Skin Micrograph Protector in a Burn Wound: Alloderm or Hydrogel Coating?

AIM OF STUDY Was to compare the dynamics of engraftment of skin micrographs in a burn wound when using protectors from an allodermal graft and from a hydrogel coating.

MATERIAL AND METHODS The experimental study was conducted on 18 rats with a scab formed 3 days after modeling a deep burn with an area of 20% of the body surface. Partial fascial necrectomy was performed: two rounded sections of the sling with a diameter of 25 mm were excised. 6 automicrographs of skin 4x4 mm, 0.3 mm thick, were applied to each surface freed from the scab. In each animal, micrographs on one of the wounds were covered with a hydrogel protector, on the other with an allodermotransplant from another animal of the group. A secondary aseptic dressing was applied to the protectors. On the 5th and 20th days after the operation, the state of micrographs was studied: blood circulation — according to laser Doppler flowmetry, microstructure in vivo — using optical coherence tomography, microstructure ex vivo — according to histological examination of biopsies.

ReSUlTS Differences in the rate of restoration of blood circulation of micrographs in the early stages of the postoperative period were found. In the first 5 days, the perfusion of micrographs under an allodermal protector exceeded the indicator in micrographs under a hydrogel coating by 44 [21; 51] % (p=0.031) due to the contribution of endothelial and neurogenic mechanisms of blood flow modulation. Starting from day 10, the differences in perfusion were levelled, but there were signs of more active endothelial regulation of blood flow under the skin (p=0.028). Histologically, the appearance of full-blooded capillaries was revealed earlier in micrographs under the alloderm than when using a hydrogel protector. By 20 days, under the condition of regular change of hydrogel coatings, the area of wound healing under the studied coatings did not significantly differ. However, the structure of the integumentary tissue under the alloderm according to the optical coherence tomography data was closer to normal skin than when using a hydrogel protector.

CONClUSIONS From the point of view of the physiology of the wound process, alloderm is the preferred option of an autograft protector in comparison with a hydrogel coating, which is probably due to the paracrine biological activity of the alloderm. However, hydrogel coatings can provide a comparable level of efficiency, provided they are regularly changed and, potentially, given the properties of cytokine activity.

1. Alekseev AA, Kozhemyakina VV, Malyutina NB, Bobrovnikov AE. Optimization of Outcomes of Skin Restoration in Patients with Deep Burns. Lechenie i profilaktika. 2020;10(1):73–79. (in Russ.)

2. Alekseev AA, Bobrovnikov AE, Malyutina NB. Emergency and Emergency Medical Care After Burn Injury. Medical Alphabet. 2016;2(15(278)):6–12. (in Russ.)

3. Alekseev AA, Bobrovnikov AE, Bogdanov VV. Meaning of Innovative Technologies for Improvement of Results in Treating Burned Patients. Medical Alphabet. 2020;(13):44–47. (in Russ.) https://doi.org/10.33667/2078-5631-2020-13-44-47

4. Leung JJ, Fish J. Skin Grafts. Univ Toronto Med J. 2009;86(2):61–64.

5. Meek CP. Successful microdermagrafting using the Meek-Wall microdermatome. Am J Surg. 1958;96(4):557–558. PMID: 13571547 https://doi.org/10.1016/0002-9610(58)90975-9

6. Kamolz LP, Schintler M, Parvizi D, Selig H, Lumenta DB. The real expansion rate of meshers and micrografts: things we should keep in mind. Ann Burns Fire Disasters. 2013;26(1):26–29. PMID: 23966895

7. Cleland H, Wasiak J, Dobson H, Paul M, Pratt G, Paul E, et al. Clinical application and viability of cryopreserved cadaveric skin allografts in severe burn: a retrospective analysis. Burns. 2014;40(1):61–66. PMID: 24018216 https://doi.org/10.1016/j.burns.2013.05.006

8. Pianigiani E, Ierardi F, Cherubini Di Simplicio F, Andreassi A. Skin bank organization. Clin Dermatol. 2005;23(4):353–356. PMID: 16023930 https://doi.org/10.1016/j.clindermatol.2004.07.016

9. Shen ZA. Application of allogeneic skin in burn surgery. Zhonghua Shao Shang Za Zhi. 2019;35(4):243–247. PMID: 31060170 https://doi.org/10.3760/cma.j.issn.1009-2587.2019.04.002

10. Tanaka H, Aoki D, Shimazaki S. Skin allograft and skin bank. Nihon Geka Gakkai Zasshi. 2005;106(12):755–759. PMID: 16869130

11. Keswani SM, Mishra MG, Karnik S, Dutta S, Mishra M, Panda S, et al. Skin banking at a regional burns centre – The way forward. Burns. 2018;44(4):870–876. PMID: 29661552 https://doi.org/10.1016/j.burns.2017.11.010

12. Tavousi SH, Ahmadabadi A, Sedaghat A, Khaleghi E, Rashchi M, Bonakdaran Z. Skin allograft procurement and transplantation in Mashhad, Iran: Are burn patients’ needs being met? Cell Tissue Bank. 2017;18(3):397–402. PMID: 28439732 https://doi.org/10.1007/s10561-017-9626-5

