Clinical Application of Autologous Three-cellular Cultured Skin Substitutes Based on Esterified Hyaluronic Acid Scaffold: Our Experience

Background: The aim of this work was to present our experience in the use of autologous three- cellular cultured skin substitutes (CSS). This method represents a surgical alternative in the treatment of a variety of pathologies, including burns, ulcers, giant nevi and tumors. Patients and Methods: CSS were obtained from full-thickness skin biopsies collected after enrolment of 11 patients in a clinical trial protocol approved by the local Institutional Review Boards of the 'La Sapienza' University of Rome and registered in clinicaltrials.gov (ID: NCT00718978). CSS consisted of a structure made by a pluristratified epithelial cell surface with melanocytes (ratio 1/20) and a basement of fibroblasts kept together by an esterified hyaluronic acid scaffold that can be surgically manipulated and is gradually reabsorbed after implantation and substituted by the host connectival stroma. Results: At the time of withdrawal of medication, the graft take was comparable to that of autografts, whereas in the follow-up visits, loss of the epithelial layer varied markedly (from 5 to 70%) while fibroblast cellular component growth prevailed. In one patient, there was complete dermal-epidermal construct survival. Conclusion: Given the anatomical complexity of the skin, we still have a long way to go before we are able to recreate all the cellular and structural characteristics of this organ. Results are, however, gradually improving, as is demonstrated by a successful graft, which was histologically shown to have a three- dimensional structure that maintained its conformation in vivo (epithelium, basement membrane, dermis, subcutis) in one patient. The take of melanocytes improved the final esthetic outcome.