The Experts below are selected from a list of 216 Experts worldwide ranked by ideXlab platform

Nadja Zoeller - One of the best experts on this subject based on the ideXlab platform.

M Gourven - One of the best experts on this subject based on the ideXlab platform.

  • emerging therapy for improving wound repair of severe radiation burns using local bone marrow derived stem cell administrations
    Wound Repair and Regeneration, 2010
    Co-Authors: Marie Prat, Francois Trompier, Pierre Battaglini, Isabelle Ernou, Laetitia Boutin, M Gourven, Marc Benderitter, Marc Brachet, Pierre Duhamel, Frederique Tissedre
    Abstract:

    The therapeutic management of severe radiation burns remains a challenging issue today. Conventional surgical treatment including excision, Skin Autograft, or flap often fails to prevent unpredictable and uncontrolled extension of the radiation-induced necrotic process. In a recent very severe accidental radiation burn, we demonstrated the efficiency of a new therapeutic approach combining surgery and local cellular therapy using autologous mesenchymal stem cells (MSC), and we confirmed the crucial place of the dose assessment in this medical management. The patient presented a very significant radiation lesion located on the arm, which was first treated by several surgical procedures: iterative excisions, Skin graft, latissimus muscle dorsi flap, and forearm radial flap. This conventional surgical therapy was unfortunately inefficient, leading to the use of an innovative cell therapy strategy. Autologous MSC were obtained from three bone marrow collections and were expanded according to a clinical-grade protocol using platelet-derived growth factors. A total of five local MSC administrations were performed in combination with Skin Autograft. After iterative local MSC administrations, the clinical evolution was favorable and no recurrence of radiation inflammatory waves occurred during the patient's 8-month follow-up. The benefit of this local cell therapy could be linked to the “drug cell” activity of MSC by modulating the radiation inflammatory processes, as suggested by the decrease in the C-reactive protein level observed after each MSC administration. The success of this combined treatment leads to new prospects in the medical management of severe radiation burns and more widely in the improvement of wound repair.

  • Emerging therapy for improving wound repair of severe radiation burns using local bone marrow-derived stem cell administrations
    Wound Repair and Regeneration, 2010
    Co-Authors: E. Bey, Francois Trompier, Pierre Battaglini, Isabelle Ernou, Laetitia Boutin, Marc Benderitter, Marc Brachet, Pierre Duhamel, Marc Prat, M Gourven
    Abstract:

    The therapeutic management of severe radiation burns remains a challenging issue today. Conventional surgical treatment including excision, Skin Autograft, or flap often fails to prevent unpredictable and uncontrolled extension of the radiation-induced necrotic process. In a recent very severe accidental radiation burn, we demonstrated the efficiency of a new therapeutic approach combining surgery and local cellular therapy using autologous mesenchymal stem cells (MSC), and we confirmed the crucial place of the dose assessment in this medical management. The patient presented a very significant radiation lesion located on the arm, which was first treated by several surgical procedures: iterative excisions, Skin graft, latissimus muscle dorsi flap, and forearm radial flap. This conventional surgical therapy was unfortunately inefficient, leading to the use of an innovative cell therapy strategy. Autologous MSC were obtained from three bone marrow collections and were expanded according to a clinical-grade protocol using platelet-derived growth factors. A total of five local MSC administrations were performed in combination with Skin Autograft. After iterative local MSC administrations, the clinical evolution was favorable and no recurrence of radiation inflammatory waves occurred during the patient's 8-month follow-up. The benefit of this local cell therapy could be linked to the "drug cell" activity of MSC by modulating the radiation inflammatory processes, as suggested by the decrease in the C-reactive protein level observed after each MSC administration. The success of this combined treatment leads to new prospects in the medical management of severe radiation burns and more widely in the improvement of wound repair. © 2010 by the Wound Healing Society.