13. Kitala D, Kawecki M, Klama-Baryła A, Łabuś W, Kraut M, Glik J, et al. Allogeneic vs. Autologous Skin Grafts in the Therapy of Patients with Burn Injuries: A Restrospective, Open-label Clinical Study with Pair Matching. Adv Clin Exp Med. 2016;25(5):923–929. PMID: 28028957 https://doi.org/10.17219/acem/61961

14. Pleshkov AS. Development of allograft skin for wound coverage (Review of the literature). Medicо-Biological and Socio-Psychological Problems of Safety in Emergency Situations. 2016;(2):34–46. (in Russ.) https://doi.org/10.25016/2541-7487-2016-0-2-34-46

15. Izmailov GA, Izmailov SG, Popov AN. Kombinierte autoallodermoplastik: klinische begrundungihrer anwendung. Zeitschrift Dermatologie Deren Grenzgebiete. 1996;182(1):13–14; 16.

16. Sachkov AV, Borovkova NV, Zhirkova EA, Mironov AS, Borisov VS, Spiridonova TG, et al. Use of cadaver skin in the treatment of wounds. The Russian Journal of Transplantation. 2018;10(4):327–335. https://doi.org/10.23873/2074-0506-2018-10-4-327-335

17. Wang C, Zhang F, Lineaweaver WC. Clinical Applications of Allograft Skin in Burn Care. Ann Plast Surg. 2020;84(3):158–160. PMID: 32028339 https://doi.org/10.1097/SAP.0000000000002282

18. Makarova ME, Borisov VS, Sachkov AV, Kaplunova MYu. Primenenie gidrogeley v praktike khirurga priemnogo otdeleniya ozhogovogo tsentra. Moskovskaya meditsina. 2019;(4):73. (in Russ.)

19. Pan Z, Ye H, Wu D. Recent advances on polymeric hydrogels as wound dressings. APL Bioeng. 2021;5(1):011504. PMID: 33644627 https://doi.org/10.1063/5.0038364eCollection 2021 Mar.

20. Karyakin NN, Klemenova IA, Luzan AS. The outcomes of lower extremities burn wounds management by using of controlled moist environment. Pirogov Russian Journal of Surgery. 2017;(7):40–43. (in Russ.). https://doi.org/10.17116/hirurgia2017740-43

21. Pang C, Ibrahim A, Bulstrode NW, Ferretti P. An overview of the therapeutic potential of regenerative medicine in cutaneous wound healing. Int Wound J. 2017;14(3):450–459. PMID: 28261962 https://doi.org/10.1111/iwj.12735

22. Tottoli EM, Dorati R, Genta I, Chiesa E, Pisani S, Conti B. Skin Wound Healing Process and New Emerging Technologies for Skin Wound Care and Regeneration. Pharmaceutics. 2020;12(8):735. PMID: 32764269 https://doi.org/10.3390/pharmaceutics12080735

23. Zhang L, Yin H, Lei X, Johnson N, Lau Y, Yuan M, et al. A Systematic Review and Meta-Analysis of Clinical Effectiveness and Safety of Hydrogel Dressings in the Management of Skin Wounds. Front Bioeng Biotechnol. 2019;7:342. PMID: 31824935 https://doi.org/10.3389/fbioe.2019.00342eCollection 2019.

24. Beschastnov VV, Ryabkov MG, Leontiev AE, Tulupov AA, Yudanova TN, Shirokova IYu, et al. Viability of Bacteriophages in the Complex Hydrogel Wound Dressings in vitro. Modern Technologies in Medicine. 2021;13(2):20–27. (in Russ.) https://doi.org/10.17691/stm2021.13.2.0

25. Kaur P, Gondil VS, Chhibber S. A novel wound dressing consisting of PVA-SA hybrid hydrogel membrane for topical delivery of bacteriophages and antibiotics. Int J Pharm. 2019;572:118779. PMID: 31740093 https://doi.org/10.1016/j.ijpharm.2019.118779

26. Gladkova ND, Petrova GA, Nikulin NK, Radenska-Lopovok SG, Snopova LB, Chumakov YuP, et al. In vivo optical coherence tomography imaging of human skin: norm and pathology. Skin Res Technol. 2001;6(1):6–16. PMID: 11428936 https://doi.org/10.1034/j.1600-0846.2000.006001006.x

27. Petrova GA, Petrova KS, Nemirova SV, Potekaev NN, Ksenofontov SYu, Vasilenkova TV. 3D-opticheskaya kogerentnaya tomografiya: prizhiznennaya otsenka morfologicheskikh osobennostey zdorovoy kozhi i patomorfologicheskaya diagnostika dermatozov. Nizhniy Novgorod: IP Yakushov Yu.I. Publ.; 2018. (in Russ.)

28. Petrova GA, Petrova KS, Nemirova SV, Karpenko AA. 3D optical coherence tomography: possibilities in the diagnosing skin neoplasms. Klinicheskaya Dermatologiya i Venerologiya. 2019;18(6):715–727. (In Russ.). https://doi.org/10.17116/klinderma201918061715

29. Deegan AJ, Lu J, Sharma R, Mandell SP, Wang RK. Imaging human skin autograft integration with optical coherence tomography. Quant Imaging Med Surg. 2021;11(2):784–796. PMID: 33532277 https://doi.org/10.21037/qims-20-750