Enhancing skin epidermal stability - Biomaterials for Treating Skin Loss - page 135

wounds. Caravaggi et al . (2003) grafted Laserskin ® seeded with autologous
keratinocytes onto Hyalograft-3D ® seeded with fibroblasts on dorsal and plantar
diabetic ulcers. For dorsal ulcers there was a significant increase in healed ulcers
compared to the control.
Lobmann et al . (2003) evaluated use of Laserskin ® seeded with autologous
keratinocytes applied without a dermal element for the treatment of non-healing
diabetic foot lesions. Eleven out of 14 grafts were successful and of the non-
responders all had a higher stage arterial occlusive disease. A small tendency for
hyperkeratosis was noted although this diminished over time after grafting and
long term stability appeared to be promising, with no ulcer recurrences within a 12-
month period in responsive wounds. Hyalograft-3D ® followed by the application
of a Laserskin ® autograft has also been reported as a successful treatment for
severe scleroderma cutaneous ulcers which had been unresponsive to previous
therapeutic attempts with vasoactive drugs, steroids and immunosuppressors
(Giuggioli et al ., 2003).
Aplasia cutis congenita
Laserskin ® , in conjunction with dermal Hyalograft-3D ® has been used for the
reparation of a severe case of Aplasia cutis congenita (ACC) (Donati et al ., 2001).
Full healing was achieved leaving no scarring.
Tattoos
A study by Price et al . (2006) involving 23 patients investigated the effect of two
different esters of hyaluronic acid (Hyalomatrix ® ), without cultured fibroblasts,
for constructing the dermis followed by application of Laserskin ® . Of the two
esters, 11p75 (75% esterification) and 11p100 (100% esterification) the overall
indication is that the total ester had a beneficial effect on wound healing although
no statistical differences were noted for the stability of the epidermal layer.
Blistering occurred in both groups but healed readily. Stability is, however, known
to be affected by differences in the dermal matrix. Collagen-based matrices
(Integra ® ) have been poor recipients of cultured keratinocytes (Pandya et al. , 1998)
although there are few reports of the use of keratinocytes grown on hyaluronic acid
epidermal matrices in conjunction with collagen dermal elements (Chan et al .,
2001).
Traumatic soft tissue loss
A combination of Hyalograft-3D ® seeded with fibroblasts and Laserskin ® seeded
with keratinocytes followed by a thin meshed split thickness skin graft was applied
to large soft tissue injuries resulting from vehicle accidents (Hollander et al. ,
2001). A near total take rate of all sheets was reported, as was the formation of a