  • New approach to radiation burn treatment by dosimetry-guided surgery combined with autologous mesenchymal stem cell therapy
    Regenerative Medicine, 2007
    Co-Authors: J.j. Lataillade, Isabelle Ernou, E. Bey, C. Doucet, H. Carsin, C. Huet, I. Clairand, J.f. Bottollier-depois, A. Chapel, M Gourven
    Abstract:

    The therapeutic management of severe radiation burns remains a challenging issue. Conventional surgical treatment (excision and Skin Autograft or rotation flap) often fails to prevent unpredictable and uncontrolled extension of the radiation necrotic process. We report here an innovative therapeutic strategy applied to the victim of a radiation accident (December 15, 2005) with an iridium gammagraphy radioactive source (192Ir, 3.3 TBq). The approach combined numerical dosimetry-guided surgery with cellular therapy using mesenchymal stem cells. A very severe buttock radiation burn (2000 Gy at the center of the Skin surface lesion) of a 27-year-old Chilean victim was widely excised (10 cm in diameter) using a physical and anatomical dose reconstruction in order to better define the limit of the surgical excision in apparently healthy tissues. A secondary extension of the radiation necrosis led to a new excision of fibronecrotic tissues associated with a local cellular therapy using autologous expanded mesenchymal stem cells as a source of trophic factors to promote tissue regeneration. Bone marrow-derived mesenchymal stem cells were expanded according to a clinical-grade technique using closed culture devices and serum-free medium enriched in human platelet lysate. The clinical evolution (radiation pain and healing progression) was favorable and no recurrence of radiation inflammatory waves was observed during the 11 month patient's follow-up. This novel multidisciplinary therapeutic approach combining physical techniques, surgical procedures and cellular therapy with adult stem cells may be of clinical relevance for improving the medical management of severe localized irradiations. It may open new prospects in the field of radiotherapy complications. © 2007 Future Medicine Ltd.

Glenn D. Warden - One of the best experts on this subject based on the ideXlab platform.

  • Cultured Skin substitutes reduce requirements for harvesting of Skin Autograft for closure of excised, full-thickness burns.
    The Journal of trauma, 2006
    Co-Authors: Steven T. Boyce, David G. Greenhalgh, Richard J. Kagan, Petra Warner, Kevin P Yakuboff, Tina Palmieri, Glenn D. Warden
    Abstract:

    Rapid and effective closure of full-thickness burn wounds remains a limiting factor in burns of greater than 50% of the total body surface area (TBSA). Hypothetically, cultured Skin substitutes (CSS) consisting of autologous cultured keratinocytes and fibroblasts attached to collagen-based sponges may reduce requirements for donor Skin, and morbidity from Autograft harvesting and widely-meshed Skin grafts. To test this hypothesis, CSS were prepared from split-thickness Skin biopsies collected after enrollment of 40 burn patients by informed consent into a study protocol approved by the local Institutional Review Boards of three participating hospitals. CSS and split-thickness Skin Autograft (AG) were applied in a matched-pair design to patients with full-thickness burns involving a mean value of 73.4% of the TBSA. Data collection consisted of photographs, area measurements of donor Skin and healed wounds after grafting, qualitative outcome by the Vancouver Scale for burn scar, and biopsies of healed Skin. Engraftment at postoperative day (POD) 14 was 81.5 +/- 2.1% for CSS and 94.7 +/- 2.0 for AG. Percentage TBSA closed at POD 28 was 20.5 +/- 2.5% for CSS, and 52.1 +/- 2.0 for AG. The ratio of closed to donor areas at POD 28 was 66.2 +/- 8.4 for CSS, and 4.0 +/- 0.0 for each harvest of AG. Each of these values was significantly different between the graft types. Correlation of percent TBSA closed with CSS at POD 28 with percent TBSA full-thickness burn generated an r value of 0.37 (p < 0.0001). Vancouver Scale scores at 1 year after were not different for erythema, pliability, or scar height, but pigmentation remained deficient in CSS. These results demonstrate that CSS reduce requirements for donor Skin harvesting for grafting of excised, full-thickness burns of greater than 50% TBSA with qualitative outcome that is comparable to meshed AG. Availability of CSS for treatment of extensive, deep burns may reduce time to wound closure, morbidity, and mortality in this patient population.

  • Principles and practices for treatment of cutaneous wounds with cultured Skin substitutes
    American journal of surgery, 2002
    Co-Authors: Steven T. Boyce, Glenn D. Warden
    Abstract:

    Abstract Background: Skin substitutes prepared from cultured Skin cells and biopolymers may reduce requirements for donor Skin Autograft, and have been shown to be effective in treatment of excised burns, burn scars, and congenital Skin lesions. Data Sources: Cultured Skin substitutes (CSS) generate Skin phenotypes (epidermal barrier, basement membrane) in the laboratory, and restore tissue function and systemic homeostasis. Healed Skin is smooth, soft and strong, but develops irregular degrees of pigmentation. Quantitative analysis demonstrates that CSS closes 67 times the area of the donor Skin, compared to less than 4 times for split-thickness Skin Autograft. Conclusions: CSS reduce requirements for donor Skin Autograft for closure of excised, full-thickness cutaneous wounds, and demonstrate qualitative outcome that is not different from meshed, split-thickness Autograft. These results offer reductions in morbidity and mortality for the treatment of burns and chronic wounds, and for cutaneous reconstruction.

