117 Minimal Scarring after Grafting a Novel Autologous Self-assembly Skin Substitute on Burn Patients
Bibliographic record
Abstract
One of the main complications for patients surviving major burn injuries are contractures and hypertrophic scars. Since the dermis is responsible for the mechanical properties of the skin, we have designed a skin substitute comprising a dermis in addition to an epidermis and evaluated this autologous self-assembly skin substitute (SASS), produced by a tissue engineering approach. The dermis comprised fibroblasts secreting an endogenous extracellular matrix, without any exogenous scaffold. Patients were recruited through Health Canada’s Special Access Program, which allowed extensive burn injuries to be acutely treated with SASSs. The SASSs were grafted on debrided full-thickness wounds according to the same protocol used for autografts. The graft take and the persistence of the SASS’s epithelium overtime were evaluated. Comparative assessment of scar quality for the SASSs, autographs (AGs) and uninjured skin using the Cutometer®, Mexameter® and DermaScan C® devices were performed on a subset of patients. SASS was used as autologous grafts of 14 severely burned patients for deep-partial thickness and full thickness burn wound coverage. The mean of the total surface area grafted was 2,321 cm2 [range 420–6 925]. The median follow-up is 2.3 years [range 1 month-8 years]. One week after grafting, on average 98% [range 85–100%] graft take was obtained. No significant contraction was observed in vivo. SASSs promoted a particularly good healing process and ensuing suppleness. Minimal hypertrophic scars were only observed between the SASSs. The integrity of the transplanted SASSs persisted over time with no defect in epidermal regeneration and no significant contractures. The SASSs were not as pigmented as normal skin, despite some concentrated pigmentation spots that can increase in number and area with time depending on the pateint’s Fitzpatrick skin phototype. Sites grafted with SASSs were comparable to adjacent split-thickness AGs and uninjured skin regarding erythema (SASS site: 292.6 ± 88.5U vs AG: 315.75 ± 61.22U vs. uninjured skin: 258.8 ± 21.5U; p>0.05; N=4 to 8), elasticity (SASS site: 0.87 ± 0.40mm vs AG: 0.90 ± 0.37mm vs. uninjured skin: 1.31 ± 0.72 mm; p>0.05), skin thickness (SASS site: 1.68 ± 0.64mm vs. AG: 1.85 ± 0.45mm vs. uninjured skin: 1.85 ± 0.45 mm; p>0.05) and microscopic features. After grafting, the SASS has very good functional characteristics: minimal contraction and hypertrophic scar as well as long-term durability and tissue regeneration. The SASS is a promising skin substitute for grafting full-thickness skin injuries.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".