Successful Skin Homografting From an Identical Twin in a Severely Burned Patient
Flame burns are a serious condition and usually have high morbidity and mortality because they effect large areas of the body surface as well as the lungs. In these patients, it is especially difficult to find healthy skin for grafting if they have more than 70% third-degree burns. Repeated autografting or synthetic wound care materials are the only treatment options to cover burned areas. Partial-thickness skin grafting from the patient's identical twin sibling may be an alternative treatment option, if possible. Here, we report a patient with severe flame injury treated with skin from his identical twin. The patient had third-degree burns covering 70% of his body surface. Initial treatment consisted of fluid and electrolyte replacement, daily wound care, and surgical debridements, as well as nutritional support. After initial treatment, we performed a successful skin grafting from his identical twin. Skin grafting between identical twins might be an alternate method for severely burned patients.
Available from: John E Connolly
- "The major disadvantage of this approach is that it takes at least 3 weeks to grow enough cells for successful grafting, due to the low number of keratinocyte stem cells recovered from skin biopsies. Much work has also been directed toward developing bioengineered skin substitutes using cultured cells (keratinocytes and/or fibroblasts) with a suitable matrix (Pham et al., 2007), but the difficulty of achieving permanent wound coverage for patients with large or intransigent wounds persists (Turk et al., 2014; Kamel et al., 2013). Bioengineered products have been hampered by immune rejection, vascularization problems, difficulty of handling, and failure to integrate due to scarring and fibrosis. "
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ABSTRACT: Epidermal stem cells have been in clinical application as a source of culture-generated grafts. Although applications for such cells are increasing due to aging populations and the greater incidence of diabetes, current keratinocyte grafting technology is limited by immunological barriers and the time needed for culture amplification. We studied the feasibility of using human fetal skin cells for allogeneic transplantation and showed that fetal keratinocytes have faster expansion times, longer telomeres, lower immunogenicity indicators, and greater clonogenicity with more stem cell indicators than adult keratinocytes. The fetal cells did not induce proliferation of T cells in coculture and were able to suppress the proliferation of stimulated T cells. Nevertheless, fetal keratinocytes could stratify normally in vitro. Experimental transplantation of fetal keratinocytes in vivo seeded on an engineered plasma scaffold yielded a well-stratified epidermal architecture and showed stable skin regeneration. These results support the possibility of using fetal skin cells for cell-based therapeutic grafting.
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