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Skin grafts have remained relatively unchanged since their introduction as a medical treatment for burns/wounds. This paper seeks to open an academic discussion as to whether their use-by date has now been passed. A skin graft substitute is described in a paradigm using fine leaf gelatine sheets which inherently possess several distinct advantages including, discarding the harvest of autologous tissue from patient donor sites. A clinical study will be needed to determine its suitability taken together with the understanding that experimental animal studies may not provide unequivocal answers to its in situ modus operandi.
This paper sets out to
demonstrate that scraping of the flat dorsal surface of human dermis with a
scalpel blade and cell plating without centrifugation can lead to the
recognition and identification of the individual packing micro pattern of
dermal reticular fibroblasts at confluence. The characteristic alignment of
papillary and reticular fibroblasts at right angles to each other led to the
positive identification of reticular fibroblasts. A non-enzymatic means of
sub-culturing (passaging), which yields fully functional, healthy cells with
normal, phenotypic morphology is also described. Implications for published subcutaneous
wound healing studies are discussed as well as the confluent reticular
fibroblast configuration, interpreted as ananatomic site identity code,which may be the address of a specific fibroblast gene pattern expression.
The human dermis
presents an ongoing problem for regenerative medicine. Current medical
management uses various acellular dermal matrices on wound sites. The challenge
for scientists is to examine, then to question accepted conventional
wisdom and to present new concepts. In this paper, Autologous Cell Therapy will
be described by using cell culture of autologous dermal
fibroblasts and their extracellular matrix as a foundation for rebuilding the
dermis in conditioned wound beds. This proposal seems to create a conflict with
the medical approach to keeping a wound bed “moist”.