for major burns, >30% TBSA, with inadequate donor sites and comorbidities, such as diabetes. However, disadvantages include a 'polka dot' appearance on healing and the fact the initial surgeries, creating the micrograft squares, are labour-intensive.

A Rare Case of Severe Muscular Necrosis Due to Extravascular Leakage of Trabectedin—Severe Tissue Damage of Trabectedin Extravasation

Trabectedin is a synthetic antineoplastic drug, binding to the minor groove of DNA and affecting DNA repair pathways, resulting in G2-M cell cycle arrest and apoptosis. Trabectedin has demonstrated high efficacy against various soft tissue sarcomas. However, its extravasation causes serious complications, such as tissue necrosis and a delay in the treatment of underlying diseases. Methods: We experienced a rare case in which trabectedin extravasation caused severe pectoralis major muscle necrosis. A 45-year-old man with multiple lung metastases of follicular dendritic cell sarcoma received 2.15 mg of trabectedin totally through a central venous access device (CVAD) system in the right precordium. Computed tomography showed extensive turbidity of subcutaneous fatty tissue and swelling of the pectoralis major muscle to the upper margin of the liver, and the creatine kinase level was elevated to 759 U/L (reference value from 54 to 286). We performed surgical debridement twice, and the CVAD was concomitantly removed; thereafter, the skin defect was reconstructed with a split skin mesh graft. Results: Histopathology showed extreme degeneration of striated muscle and fatty tissue. Unfortunately, disability of the right arm abducens persisted after treatment because of debridement around the right humerus muscle. Discussion: Several reports have described cases of the extravasation of trabectedin. A few have mentioned severe muscular degeneration similar to that shown in the present case. Because trabectedin is a strong vesicant cytotoxic agent, it is principally administered through a CVAD rather than peripheral vessels and is continued during the nighttime; this can lead to a delay in patients or attending doctors noticing any extravasation. We need to spread appropriate knowledge of this drug and make an effort to prevent severe complications like in the present case.

Repair soft-tissue defect in forefoot with reversed lateral soleus muscle flap

To summarize clinical application results of repair soft tissue defect in forefoot with a reversed lateral soleus muscle flap on peroneal artery pedicle. From January 2005 to January 2013, 8 patients with soft-tissue defect on forefoot were underwent reconstruction with a reversed lateral soleus muscle flap on peroneal artery pedicle. There were 6 males and 2 female, aged from 16 to 48 years with an average of 26.8 years old. The reversed lateral soleus muscle flap was transposed to the forefoot defect area, then immediate coverage of the muscle flaps were performed by a meshed split-thickness free skin graft. The donor site was closed directly. The muscle flap survey was observed after the repair of the forefoot. All muscle flaps had survived completely. No clinical vascular deficiency was found on muscle flaps postoperatively. One case occurred recipient area sustained insignificant superficial infection, one patient developed distal muscle flap small skin graft necrosis, and spontaneous heal by 2 weeks' change dressing. Follow-up period was ranged form 2.5 to 5.5 years with an average of 3.5 years postoperatively. A good contour was confirmed at the recipient area. According to Cedell questionnaire, 6 patients obtained good results and 2 fair. When the local skin flap or muscle flap application is limited, lateral soleus muscle flap survey is satisfactory after repair and very suitable for repair of soft tissue defect of forefoot.

Novel Application of Cultured Epithelial Autografts (CEA) with Expanded Mesh Skin Grafting Over an Artificial Dermis or Dermal Wound Bed Preparation.

Cultured epithelial autografts (CEA) with highly expanded mesh skin grafts were used for extensive adult burns covering more than 30% of the total body surface area. A prospective study on eight patients assessed subjective and objective findings up to a 12-month follow-up. The results of wound healing for over 1:6 mesh plus CEA, gap 1:6 mesh plus CEA, and 1:3 mesh were compared at 3, 6, and 12 months using extensibility, viscoelasticity, color, and transepidermal water loss by a generalized estimating equation (GEE) or generalized linear mixed model (GLMM). No significant differences were observed among the paired treatments at any time point. At 6 and 12 months, over 1:6 mesh plus CEA achieved significantly better expert evaluation scores by the Vancouver and Manchester Scar Scales (p < 0.01). Extended skin grafting plus CEA minimizes donor resources and the quality of scars is equal or similar to that with conventional low extended mesh slit-thickness skin grafting such as 1:3 mesh. A longitudinal analysis of scars may further clarify the molecular changes of scar formation and pathogenesis.

