Full Thickness Skin Expansion ex vivo in a Newly Developed Reactor and Evaluation of Auto-Grafting Efficiency of the Expanded Skin Using Yucatan Pig Model

BACKGROUND: Skin grafts are required in numerous clinical procedures, such as reconstruction after skin removal and correction of contracture or scarring after severe skin loss caused by burns, accidents, and trauma. The current standard for skin defect replacement procedures is the use of autologous skin grafts. However, donor-site tissue availability remains a major obstacle for the successful replacement of skin defects and often limits this option. The aim of this study is to effectively expand full thickness skin to clinically useful size using an automated skin reactor and evaluate auto grafting efficiency of the expanded skin using Yucatan female pigs. METHODS: We developed an automated bioreactor system with the functions of real-time monitoring and remote-control, optimization of grip, and induction of skin porosity for effective tissue expansion. We evaluated the morphological, ultra-structural, and mechanical properties of the expanded skin before and after expansion using histology, immunohistochemistry, and tensile testing. We further carried out in vivo grafting study using Yucatan pigs to investigate the feasibility of this method in clinical application. RESULTS: The results showed an average expansion rate of 180%. The histological findings indicated that external expansion stimulated cellular activity in the isolated skin and resulted in successful grafting to the transplanted site. Specifically, hyperplasia did not appear at the auto-grafted site, and grafted skin appeared similar to normal skin. Furthermore, mechanical stimuli resulted in an increase in COL1A2 expression in a suitable environment. CONCLUSION: These findings provided insight on the potential of this expansion system in promoting dermal extracellular matrix synthesis in vitro. Conclusively, this newly developed smart skin bioreactor enabled effective skin expansion ex vivo and successful grafting in vivo in a pig model.

Comparison of Three-Dimensional Accuracy between Digital Models Obtained from Impression Scan and Model Scan / 대한치과재료학회지

The purpose of the study is to compare and analyze the accuracy of digital images obtained from impression and stone model with model scanner and to find out clinical effectiveness. A mandibular left first molar composite resin tooth was made for abutment. Digital models were obtained with a same model scanner(Ceramill Map 400, Amann Girrbach, Austria); (1) Fabricated resin model was scanned(Group C). (2) 10 impressions were taken with putty and polyvinyl siloxane, then were scanned (Group I). (3) Type IV stone was poured in each impressions made in step(2) and 10 stone models were scanned(Group S). 3 dimensional super-impositional program (Geomagic control X, 3D Systems, USA) was used to analyze the STL files. Stone model scan(Group S) showed lower deviation than impression scan(Group I) compared to the control group(P < 0.001). Both Group I and Group S showed signs of expansion in the occlusion surface and margin surface while showing contraction in the axial surface. The deviations were smaller in order of occlusal plane, horizontal plane of margin and axial plane. Within the limited boundary of this study, the digital model obtained from stone model scan showed smaller deviation than the digital model obtained from impression scan.