Plastic Surgery Research Council
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Presenter: Shuangbai Zhou, MD
Co-Authors: Li QF; Zan T; Gu B; Liu K; Xie Y; Gan YK; Chiang CA; Wang J; Xu KM; Pu LQ
Shanghai Jiao Tong University

BACKGROUND: Recent studies show that autologous stem cells transplantation may contribute to skin regeneration during soft tissue expansion. Randomized clinical trial is needed to determine whether intradermal autologous bone marrow mononuclear cells (BMNCs) injection could improve clinical outcome and accelerate skin regeneration during soft tissue expansion.

METHODS: In this single-center, double-blinded, randomized and controlled clinical trial, 42 patients between 18 and 60 years old who presented with thin expanded skin during tissue expansion were recruited and randomly assigned to receive autologous BMNCs and placebo injections. A total of 2.4-12.5?107 cells of BMNCs was injected intradermally into the expanded skin. The primary endpoint was the absolute change of the expansion at 4 weeks and 8 weeks after treatment, expressed as expansion index (Total inflated volume divided by the designed volume, EI). Secondary end points were the thickness of expanded skin measured by duplex ultrasonic scanning and the texture of expanded skin evaluated by visual analogue scale both at 4 and 8 weeks.

RESULTS: Compared with Control Group, BMNCs Group appeared to have significantly higher EI both at 4 weeks (Mean±SD, 3.36±1.00 vs. 2.76±0.69, p=0.039) and at 8 weeks (4.05±1.06 vs. 3.00±0.74, p=0.001). Duplex ultrasonic scanning showed that BMNCs Group had superior in thickness of expanded skin at both 4 weeks (Epidermis, 0.21±0.04 vs. 0.15±0.03 mm, p<0.001; Dermis, 1.01±0.38 vs. 0.65±0.24 mm, p=0.001) and 8 weeks (Epidermis, 0.19±0.04 vs. 0.14±0.03 mm, p<0.001; Dermis 0.95±0.38 vs. 0.52±0.19 mm, p<0.001). A higher score of expanded skin texture was found in BMNCs group at both 4 weeks (79.4±8.40 vs. 54.2±11.2, p<0.001) and 8 weeks (69.8±11.2 vs 45.0±10.7, p<0.001).

CONCLUSIONS: The results from this study indicate significantly beneficial effects of autologous stem cells therapy in patients with deteriorating expanded skin through accelerating skin regeneration. This novel approach, if confirmed by future multicenter clinical trial, will provide a new alternative in providing tissue reconstruction with larger autologous skin.

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