A comparative clinical study of partial thickness mesh skin grafts with and without addition of platelet rich plasma in dogs

The objective of this study was to reconstruct the skin defects with partial thickness mesh skin grafts and to compare the efficacy of platelet rich plasma along with skin grafting. The present study was performed on ten dogs with twelve wounds which were unamenable to primary closure. All the wounds were reconstructed with partial thickness mesh skin grafting technique in which six wounds were assigned to group–I and remaining were similarly reconstructed followed by injection of platelet rich plasma were assigned to group-II. It was concluded from the present study that, partial thickness mesh skin grafting procedure showed good results for correction of skin defects. The group II wounds showed early primary healing with no difference in graft viability.

Efficacy of Conventional and Liposomal Povidone-Iodine in Infected Mesh Skin Grafts: An Exploratory Study.

IntroductionInfection is a major threat to wound healing and a leading cause of graft loss in patients undergoing meshed skin grafts (MSGs). Therefore, topical antisepsis is important in the overall treatment scheme.MethodsAn exploratory satellite group of 14 patients with infected MSGs were enrolled as part of a prospective, randomized, controlled, parallel-group, open-label, pilot Phase II study that investigated the efficacy and tolerability of 3% liposomal povidone–iodine hydrogel (PVP–ILH, Repithel®; RepiGel®) versus chlorhexidine gauze in non-infected MSGs. The satellite group included both patients with infected wound beds prior to grafting and patients with infection of a previously placed graft, with MSG sizes ranging from 50 to 1000 cm2, who were randomized to treatment with (PVP–ILH) or 10% povidone–iodine ointment (Betaisodona®; BETADINE®). Medication was applied in a 2-mm layer and dressing changes with identical application of study medication took place daily. Wounds were evaluated by photoplanimetry, microbiologically and subjectively by patients and physicians.ResultsThe results for the main study group have been reported previously. In the satellite group, both PVP–ILH and povidone–iodine ointment performed remarkably well with respect to lowering the bacterial count and restoring wound healing, with different emphasis. Povidone–iodine ointment showed excellent antibacterial efficacy with no detectable microorganisms by Day 10, and rapid re-epithelialization (mean 90% by Day 6). PVP–ILH also demonstrated rapid re-epithelialization (mean 72% by Day 6) with a trend towards improved subjective measures of wound healing quality. Four patients (40%) receiving PVP–ILH experienced partial graft loss (10–15% of total MSG area); no patients in the povidone–iodine ointment group experienced graft loss.ConclusionOur results suggest that povidone–iodine ointment has a strong role in managing infected wounds, especially when a high concentration of povidone–iodine may be warranted, while PVP–ILH indicated similar beneficial results on markers of wound healing quality in larger infected wounds.Trial RegistrationThe trial was conducted prior to mandatory registration of drug products, PVP–ILH represents a medicated device in the EU and many other countries.FundingMundipharma Research GmbH & Co. KG.

Differential effects of Losartan and Atorvastatin in partial and full thickness burn wounds.

Healing of burn wounds is often associated with scar formation due to excessive inflammation and delayed wound closure. To date, no effective treatment is available to prevent the fibrotic process. The Renin Angiotensin System (RAS) was shown to be involved in fibrosis in various organs. Statins (e.g. Atorvastatin), Angiotensin receptor antagonists (e.g. Losartan) and the combination of these drugs are able to reduce the local RAS activation, and reduced fibrosis in other organs. We investigated whether inhibition of the RAS could improve healing of burn wounds by treatment with Atorvastatin, Losartan or the combination of both drugs. Therefore, full and partial thickness burn wounds were inflicted on both flanks of Yorkshire pigs. Oral administration of Atorvastatin, Losartan or the combination was started at post-burn day 1 and continued for 28 days. Full thickness wounds were excised and transplanted with an autologous meshed split-thickness skin graft at post-burn day 14. Partial thickness wounds received conservative treatment. Atorvastatin treatment resulted in enhanced graft take and wound closure of the full thickness wounds, faster resolution of neutrophils compared to all treatments and reduced alpha-smooth muscle actin positive cells compared to control treatment. Treatment with Losartan and to a lesser extent the combination therapy resulted in diminished graft take, increased wound contraction and poorer scar outcome. In contrast, Losartan treatment in partial thickness wounds decreased the alpha-smooth muscle actin+ fibroblasts and contraction. In conclusion, we showed differential effects of Losartan and Atorvastatin in full and partial thickness wounds. The extensive graft loss seen in Losartan treated wounds is most likely responsible for the poor clinical outcome of these full thickness burn wounds. Therefore, Losartan treatment should not be started before transplantation in order to prevent graft loss. Atorvastatin seems to accelerate the healing process in full thickness wounds possibly by dampening the pro-inflammatory response.

Cultured Human Epidermis Combined With Meshed Skin Autografts Accelerates Epithelialization and Granulation Tissue Formation in a Rat Model.

