Tissue Engineering for Complex Wounds: Esterified Hyaluronic Acid Matrix (eHAM) Literature Review and Case Series
Main Article Content
Abstract
Background: Complex soft tissue injuries are difficult to heal and costly to treat. Current solutions are often insufficient to heal complex wounds. Tissue engineering for acute wounds is a new approach. Tissue engineering focuses on regenerating tissue based on the use of biologic scaffolds and cell signalling. New technologies use a tissue engineering approach to ensure a smooth transition between the phases of wound healing. Hyaluronic Acid (HA) has become a recent focus of interest. This study aimed to review the experience of patients treated with electrospun non-woven cross-linked hyaluronic acid matrix (eHAM) in the management of acute and chronic wounds.
Methods: A case series study was performed of consecutive adults (age >18 years old) treated with eHAM to manage their wound within an 18-month period. Data were analysed for demographic information and time to healing. Results: 12 cases with full thickness wound depths were found in the 16 months of the study. Wound size for all patients decreased after the first eHAM application with mean delta wound size -56.99 cm2; 66.67% had a second eHAM application, 25% had a third eHAM application. 41.67% patients healed using just eHAM therapy.
Conclusion: Our preliminary experience demonstrates that electrospun non-woven cross-linked hyaluronic acid matrix (eHAM) is a valuable tool to assist in the healing of complex wounds. In our study, many patients were able to heal using eHAM therapy alone. Clinical benefit was demonstrated after first eHAM application, where wound size was markedly reduced for all patients.
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References
2. Sinno, H. & Prakash, S. Complements and the wound healing cascade: an updated review. Plastic surgery international 2013 (2013).
3. Krzyszczyk, P., Schloss, R., Palmer, A. & Berthiaume, F. The role of macrophages in acute and chronic wound healing and interventions to promote pro-wound healing phenotypes. Frontiers in physiology 9, 419 (2018).
4. Glass, G., Murphy, G., Esmaeili, A., Lai, L. M. & Nanchahal, J. Systematic review of molecular mechanism of action of negative‐pressure wound therapy. British Journal of Surgery 101, 1627-1636 (2014).
5. Bassetto, F. et al. Histological evolution of chronic wounds under negative pressure therapy. Journal of plastic, reconstructive & aesthetic surgery 65, 91-99 (2012).
6. Papakonstantinou, E., Roth, M. & Karakiulakis, G. Hyaluronic acid: A key molecule in skin aging. Dermato-endocrinology 4, 253-258 (2012).
7. Weissmann, B., Meyer, K., Sampson, P. & Linker, A. Isolation of oligosaccharides enzymatically produced from hyaluronic acid. Journal of Biological Chemistry 208, 417-429 (1954).
8. Fallacara, A., Baldini, E., Manfredini, S. & Vertuani, S. Hyaluronic acid in the third millennium. Polymers 10, 701 (2018).
9. Tavianatou, A. G. et al. Hyaluronan: molecular size-dependent signaling and biological functions in inflammation and cancer. FEBS J 286, 2883-2908, doi:10.1111/febs.14777 (2019).
10. Neuman, M. G., Nanau, R. M., Oruña-Sanchez, L. & Coto, G. Hyaluronic acid and wound healing. Journal of Pharmacy & Pharmaceutical Sciences 18, 53-60 (2015).
11. Graca, M. F. P., Miguel, S. P., Cabral, C. S. D. & Correia, I. J. Hyaluronic acid-Based wound dressings: A review. Carbohydr Polym 241, 116364, doi:10.1016/j.carbpol.2020.116364 (2020).
12. Aya, K. L. & Stern, R. Hyaluronan in wound healing: rediscovering a major player. Wound repair and regeneration 22, 579-593 (2014).
13. Chen, W. J. in Hyaluronan 147-156 (Elsevier, 2002).
14. Webber, J., Jenkins, R. H., Meran, S., Phillips, A. & Steadman, R. Modulation of TGFβ1-dependent myofibroblast differentiation by hyaluronan. The American journal of pathology 175, 148-160 (2009).
15. Stern, R., Asari, A. A. & Sugahara, K. N. Hyaluronan fragments: an information-rich system. European journal of cell biology 85, 699-715 (2006).
16. Longaker, M. T. et al. Studies in fetal wound healing. V. A prolonged presence of hyaluronic acid characterizes fetal wound fluid. Annals of surgery 213, 292 (1991).
