Neoskin development in the fetus with the use of a three-layer graft: an animal model for in utero closure of large skin defects

Abstract

Objective: To assess the ability of a three-layer graft in the closuse of large fetal skin defects. Methods: Ovine fetuses underwent a large (4 × 3 cm) full-thickness skin defect over the lumbar region at 105 days’ gestation (term = 140 days). A bilaminar artificial skin was placed over a cellulose interface to cover the defect (3-layer graft). The skin was partially reapproximated with a continuous nylon suture. Pregnancy was allowed to continue and the surgical site was submitted to histopathological analysis at different post-operative intervals. Results: Seven fetuses underwent surgery. One maternal/fetal death occurred, and the remaining 6 fetuses were analyzed. Artificial skin adherence to the wound edges was observed in cases that remained in utero for at least 15 days. Neoskin was present beneath the silicone layer of the bilaminar artificial skin. Conclusions: Our study shows that neoskin can develop in the fetus using a 3-layer graft, including epidermal growth beneath the silicone layer of the bilaminar skin graft. These findings suggest that the fetus is able to reepithelialise even large skin defects. Further experience is necessary to assess the quality of this repair.

Keywords::

• Skin
• artificial
• fetal therapies
• wound healing
• sheep
• disease models
• animal
• ultrasonography
• prenatal video-assisted surgery
• meningomyelocele

Acknowledgments

We would like to thank Rogério Chaccur Abou-Jamra (in memoriam) and Rita de Cássia Sanchez e Oliveira, for their collaboration in the surgeries. I would also like to thank Erica Stein Ciasca Stein and Silvia Rejane Fontoura Herrera, M.D. for their collaboration in the elaboration of the manuscript. The Albert Einstein Teaching and Research Institute Ethics Committee− São Paulo− Brazil (Instituto de Ensino e Pesquisa da Sociedade Beneficente Israelita Albert Einstein) approved the study (CEUA/Einstein: number 245-07 on 17 May 2007). This study was funded by a grant from Instituto de Ensino e Pesquisa da Sociedade Beneficente Israelita Albert Einstein− São Paulo− SP− Brazil.

Disclosure of interest

The Promedon, a Latin American sales company for Integra (Plainsboro, USA), provided, without charges (donated), the Integra® (artificial skin) used in the present study. No other conflict of interest, including shares, employment, reimbursement for attending a meeting, fees for speaking, and funds for a member of staff, research consulting and organising education, was obtained from this or any other companies. The authors declare no conflict of interest and are solely responsible for the content of their paper.