PRS PSRC Podium Proofs 2016
Bernhard J. Jank, MD,* Jeremy Goverman, MD, FACS,* Jacques P. Guyette, PhD,* Jon M. Charest, MS,* Mark Randolph, MAS,* Joshua R. Gershlak, MS,† Glenn R. Gaudette, PhD,† Martin Purschke, PhD,* Emilia Javorsku, MD, MPH,* David A. Leonard, MD,* Curtis L. Cetrulo, Jr, MD, FACS, FAAP,* William G. Austen, Jr, MD, FACS,* Harald C. Ott, MD*
From the *Massachusetts General Hospital, Boston, Mass.; and †Worcester Polytechnic Institute, Worcester, Mass.
PURPOSE: Current treatments for skin loss result in contracture, scar, and poor function; therefore, the creation of an autologous full-thickness skin analog remains of paramount importance. The purpose of this project was to create a full-thickness skin analog by perfusion decellularization of a porcine fasciocutaneous flap.
METHODS: Fasciocutaneous porcine flaps were harvested, and perfusion decellularization was performed via vascular pedicle. The resulting matrix was characterized; in vitro biocompatibility and mechanical testing were performed; and regenerative potential was evaluated. Immunological response, biocompatibility, and regenerative potential were assessed using in vivo models.
RESULTS: Perfusion decellularization removed all cellular components with preservation of ECM proteins in a similar composition to native skin. Biaxial testing revealed preserved elastic properties. Immunologic response and biocompatibility assessed via implantation and compared with native xenogenic skin and commercially available dermal substitutes revealed that neovascularization and tissue integration were most optimal for our flap. Composition of infiltrating immune cells was similar to sham and resembled inflammatory phase of healing. Implantation into full-thickness skin defects demonstrated optimal tissue integration and skin regeneration without cicatrization.
CONCLUSIONS: We have developed a protocol for the generation of a full-thickness skin matrix of clinically relevant size, containing a vascular pedicle that can be utilized for perfusion decellularization and, ultimately, anastomosis to recipient vascular system precellularization. We demonstrate formidable regenerative potential and favorable immunological response resulting in optimal tissue integration.