Histopathological Analysis of Decellularized Porcine Small Intestinal Submucosa after Treatment of Skin Ulcer
Background:. Decellularized porcine small intestinal submucosa (SIS), commercialized as an extracellular matrix rich in cell-inducing substrates and factors, has been clinically applied to treat intractable skin ulcers and has shown therapeutic effects. The SIS reportedly induces cell infiltration a...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2021-12-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003967 |
| _version_ | 1819176553941041152 |
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| author | Hisashi Kobayashi, MD Yasuo Imai, MD, PhD Takayuki Hirao, MD Ko Nakao, MD Hayato Kajinaka, MD Kazuo Kishi, MD, PhD |
| author_facet | Hisashi Kobayashi, MD Yasuo Imai, MD, PhD Takayuki Hirao, MD Ko Nakao, MD Hayato Kajinaka, MD Kazuo Kishi, MD, PhD |
| author_sort | Hisashi Kobayashi, MD |
| collection | DOAJ |
| description | Background:. Decellularized porcine small intestinal submucosa (SIS), commercialized as an extracellular matrix rich in cell-inducing substrates and factors, has been clinically applied to treat intractable skin ulcers and has shown therapeutic effects. The SIS reportedly induces cell infiltration and integrates with the ulcer bed after 3–7 days of application. The attached SIS degenerates over time, and the remaining mass appears as slough, below which is granulation tissue that is essential for healing. This study aimed to determine whether the slough should be removed in clinical settings.
Methods:. Five patients with intractable skin ulcers were included in this case series. Seven days after applying a two-layer fenestrated-type SIS to the ulcer, the removed slough was histopathologically examined.
Results:. The collagen fibers of the SIS somewhat degenerated, and inflammatory cell infiltration was observed from the ulcer side to the surface side of the SIS. Neovascularization was similarly observed on the ulcer side. The degree of inflammatory cell infiltration decreased from the ulcer side to the surface side, whereas pus (ie, aggregates of neutrophils) was observed on the surface and ulcer edges. Additionally, the removed slough contained regenerative epithelium on the ulcer side of the remaining collagen fibers.
Conclusions:. After treating intractable skin ulcers using SIS, we recommend removal of the upper surface and ulcer edge of the degenerated SIS or slough to prevent infection and preservation of the lower side of the degenerated SIS to maintain the granulation tissue and regenerative epithelium. |
| first_indexed | 2024-12-22T21:12:36Z |
| format | Article |
| id | doaj.art-bb370bb0ae2249abba565e63af5f0c9e |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-12-22T21:12:36Z |
| publishDate | 2021-12-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-bb370bb0ae2249abba565e63af5f0c9e2022-12-21T18:12:29ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742021-12-01912e396710.1097/GOX.0000000000003967202112000-00033Histopathological Analysis of Decellularized Porcine Small Intestinal Submucosa after Treatment of Skin UlcerHisashi Kobayashi, MD0Yasuo Imai, MD, PhD1Takayuki Hirao, MD2Ko Nakao, MD3Hayato Kajinaka, MD4Kazuo Kishi, MD, PhD5From the * Department of Plastic and Reconstructive Surgery, Teikyo University Chiba Medical Center, Chiba, Japan† Department of Diagnostic Pathology, Ota Memorial Hospital, Gunma, Japan‡ Department of Plastic and Reconstructive Surgery, Ota Memorial Hospital, Gunma, Japan§ Department of Plastic and Reconstructive Surgery, Saitama Medical Center, Saitama, Japan¶ Department of Plastic and Reconstructive Surgery, Nasu Red Cross Hospital, Tochigi, Japan‖ Department of Plastic and Reconstructive Surgery, School of Medicine, Keio University, Tokyo, Japan.Background:. Decellularized porcine small intestinal submucosa (SIS), commercialized as an extracellular matrix rich in cell-inducing substrates and factors, has been clinically applied to treat intractable skin ulcers and has shown therapeutic effects. The SIS reportedly induces cell infiltration and integrates with the ulcer bed after 3–7 days of application. The attached SIS degenerates over time, and the remaining mass appears as slough, below which is granulation tissue that is essential for healing. This study aimed to determine whether the slough should be removed in clinical settings. Methods:. Five patients with intractable skin ulcers were included in this case series. Seven days after applying a two-layer fenestrated-type SIS to the ulcer, the removed slough was histopathologically examined. Results:. The collagen fibers of the SIS somewhat degenerated, and inflammatory cell infiltration was observed from the ulcer side to the surface side of the SIS. Neovascularization was similarly observed on the ulcer side. The degree of inflammatory cell infiltration decreased from the ulcer side to the surface side, whereas pus (ie, aggregates of neutrophils) was observed on the surface and ulcer edges. Additionally, the removed slough contained regenerative epithelium on the ulcer side of the remaining collagen fibers. Conclusions:. After treating intractable skin ulcers using SIS, we recommend removal of the upper surface and ulcer edge of the degenerated SIS or slough to prevent infection and preservation of the lower side of the degenerated SIS to maintain the granulation tissue and regenerative epithelium.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003967 |
| spellingShingle | Hisashi Kobayashi, MD Yasuo Imai, MD, PhD Takayuki Hirao, MD Ko Nakao, MD Hayato Kajinaka, MD Kazuo Kishi, MD, PhD Histopathological Analysis of Decellularized Porcine Small Intestinal Submucosa after Treatment of Skin Ulcer Plastic and Reconstructive Surgery, Global Open |
| title | Histopathological Analysis of Decellularized Porcine Small Intestinal Submucosa after Treatment of Skin Ulcer |
| title_full | Histopathological Analysis of Decellularized Porcine Small Intestinal Submucosa after Treatment of Skin Ulcer |
| title_fullStr | Histopathological Analysis of Decellularized Porcine Small Intestinal Submucosa after Treatment of Skin Ulcer |
| title_full_unstemmed | Histopathological Analysis of Decellularized Porcine Small Intestinal Submucosa after Treatment of Skin Ulcer |
| title_short | Histopathological Analysis of Decellularized Porcine Small Intestinal Submucosa after Treatment of Skin Ulcer |
| title_sort | histopathological analysis of decellularized porcine small intestinal submucosa after treatment of skin ulcer |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000003967 |
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