  • The 1999 clinical research award. Cultured Skin substitutes combined with Integra Artificial Skin to replace native Skin Autograft and allograft for the closure of excised full-thickness burns.
    The Journal of burn care & rehabilitation, 1999
    Co-Authors: Steven T. Boyce, Richard J. Kagan, Kevin P Yakuboff, Nicholas A. Meyer, Glenn D. Warden
    Abstract:

    Prompt and permanent closure of excised full-thickness burns remains a critical factor in a patient's recovery from massive burn injuries. Hypothetically, Integra Artificial Skin (Integra) may replace the need for allografts for immediate wound coverage, and cultured Skin substitutes (CSS) that contain stratified epithelium may replace the need for Autografts for definitive wound closure. To test this hypothesis, 3 patients with full-thickness burns of greater than 60% of their total body surface areas had their eschar excised within 14 days of admission. Integra was applied, and a Skin biopsy was collected from each patient for the preparation of CSS. At 3 weeks or more after the application of the Integra and the collection of Skin biopsies, the outer silastic cover of the Integra was removed and CSS were grafted. The CSS were irrigated with nutrients and antimicrobials for 6 days and then dressed with antimicrobial ointment and cotton gauze. Treated wounds were traced on days 14 and 28 after the grafting of CSS for determination of engraftment and wound closure, respectively. Cost analysis was not performed. Engraftment on postoperative day (POD) 14 was 98% ± 1% (mean ± standard error of the mean), the ratio of closed:donor areas on POD 28 was 52.3 ± 5.2, and no treated sites required regrafting. The histology of the closed wounds showed stable epithelium that covered a layer of newly formed fibrovascular tissue above the reticulated structure of the degrading Integra. The clinical outcomes of the closed wounds after POD 28 demonstrated smooth, pliable, and hypopigmented Skin. Two patients who had received CSS grafts over Integra on their backs were positioned supine on air beds from POD 8 or POD 9 with minimal graft loss because of mechanical loading. One patient with a full-thickness burn of 88% of the total body surface area was covered definitively at 55 days postburn. These results demonstrate that the combination of CSS and Integra can accomplish functionally stable and cosmetically acceptable wound closure in patients with extensive full-thickness burns. This combination of alternatives to the conventional grafting of split-thickness Skin permits the substitution of cadaveric allograft with Integra and the substitution of donor Autograft with CSS. This approach to the closure of excised full-thickness burns is expected to reduce greatly the time to definitive closure of burn wounds and to reduce the morbidity associated with the harvesting of donor sites for split-thickness Skin Autografts.

  • Comparative assessment of cultured Skin substitutes and native Skin Autograft for treatment of full-thickness burns.
    Annals of surgery, 1995
    Co-Authors: Steven T. Boyce, Michael J. Goretsky, David G. Greenhalgh, Richard J. Kagan, Mary T. Rieman, Glenn D. Warden
    Abstract:

    OBJECTIVE: Comparison of cultured Skin substitutes (CSSs) and split-thickness Autograft (STAG) was performed to assess whether the requirement for autologous Skin grafts may be reduced in the treatment of massive burns. SUMMARY BACKGROUND DATA: Cultured Skin substitutes consisting of collagen-glycosaminoglycan substrates populated with autologous fibroblasts and keratinocytes have been demonstrated to close full-thickness Skin wounds in athymic mice and to express normal Skin antigens after closure of excised wounds in burn patients. METHODS: Data were collected from 17 patients between days 2 and 14 to determine incidence of exudate, incidence of regrafting, coloration, keratinization, and percentage of site covered by graft (n = 17). Outcome was evaluated on an ordinal scale (0 = worst; 10 = best) beginning at day 14, with primary analyses at 28 days (n = 10) and 1 year (n = 4) for erythema, pigmentation, epithelial blistering, surface roughness, Skin suppleness, and raised scar. RESULTS: Sites treated with CSSs had increased incidence of exudate (p = 0.06) and decreased percentage of engraftment (p < 0.05) compared with STAG. Outcome parameters during the first year showed no differences in erythema, blistering, or suppleness. Pigmentation was greater, scar was less raised, but regrafting was more frequent in CSS sites than STAG. No differences in qualitative outcomes were found after 1 year, and antibodies to bovine collagen were not detected in patient sera. CONCLUSIONS: These results suggest that outcome of engrafted CSSs is not different from STAG and that increased incidence of regrafting is related to decreased percentage of initial engraftment. Increased rates of engraftment of CSSs may lead to improved outcome for closure of burn wounds, allow greater availability of materials for grafting, and reduce requirements for donor Skin Autograft.

