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    Alternative to skin grafting

    Stem cells, advanced technology makes future of wound healing for burn patients look promising

    Skin substitutes hold much potential for wound healing and will offer an alternative to skin grafting, according to a scientist at Sunnybrook Research Institute, Ross Tilley Burn Centre, Toronto, Ontario, Canada.

    "We can make skin substitutes using cells from patients. There are adult stem cells in almost every organ of the body and these cells are potential sources of cells for skin regeneration," explains Saeid Amini-Nik M.Sc., M.D., Ph.D., a stem cell biologist who spoke during the annual meeting of the Canadian Association of Wound Care (November 2016, Niagra Falls, Ontario, Canada).

    Growing burden

    With the aging of the population and the rising incidence in diabetes, there is a growing burden in managing wounds with deficient healing, according to Dr. Amini-Nik. The cost of the treatment of chronic wounds in the United States has been put at more than $25 billion annually, he notes1.

    There are an estimated two million burns annually in the United States, 70K of which require hospitalization. Dr. Amini-Nik notes that 10K patients in the United States die annually of infections or other complications associated with serious burns.

    Even when patients survive burn injuries, there are some ongoing issues that they have to cope with such as pain and scarring, Dr. Amini-Nik notes.

    "If patients survive, there is a high morbidity and a strong psychosocial impact," he says.

    When there is an injury to the skin, normal healing with a scar does not always occur2,3, explains Dr. Amini-Nik, an assistant professor in the department of surgery at the University of Toronto in Toronto.

    Skin healing can be deficient because of the presence of systemic conditions like diabetes, and it can be deficient in the elderly population4,5, Dr. Amini-Nik notes.

    "Sometimes there can be excessive healing, and that is associated with scars like keloids," Dr. Amini-Nik says.

    Human skin is a reservoir for stem cells. Here we see human skin stained with different markers of stem cells and differentiated cells. Photo: Saeid Amini-Nik M.Sc., M.D., Ph.D.

    Restoring skin

    Skin grafting is a means of restoring the skin so it can again perform multiple functions such as acting as a barrier and keeping the body hydrated, Dr. Amini-Nik says. However, bleeding, infection, and nerve damage can occur. Repeat skin grafts may be required, thus making skin grafting an inefficient process, Dr. Amini-Nik explains.

    Skin substitutes have reduced morbidity and mortality associated with skin wounds, but there are some disadvantages with using cultured skin substitutes, according to Dr. Amini-Nik. Those include a wait time of three to 12 weeks after taking a biopsy before applying a cultured skin substitute, and the potentially significant cost of the application of a cultured skin substitute to a wound.

    "The cost of a cultured skin substitute is about $15 per cm2," Dr. Amini-Nik says.

    In addition, inadequate skin regeneration may result when wounds are very inflammatory, Dr. Amini-Nik explains.

    Most skin substitutes that are used in wound healing are acellular and fail to use growth factors to aid in wound healing. Basic elements of an effective skin substitute would include scaffold materials, growth factor and cells, Dr. Amini-Nik6 says.

    NEXT: Hydrogel skin substitute

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