Background:Chronic wounds represent a major problem to our society.Therefore,advanced wound-healing strategies for the treatment of these wounds are expanding into the field of tissue engineering.Objectives:To develop a novel tissue-engineered,autologous,full-thickness skin substitute of entirely human origin and to determine its ability to heal chronic wounds.Methods:Skin substitutes(fully differentiated epidermis on fibroblast-populated human dermis)were constructed from 3-mm punch biopsies isolated from patients to be treated.Acellular allodermis was used as a dermal matrix.After a prior5-day vacuum-assisted closure therapy to prepare the wound bed,skin substitutes were applied in a simple one-step surgical procedure to 19 long-standing recalcitrant leg ulcers(14 patients;ulcer duration 0.5-50 years).Results:The success rate in culturing biopsies was 97%.The skin substitute visibly resembled an autograft.Eleven of the 19 ulcers(size 1-10 cm2)healed within 8 weeks after a single application of the skin substitute.The other eight larger(60-150 cm2)and/or complicated ulcers healed completely(n = 5)or continued to decrease substantially in size(n = 3)after the 8-week follow-up period.Wound healing occurred by direct take of the skin substitute(n = 12)and/or stimulation of granulation tissue/epithelialization(n = 7).Skin substitutes were very well tolerated and pain relief was immediate after application.Conclusions Application of this novel skin substitute provides a promising new therapy for healing chronic wounds resistant to conventional therapies.
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