17. Harding, K. (Elsevier BV, 2000).
18. Gravante, G. et al. Hyalomatrix PA in burn care practice: results from a national retrospective survey, 2005 to 2006. Ann Plast Surg 64, 69-79, doi:10.1097/SAP.0b013e31819b3d59 (2010).
19. Longinotti, C. The use of hyaluronic acid based dressings to treat burns: A review. Burns & trauma 2, 2321-3868.142398 (2014).
20. Langer, R., Lanza, R., Langer, R. S. & Vacanti, J. P. Principles of tissue engineering. (Academic Press, 2000).
21. Burke, J. F., Yannas, I. V., Quinby Jr, W. C., Bondoc, C. C. & Jung, W. K. Successful use of a physiologically acceptable artificial skin in the treatment of extensive burn injury. Annals of surgery 194, 413 (1981).
22. Green, H., Kehinde, O. & Thomas, J. Growth of cultured human epidermal cells into multiple epithelia suitable for grafting. Proceedings of the National Academy of Sciences 76, 5665-5668 (1979).
23. Atiyeh, B. S. & Costagliola, M. Cultured epithelial autograft (CEA) in burn treatment: three decades later. Burns 33, 405-413 (2007).
24. Cortivo, R., Brun, P., Rastrelli, A. & Abatangelo, G. In vitro studies on biocompatibility of hyaluronic acid esters. Biomaterials 12, 727-730 (1991).
25. Zacchi, V. et al. In vitro engineering of human skin‐like tissue. Journal of Biomedical Materials Research: An Official Journal of The Society for Biomaterials, The Japanese Society for Biomaterials, and the Australian Society for Biomaterials 40, 187-194 (1998).
26. Galassi, G. et al. In vitro reconstructed dermis implanted in human wounds: degradation studies of the HA-based supporting scaffold. Biomaterials 21, 2183-2191 (2000).
27. Janzekovic, Z. A new concept in the early excision and immediate grafting of burns. The Journal of trauma 10, 1103-1108 (1970).
28. Janzekovic, Z. Early surgical treatment of the burned surface. (1972).
29. Burke, J. F., Bondoc, C. C. & Quinby, W. C. Primary burn excision and immediate grafting: a method shortening illness. Journal of Trauma and Acute Care Surgery 14, 389-395 (1974).
30. Herndon, D. N. et al. A comparison of conservative versus early excision. Therapies in severely burned patients. Annals of surgery 209, 547 (1989).
31. Desai, M. H. et al. Early burn wound excision significantly reduces blood loss. Annals of surgery 211, 753 (1990).
32. Gravante, G. et al. The use of Hyalomatrix PA in the treatment of deep partial-thickness burns. Journal of burn care & research 28, 269-274 (2007).
33. Osti, E. Skin ph variations from the acute phase to re-epithelialization in burn patients treated with new materials (burnshield®, semipermeable adhesive film, dermasilk®, and hyalomatrix®). Non-invasive preliminary experimental clinical trial. Annals of burns and fire disasters 21, 73 (2008).
34. Litwiniuk, M., Krejner, A., Speyrer, M. S., Gauto, A. R. & Grzela, T. Hyaluronic acid in inflammation and tissue regeneration. Wounds 28, 78-88 (2016).
35. Park, H., Copeland, C., Henry, S. & Barbul, A. Complex wounds and their management. Surgical Clinics 90, 1181-1194 (2010).
36. Liu, X., Dadireddy, K. & Velamuri, S. R. Esterified Hyaluronic Acid Matrix in Lower Extremity Reconstruction With Exposed Tendon and Bone: A Retrospective Review. Journal of Burn Care & Research 41 (2020).
37. Vaienti, L. et al. Limb trauma: the use of an advanced wound care device in the treatment of full-thickness wounds. Strategies in trauma and limb reconstruction 8, 111-115 (2013).
38. Myers, S. R., Partha, V. N., Soranzo, C., Price, R. D. & Navsaria, H. A. Hyalomatrix: a temporary epidermal barrier, hyaluronan delivery, and neodermis induction system for keratinocyte stem cell therapy. Tissue engineering 13, 2733-2741 (2007).
39. Aballay, A. & Hermans, M. H. Neodermis formation in full thickness wounds using an esterified hyaluronic acid matrix. Journal of Burn Care & Research 40, 585-589