Peter Golinski - One of the best experts on this subject based on the ideXlab platform.

Steven T. Boyce - One of the best experts on this subject based on the ideXlab platform.

  • Cultured Skin substitutes reduce requirements for harvesting of Skin Autograft for closure of excised, full-thickness burns.
    The Journal of trauma, 2006
    Co-Authors: Steven T. Boyce, David G. Greenhalgh, Richard J. Kagan, Petra Warner, Kevin P Yakuboff, Tina Palmieri, Glenn D. Warden
    Abstract:

    Rapid and effective closure of full-thickness burn wounds remains a limiting factor in burns of greater than 50% of the total body surface area (TBSA). Hypothetically, cultured Skin substitutes (CSS) consisting of autologous cultured keratinocytes and fibroblasts attached to collagen-based sponges may reduce requirements for donor Skin, and morbidity from Autograft harvesting and widely-meshed Skin grafts. To test this hypothesis, CSS were prepared from split-thickness Skin biopsies collected after enrollment of 40 burn patients by informed consent into a study protocol approved by the local Institutional Review Boards of three participating hospitals. CSS and split-thickness Skin Autograft (AG) were applied in a matched-pair design to patients with full-thickness burns involving a mean value of 73.4% of the TBSA. Data collection consisted of photographs, area measurements of donor Skin and healed wounds after grafting, qualitative outcome by the Vancouver Scale for burn scar, and biopsies of healed Skin. Engraftment at postoperative day (POD) 14 was 81.5 +/- 2.1% for CSS and 94.7 +/- 2.0 for AG. Percentage TBSA closed at POD 28 was 20.5 +/- 2.5% for CSS, and 52.1 +/- 2.0 for AG. The ratio of closed to donor areas at POD 28 was 66.2 +/- 8.4 for CSS, and 4.0 +/- 0.0 for each harvest of AG. Each of these values was significantly different between the graft types. Correlation of percent TBSA closed with CSS at POD 28 with percent TBSA full-thickness burn generated an r value of 0.37 (p < 0.0001). Vancouver Scale scores at 1 year after were not different for erythema, pliability, or scar height, but pigmentation remained deficient in CSS. These results demonstrate that CSS reduce requirements for donor Skin harvesting for grafting of excised, full-thickness burns of greater than 50% TBSA with qualitative outcome that is comparable to meshed AG. Availability of CSS for treatment of extensive, deep burns may reduce time to wound closure, morbidity, and mortality in this patient population.

  • Principles and practices for treatment of cutaneous wounds with cultured Skin substitutes
    American journal of surgery, 2002
    Co-Authors: Steven T. Boyce, Glenn D. Warden
    Abstract:

    Abstract Background: Skin substitutes prepared from cultured Skin cells and biopolymers may reduce requirements for donor Skin Autograft, and have been shown to be effective in treatment of excised burns, burn scars, and congenital Skin lesions. Data Sources: Cultured Skin substitutes (CSS) generate Skin phenotypes (epidermal barrier, basement membrane) in the laboratory, and restore tissue function and systemic homeostasis. Healed Skin is smooth, soft and strong, but develops irregular degrees of pigmentation. Quantitative analysis demonstrates that CSS closes 67 times the area of the donor Skin, compared to less than 4 times for split-thickness Skin Autograft. Conclusions: CSS reduce requirements for donor Skin Autograft for closure of excised, full-thickness cutaneous wounds, and demonstrate qualitative outcome that is not different from meshed, split-thickness Autograft. These results offer reductions in morbidity and mortality for the treatment of burns and chronic wounds, and for cutaneous reconstruction.

