Your experts for skin transplantation

Hier erläutern wir Ihnen die verschiedenen Möglichkeiten der Hautverpflanzung. Lernen Sie die Vor- und Nachteile der SkinDot-Transplantation, Spalthaut-Transplantation, Kulturhautverfahren im Labor gezüchteter Zellen und die Möglichkeiten des Ersatzes tieferHautschichten (dermale Ersatzverfahren) kennen. Welche Hauttransplantation eignet sich wofür?

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This term, which is firmly established in medical care, refers to cells cultivated in the laboratory (cultured = cultivated in the laboratory, epithelial = epidermal = top layer of skin, autograft = graft from the patient’s own body tissue). CEA grafts, which are now routinely used worldwide, consist of a multilayered layer of the patient’s own skin cells (keratinocytes)

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The advantages lie in the virtually unlimited number of cells that can be cultured. In the context of superficial wounds in which the subcutis (dermis) is preserved. CEA grafts lead to cosmetically flawless postoperative results. However, they are thus suitable only for replacement of the thin epidermis. In contrast, the results are extremely poor, both functionally and aesthetically, when the subcutis (dermis) is lost and when transplanted to fat or muscle tissue. It was not until work by Cuono in 1987 and Hickersen in 1994, who initially transplanted cadaveric skin into the wound bed, that better clinical results were obtained with CEA. Thus, it is important to introduce subcutaneous components (derived from cadaveric skin) into the wound bed prior to the use of CEA grafts in order to increase the healing rate of the laboratory-grown cells. This is accomplished in the case of subcutaneous loss primarily by transplanting cadaveric skin prior to application of the laboratory-grown skin cells. The cadaver skin heals due to the immunosuppression associated with the severe burn injury and can serve as a temporary skin substitute for a 3-4 week period. During this time, the skin cells are cultured in the laboratory. In this way, in several surgical steps, it is possible to successfully transplant the cultured cells.

Cultured Epithelial Autograft (CEA) as suspension

The laboratory-grown skin cells can not only be transplanted as a three-dimensional matrix (sheet), but can also be sprayed onto the wound. Hunyadi et. al. were the first to apply laboratory-grown skin cells (keratinocytes) in droplet form to chronic wounds.

Later, technical inventions were added that allowed cell suspensions to be sprayed onto the wound, increasing the uniform distribution of cells on the wound compared with grafting by pipetting. Since the skin cells grown in the laboratory do not need to accumulate in multiple layers of the three-dimensional matrix in this method, the method of growing cells for spraying is much easier. When the skin cells are grown in the laboratory, they only need to be grown for a few days. Another method is not to grow the skin cells, but to obtain the skin cells directly from a small piece of skin during surgery. In this method, the skin cells are not multiplied or cultured, but the small piece of healthy skin is dissolved into individual cells. Then, the cells obtained from the small piece of healthy skin are sprayed onto the wound.

However, this modern method also has the disadvantage that only the epidermis can be replaced. In addition, parts of the subcutis (dermis) must be present in the wound so that the sprayed cells can grow in the wound. The best known commercially available product for cell spraying without cultivation in the laboratory is Recell®. The advantage of is Recell® is rapid and safe wound closure in very superficial skin defects, especially superficial burns and scalds in the facial area.

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