Treatment Of Full-thickness Wounds With Microfragmented Adipose Tissue And Plasma-based Hydrogels
David Larson, Randolph Stone, II, John Wall, Shanmugasundaram Natesan, Robert Christy.
US Army Institute of Surgical Research, Fort Sam Houston, TX, USA.
Background: Full-thickness skin wounds often incur severe damage to the subcutaneous adipose tissue. Surgical intervention involves autograft/allograft application and does not replace adipose tissue which often leads to wound contraction and scarring. We hypothesize that reconstruction of hypodermis using purified microfragmented adipose tissue (“Lipogems”) as a stem cell alternative combined with blood plasma-based hydrogels will improve graft-take, perfusion, contraction, and scar appearance in a porcine full-thickness excisional wound. Methods: Lipogems were isolated from porcine adipose tissue using a point-of-care non-enzymatic medical device. Lipogems-plasma hydrogels were prepared by suspending Lipogems in a polyethylene glycol-platelet free plasma (PEG-PFP) liquid mixture and cross-linking with thrombin. Full-thickness 6 cm diameter excisional wounds were created on the dorsum of anesthetized Yorkshire pigs and divided among four treatment groups: Lipogems, PEG-PFP hydrogels, Lipogems+PEG-PFP hydrogels, and no treatment. A positive control group was created by tangential excision to the top of the hypodermis (fat). All wounds were autografted with a meshed split-thickness skin graft (mSTSG). Results: Successful graft-take was observed on day 7 for all wounds. The perfusion measured on day 7 in wounds treated with Lipogems+PEG-PFP hydrogels was not different from the positive control group, indicating a beneficial effect of PEG-PFP+Lipogems. The overall contraction measured at day 60 of wounds treated were significantly higher in comparison to the positive control group. No difference in melanin content occurred between any of the treatment groups. Wounds treated with Lipogems±PEG-PFP did not show a significant difference in erythema compared to the positive control, indicating synergistic treatment with hydrogel and Lipogems in reducing wound erythema. Conclusions: Mechanically processed adipose tissue retains viability and essential factors necessary for active healing to take place. The Lipogems+PEG-PFP hydrogels described in this study provide a ‘point-of-care’ treatment option to mitigate scarring that may be translated to burn wounds. The entire protocol can be carried out in a clinical suite; thus requiring less sophisticated laboratory equipment to isolate and deliver stem cells.
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