Autologous mesenchymal stem cells application in post-burn scars treatment: a preliminary study.

Mesenchymal stem cells (MSCs) are multi-potent cells characterized by long term self-renewal and by potential for differentiation into cells of different mesenchymal tissue types such as fibroblasts, osteocytes, chondrocytes, and adipocytes. Their unique properties offer broad therapeutic potentials. Bone marrow has been used as the most common MSCs source, but it is gradually going to be replaced by adipose tissue which showed to contain more MSCs per unit than the bone marrow and clinical application of MSCs procured from the adipose tissue have been demonstrating at least similar results. Post-burn scars result frequently in severe both functional and aesthetic impairments in restitution and rehabilitation periods of the burn disease. Despite extensive research in the last decades, the exact mechanisms of scar formation remains unclear. The development of post-burn scars is influenced by multiple factors such as initial depth of the burn, methods of burn wound therapy, duration of the open wound until final wound closure, burn wound infection, genetic predisposition, and many others in both acute and rehabilitation periods. The aim of this study was to point out versatility of the implementation of this method with respect to different types of scars (atrophic scars, hypertrophic scars, keloids). Autologous adipose tissue derived MSCs were applied to post-burn scars in all 8 patients undergoing surgical scar reconstructions at the Department of Burns and Reconstructive Surgery of the University Hospital in Bratislava. The study was approved by Ethical Committee of Ruzinov Hospital. The procedures used for scar reconstructions included dermabrasion, scar excisions, contractures corrections and local plasties combined by lipografting of lipoaspirate containing parenchymal adipocytes and stromal vascular fraction including MSCs, or application of separated autologous MSCs isolated from lipoaspirates. Based on desired result one of these MSCs application methods was selected depending on characteristics of reconstructed scar and required volume of transferred fat. Isolation of MSCs following procurement was provided by the Central Tissue Bank cell culture laboratory which is one of the parts of the burn department. The average time of scars duration was 79 months, ranging from 6 to 216 months. The postburns scars were assessed clinically according to Vancouver Scar Scale (VSS) prior to surgery, including photo documentation, and re-evaluated after 6 months following MSCs application. As the results have shown, the average VSS score before treatment was 7.88 points ranging from 4 to 11 points. The average VSS 6 months after surgical procedure and MSCs application was 2.34 points ranging from 1 to 4 points. According to the results obtained, the favourable effect of adipose tissue derived autologous MSCs application on scar remodelling following surgical reconstruction of post-burn scars could be promising.

Mesenchymal stem cells for chronic wounds therapy.

Wound healing is a complex process that involves interaction of soluble mediators, extracellular matrix and infiltrating blood cells. Chronic and non-healing skin defects contribute significantly to morbidity and mortality of many patients. Recently, despite the current medical progress, the chronic and non-healing wounds still represent a serious medical problem. In many cases, conventional therapeutic approaches, such as dermal substitutes and growth factor therapy failed and do not produce the expected results, patients are exposed to a high risk of infection, sepsis or amputation. For that reason clinicians and researchers are forced to searching for alternative methods to induce healing process which may result into complete wound closure. Mesenchymal stem cells (MSCs) represent a unique tool of tissue engineering and regenerative medicine and a promising therapeutic strategy. Due to their unique biological properties, MSCs seem to be the perspective modality method for these patients. Many preclinical and clinical studies suggest the possibility of using these cells in tissue regeneration, healing acute and chronic wounds and scar remodelling. The objective of the present review is to summarize the current information and preclinical data about MSCs, their biological characteristics and mode of action during regenerative and healing processes, as well as their clinical application in chronic wounds treatment.

Clinical Experience With the Use of Negative Pressure Wound Therapy Combined With a Silver-impregnated Dressing in Mixed Wounds: A Retrospective Study of 50 Cases.

UNLABELLED: Although negative pressure wound therapy (NPWT) has been used for more than 20 years, as far as the authors are aware, there is little research aimed at the evaluation of the combination of NPWT with a silver-impregnated dressing. OBJECTIVE: The aim of this study was to examine the effect, efficacy, and safety of NPWT in conjunction with a silver-impregnated dressing. MATERIALS AND METHODS: The authors used a retrospective study of 54 acute and chronic wounds treated in 50 patients over a 2-year period. Demographic data, wound characterizations, wound cultures before and after NPWT, the duration of NPWT and number of sponge changes for each patient, the types of surgical procedures used for wound closure following NPWT, and the healing time and length of hospital stays were recorded. RESULTS: In 26 wounds, deep structures (ie, bones and tendons) were exposed. The mean NPWT duration was 9.2 days. Mean healing time was 16 days. There was a statistically significant decrease in the pathogenic microbial strains after NPWT treatment combined with the silver-impregnated dressing (paired t test; P = 0.0038). The shift from complicated to easier surgical wound-closure procedures was observed. DISCUSSION: According to all results obtained, described, and discussed, the authors consider the use of a nonadherent silver-impregnated dressing in conjunction with NPWT to be beneficial and efficacious. No adverse events or reactions related to the silver-impregnated contact layer used during NPWT have been observed in the patients, which confirmed the safety of this method.