IntroductionAs the take rate of cultured epidermal autografts in burn wound treatment is variable, widely expanded meshed auto skin grafts are often used in combination with cultured epidermal autograft to increase the take rate and achieve definitive wound coverage. However, a long time (3–4 weeks) required to prepare a cultured epidermis sheet is a disadvantage. Allogeneic cultured epidermis can be prepared in advance and cryopreserved to be used in combination with auto meshed skin grafts for treating third-degree burns. Nevertheless, the human cultured epidermis (hCE) has not been proved to accelerate wound healing after meshed skin grafting. Here, we investigated the effect of hCE on wound healing in a rat model of meshed skin grafting.Materials and MethodsHuman cultured epidermis was prepared from human neonatal foreskin and assessed by the release of growth factors into the culture medium using enzyme-linked immunosorbent assay. Skin wounds were inflicted on male F344 rats and treated by the application of widely meshed (6:1 ratio) autogenous skin grafts with or without hCE (n = 8 rats per group). Wound area, neoepithelium length, granulation tissue formation, and neovascularization were evaluated on day 7 postgrafting.ResultsHuman cultured epidermis secreted IL-1α, Basic fibroblast growth factor, platelet-derived growth factor-AA, TGF-α, TGF-β1, and vascular endothelial growth factor in vitro. In rats, hCE accelerated wound closure (P = 0.003), neoepithelium growth (P = 0.019), and granulation tissue formation (P = 0.043), and increased the number of capillaries (P = 0.0003) and gross neovascularization area (P = 0.008) compared with the control group.ConclusionsThe application of hCE with meshed grafts promoted wound closure, possibly via secretion of growth factors critical for cell proliferation and migration, suggesting that hCE can enhance the healing effect of widely expanded skin autografts.

Negative pressure wound therapy using polyvinyl alcohol foam to bolster full‐thickness mesh skin grafts in dogs

To report the use of negative pressure wound therapy (NPWT) with polyvinyl alcohol (PVA) foam to bolster full-thickness mesh skin grafts in dogs. Retrospective case series. Client-owned dogs (n = 8). Full-thickness mesh skin graft was directly covered with PVA foam. NPWT was maintained for 5 days (in 1 or 2 cycles). Grafts were evaluated on days 2, 5, 10, 15, and 30 for graft appearance and graft take, granulation tissue formation, and complications. Firm attachment of the graft to the recipient bed was accomplished in 7 dogs with granulation tissue quickly filling the mesh holes, and graft take considered excellent. One dog had bandage complications after cessation of the NPWT, causing partial graft loss. The PVA foam did not adhere to the graft or damage the surrounding skin. The application of NPWT with a PVA foam after full-thickness mesh skin grafting in dogs provides an effective method for securing skin grafts, with good graft acceptance. PVA foam can be used as a primary dressing for skin grafts, obviating the need for other interposing materials to protect the graft and the surrounding skin.

Abstract: 10.40 Paracrine Factors From Human Peripheral Blood Mononuclear Cells Improve Wound Healing, Scar Quality, And Angiogenesis In A Porcine Burn Model

INTRODUCTION: Burn injuries are a serious threat to patients and often require surgical treatment. Split-thickness skin grafting aims to achieve rapid wound closure but requires a well-vascularized wound bed. The cell-free secretome of peripheral blood mononuclear cells (PBMCs) _ comprising all secreted factors produced over 24 hours _ has been shown to improve wound healing and angiogenesis in previous studies. We used human PBMC secretomes in an in vivo model that resembles the clinical setting to investigate its potential to improve the quality of regenerating skin, increase angiogenesis, and reduce scar formation after burn injury and skin grafting. MATERIALS AND METHODS: Human PBMC secretomes were harvested after 24 hours under standard cell culture conditions. Gamma irradiation was used to induce apoptosis and create an additional stimulus. Standardized full-thickness burn injuries were created on the back of female pigs. After 24 hours, the necrotic areas were excised and the wounds were covered with split-thickness mesh skin grafts. Wounds were treated repeatedly with either the secretome of cultured PBMCs (SecPBMC), apoptotic PBMCs (Apo-SecPBMC), or controls. Wounds were analysed and wound biopsies were taken on days 2, 5, and 10. RESULTS: We found a markedly increased mean epidermal thickness in wounds treated with either SecPBMC (116.7 μm ± 34.7) or Apo-SecPBMC (133.2 μm ± 37.6) compared to the medium (78.3 μm ± 29.2) and NaCl groups (79.3 μm ± 13.7). Epidermal differentiation (expression of keratin-10) was more advanced in the treated wounds compared to controls. Apo-SecPBMC treatment induced a two-fold increase in CD31+ cells (p<0.05 vs. all other groups), indicating more angiogenesis. The parameters of early scarring were improved in secretome-treated wounds. CONCLUSIONS: These data suggest that the repeated application of PBMC secretomes significantly improves wound healing, skin quality, and scar formation in a porcine model of burn injury and skin grafting.