  • The 1999 clinical research award. Cultured Skin substitutes combined with Integra Artificial Skin to replace native Skin Autograft and allograft for the closure of excised full-thickness burns.
    The Journal of burn care & rehabilitation, 1999
    Co-Authors: Steven T. Boyce, Richard J. Kagan, Kevin P Yakuboff, Nicholas A. Meyer, Glenn D. Warden
    Abstract:

    Prompt and permanent closure of excised full-thickness burns remains a critical factor in a patient's recovery from massive burn injuries. Hypothetically, Integra Artificial Skin (Integra) may replace the need for allografts for immediate wound coverage, and cultured Skin substitutes (CSS) that contain stratified epithelium may replace the need for Autografts for definitive wound closure. To test this hypothesis, 3 patients with full-thickness burns of greater than 60% of their total body surface areas had their eschar excised within 14 days of admission. Integra was applied, and a Skin biopsy was collected from each patient for the preparation of CSS. At 3 weeks or more after the application of the Integra and the collection of Skin biopsies, the outer silastic cover of the Integra was removed and CSS were grafted. The CSS were irrigated with nutrients and antimicrobials for 6 days and then dressed with antimicrobial ointment and cotton gauze. Treated wounds were traced on days 14 and 28 after the grafting of CSS for determination of engraftment and wound closure, respectively. Cost analysis was not performed. Engraftment on postoperative day (POD) 14 was 98% ± 1% (mean ± standard error of the mean), the ratio of closed:donor areas on POD 28 was 52.3 ± 5.2, and no treated sites required regrafting. The histology of the closed wounds showed stable epithelium that covered a layer of newly formed fibrovascular tissue above the reticulated structure of the degrading Integra. The clinical outcomes of the closed wounds after POD 28 demonstrated smooth, pliable, and hypopigmented Skin. Two patients who had received CSS grafts over Integra on their backs were positioned supine on air beds from POD 8 or POD 9 with minimal graft loss because of mechanical loading. One patient with a full-thickness burn of 88% of the total body surface area was covered definitively at 55 days postburn. These results demonstrate that the combination of CSS and Integra can accomplish functionally stable and cosmetically acceptable wound closure in patients with extensive full-thickness burns. This combination of alternatives to the conventional grafting of split-thickness Skin permits the substitution of cadaveric allograft with Integra and the substitution of donor Autograft with CSS. This approach to the closure of excised full-thickness burns is expected to reduce greatly the time to definitive closure of burn wounds and to reduce the morbidity associated with the harvesting of donor sites for split-thickness Skin Autografts.

  • Comparative assessment of cultured Skin substitutes and native Skin Autograft for treatment of full-thickness burns.
    Annals of surgery, 1995
    Co-Authors: Steven T. Boyce, Michael J. Goretsky, David G. Greenhalgh, Richard J. Kagan, Mary T. Rieman, Glenn D. Warden
    Abstract:

    OBJECTIVE: Comparison of cultured Skin substitutes (CSSs) and split-thickness Autograft (STAG) was performed to assess whether the requirement for autologous Skin grafts may be reduced in the treatment of massive burns. SUMMARY BACKGROUND DATA: Cultured Skin substitutes consisting of collagen-glycosaminoglycan substrates populated with autologous fibroblasts and keratinocytes have been demonstrated to close full-thickness Skin wounds in athymic mice and to express normal Skin antigens after closure of excised wounds in burn patients. METHODS: Data were collected from 17 patients between days 2 and 14 to determine incidence of exudate, incidence of regrafting, coloration, keratinization, and percentage of site covered by graft (n = 17). Outcome was evaluated on an ordinal scale (0 = worst; 10 = best) beginning at day 14, with primary analyses at 28 days (n = 10) and 1 year (n = 4) for erythema, pigmentation, epithelial blistering, surface roughness, Skin suppleness, and raised scar. RESULTS: Sites treated with CSSs had increased incidence of exudate (p = 0.06) and decreased percentage of engraftment (p < 0.05) compared with STAG. Outcome parameters during the first year showed no differences in erythema, blistering, or suppleness. Pigmentation was greater, scar was less raised, but regrafting was more frequent in CSS sites than STAG. No differences in qualitative outcomes were found after 1 year, and antibodies to bovine collagen were not detected in patient sera. CONCLUSIONS: These results suggest that outcome of engrafted CSSs is not different from STAG and that increased incidence of regrafting is related to decreased percentage of initial engraftment. Increased rates of engraftment of CSSs may lead to improved outcome for closure of burn wounds, allow greater availability of materials for grafting, and reduce requirements for donor Skin Autograft.