SGB3 - Session 3: From the concept to the solution: How is research developed in wound healing?
Extracellular matrix (ECM) has been inspiring the design of bio-instructive materials to bioengineer tissues and biological microenvironments. Yet, ECM’s role is not exclusively defined by direct cell-ECM interactions and biomechanics, but also by its capacity to store soluble biochemical cues. These multiple features are particularly critical in the fabrication of complex tissue analogues or disease models in which pathophysiological markers must be represented. We have been focusing on the physiology of skin tissue and on the ECM-associated alterations occurring in differente skin diseases to build biologically relevant 3D tissue models. Proteomic analyses have been confirming that there are specific and main ECM proteins that are differently altered according to the skin diseases and in relation to healthy tissue. Moreover, these changes are linked to hallmarks of the diseases being therefore imperative in the recreation of the different microenvironments/microfunctionalities found in diseased skin tissue. Under this context, and considering the great value of 3D printing technologies to fabricate complex skin analogues, we have been developing new bioinks to increase the level of ECM mimicky of the printed structures and consequently of their overall functionality.
Surgical closure of complex and severe full thickness wounds remains challenging. However recent developments within the last 1 -2 decades have added valubale tools to restore large wounds and tissue defects even in the elderly and in wounds with poor vascularization.
One of the inventions that acted as game changers ist he application of topial negative pressure (TNP) to wounds, exerting physical and foreces with macro- and microstrains. Research is still ongoing to further elucidate the exact further molecular and cellular mechanisms etc. that help to better expain the clinically proven positive effects. On the other hand research towards the detection and understanding of biofilm in contaminated wounds have urged innovations to eliminate the bacterial burden. This led to the invention of instillational TNP and has further changed the preparation of infeected wound beds t ofacilitate surgical closure.
In addition surgical advances with the clinical introduction of the perforator flap technology has minimized donor site problems and optimized the resulting scar situation.
Also the introduciton and standardization of venous grafts for arterial bypass surgery to allow free flap transplantation in poorly vascularized recipient wound beds has had an enormous impact on the cure of problem wounds.
Conclusion: Taken together the afore mentioned developments have expanded the range of surgical possibilities to cure complex severe woundseven in the elderly. Combinations of these developments and an individualized approach of vascular reconstruction and flap reconstruction, either in a single stage or a two staged approach turned out to be game changers.
The management of severe burns and other full skin defects remains a significant challenge. The autologous split thickness skin is still the standard of care for grafting of extensive full thickness burns. This technique inevitably leads to scarring. Tissue-engineered skin constructs such as dermal templates and full skin constructs can improve the quality of scars, however, despite promising results, these products still do not have firm footing in treatment protocols. This presentation will cover current available evidence, and highlight the challenges faced and developments undertaken towards creating effective personalized treatment strategies of artificial skin and tissue engineering for patients with full thickness wounds.
The last decades have witnessed a leap forward in the outcome of burn injuries, with children suffering major burns over 95% total body surface area (TBSA) now having a significant chance of survival. This was achieved with advances in all aspects of the multi-disciplinary team management. However, the challenge we still face is to improve the quality of life for these young survivors. Improving scarring after burns should surely be one of our goals.
Early wound closure is key to good post burn scarring outcomes. Optimizing patients’ care and avoiding complications that can convert a partial thickness burn to a deeper injury, or delayed healing, is a key strategy of modern burn care.
Advances in burn wound care and the advent of quality skin substitutes has helped improving post burn scarring outcomes. On the other hand, for established scarring, laser therapy during the last 10 years has made significant improvements.
These advances can be divided into 3 categories; firstly, a platform that aims at preserving tissues, secondly, antimicrobial and anti-scarring wound dressings, and finally, interventions that improve established scarring, such as laser therapy.
An overview of the above will be provided.