Evaluation of a composite skin substitute to treat venous stasis Ulcers: a pilot study

Abstract

Venous leg ulcers represent a therapeutic challenge, and they are associated to significant morbidity and cost. Many advances have been made to develop and apply biological skin substitutes, showing they can be beneficial for patients with burns, leg ulcers, and other skin lesions. Autologous cultivated keratinocytes have been demonstrated to be useful in leg ulcer treatment, but the lack of a dermal component may compromise their effects and the quality of the scar. Purpose: To evaluate a composite skin graft of human acellular dermis and autologous keratinocyte culture to treat leg ulcer. Methods: Two patients with four long-term chronic ulcers were treated with a composite skin graft of human acellular dermis and autologous keratinocyte culture for a month in this pilot study. Results: The four ulcers had a surface reduction of 72.21%, 36.36%, 60.93%, and 15.90% after one month of treatment. No adverse tissue reactions were observed. Histology and immunohistochemistry showed that humam acellular dermis was free of donor’s cells, and the composite skin substitute preserved the architecture of the normal skin, including the basement membrane components and stratified epidermis. Conclusions: These preliminary observations suggest that such composite skin substitute could be an alternative to recalcitrant leg ulcers.