Background and study aims Circular ESD (CESD) is a treatment option for patients with extensive early esophageal cancer. Its major drawback is the development of a stricture. Stenting may represent an attractive prevention strategy. We designed an experimental study to assess the effect of stents covered with acellular biomatrix (AB) and a drug-eluting stent. Materials and methods Thirty-five 35 pigs underwent CESD and were randomized into six groups: G1 (control), G2 (SEMS), G3 (SEMS + AB), G4 (SEMS + AB + steroid-eluting layer), G5 (biodegradable stent [BD]), G6 (BD + AB). SEMS were placed alongside the post-CESD defect, fixed and removed after 21 days. The main outcomes were stricture development, severity, and histopathology. Results Pigs with BD stents (G5, 6) experienced severe inflammation and hypergranulation without biodegradation, therefore, these groups were closed prematurely. Significant strictures developed in 29 of 30 pigs (96.7 %). The most severe stricture developed in G2 and G4 (narrowest diameter (mm) 8.5 ± 3, 3 (G2) and 8.6 ± 2.1 (G4) vs. 17 ± 7.3 (G1) and 13.5 ± 8.3 (G3); P < 0.01. Signs of re-epithelization were present in 67 % and 71 % in G1 and G2 and in 100 % in G3 and G4. The most robust re-epithelization layer was present in G4. The inflammation was the most severe in G1 (mean score 2.3) and least severe in G4 (0.4). Conclusions Stenting did not effectively prevent development of post-CESD esophageal stricture. SEMS with AB resulted in improved re-epithelization and decreased stricture severity. Steroid-eluting SEMS suppressed inflammation. BD stents seem inappropriate for this indication.

• Publication type
• Journal Article MeSH

Xe-Derma(®) is a new biological acellular temporary wound cover derived from pig dermis in the form of a mesh of collagen and elastic fibers. It is recommended for use in similar indications as classical pig xenografts. A data collection of 2 burns centres in the treatment of burns with Xe-Derma(®) was obtained from the medical records of 101 patients admitted from January 1, 2010 to December 31, 2011. The primary objectives of the study were to assess efficacy and safety when using Xe-Derma(®) in burn treatment, and to analyse the course of healing. The secondary objectives were to define the suitable spectrum of indications of Xe-Derma(®) in terms of burn depth, and to evaluate subsequent scarring using the Vancouver Scar Scale. No undesirable systemic effects or adverse device events were observed. The use of Xe-Derma(®) was not associated with a higher risk of burn wound infection. On the other hand, the infection was the most common cause of Xe-Derma(®) dissolution. The majority of patients (81.4%) had no signs of Xe-Derma(®) dissolution. The mean healing time in the group of patiens under review was close to 12 days and mean hospitalization time was almost 14 days. Using Xe-Derma(®) proved to be effective as a temporary covering for partial-thickness burns with the capacity of spontaneous healing. It proved to be a well-tolerated wound coverage with minimal complications and low level of pain during dressing changes. Xe-Derma(®) firmly adhered to the wound bed. There was a lower frequency of wound dressing changes and only a minimal rate of wound infection.

Le Xe-Derma® est un nouveau pansement acellulaire biologique provisoire à base de derme porcin, se présentant sous la forme d’un filet de fibres de collagène et d’élastine. Son utilisation est recommandée dans les indications similaires aux xenogreffes porcines classiques. Nous avons recueilli et analysé les données de 101 patients, dont les brûlures ont été traitées par Xe- Derma® dans 2 centres de grands brûlés entre le 1er janvier 2010 et le 31 décembre 2011. L’objectif principal de cette étude consistait à évaluer l’efficacité et la sécurité de l’utilisation du Xe-Derma® pour le traitement des brûlures et d’analyser le processus de guérison. Les objectifs secondaires étaient de déterminer un spectre d’indications pour l’utilisation du Xe-Derma® selon la gravité de la brûlure et d’évaluer le processus de cicatrisation consécutif à l’aide de la VSS (Vancouver Scar Scale, échelle cicatricielle de Vancouver). Aucun effet systémique défavorable ou effet local indésirable n’a été observé. L’utilisation du Xe-Derma® n’a pas été associée à un risque plus élevé d’apparition d’infections de la plaie. En revanche, les infections ont représenté la cause la plus fréquente de dissolution du Xe-Derma®. La majorité des patients (81,4%) n’ont toutefois manifesté aucun signe de dissolution du Xe-Derma®. Quelle que soit la gravité de la brûlure, le durée moyenne de guérison était proche de 12 jours et la durée moyenne d’hospitalisation était de presque 14 jours. L’utilisation du Xe-Derma® s’est avérée efficace en tant que pansement provisoire sur les brûlures de second degré, présentant un potentiel de guérison spontanée. Le Xe-Derma® est un pansement bien toléré, causant peu de complications et réduisant la douleur lors des changements de pansement. Il adhère très bien au fond de la plaie. La faible fréquence de changement de pansement a permis de limiter les infections des brûlures.

• Keywords
• Xe-Derma®, acellular pig skin, biological temporary wound cover, burns,
• Publication type
• Journal Article MeSH

The purpose of this study was to compare, by means of in vitro cultivation technique, five marketed brands of wound covers used in the treatment of burns and other skin defects (Biobrane(®), Suprathel(®), Veloderm(®), Xe-Derma(®), and Xenoderm(®)) for their ability to stimulate the keratinocyte growth, stratification, and differentiation. In three independent experiments, human keratinocytes were grown on the tested covers in organotypic cultures by the 3T3 feeder layer technique. Vertical paraffin sections of the wound covers with keratinocytes were processed using hematoxylin-eosin staining and immunostaining for involucrin. Keratinocyte populations on the dressings were assessed for (1) number of keratinocyte strata (primary variable), (2) quantitative growth, (3) thickness of the keratinocyte layer, and (4) cell differentiation. The Xe-Derma wound cover provided the best support to keratinocyte proliferation and stratification, with the number of keratinocyte strata significantly (p < 0.05) higher in comparison to all products studied, except Xenoderm. However, in contrast to Xe-Derma, Xenoderm did not significantly differ from the other dressings. The results of this in vitro study show that the brands based on porcine dermal matrix possess the strongest effect on keratinocyte proliferation and stratification. The distinctive position of Xe-Derma may be related to its composition, where natural dermal fibers form a smooth surface, similar to the basement membrane. Furthermore, the results indicate that in vitro evaluation of effects on epithelial growth may accelerate the development of new bio-engineering-based wound covers.

• Keywords
• Wound cover, differentiation, keratinocyte growth,
• Publication type
• Journal Article MeSH

Toxic epidermal necrolysis is a rare condition involving the skin at the dermoepidermal junction, with possible inclusion of mucous membranes. The condition is associated with systemic toxicity and high mortality rates. Successful treatment requires optimization of local as well as systemic therapy. We report the case of a young woman who developed toxic epidermal necrolysis, possibly resulting from lamotrigine therapy. Local therapy included a combination of a biological cover and alginate together with a synthetic cover (Aquacel Ag®).

La nécrolyse épidermique toxique est une maladie rare touchant la peau à la jonction dermo-épidermique, avec inclusion possible des muqueuses. La condition est associée à une toxicité systémique et des taux de mortalité élevés. Le succès du traitement nécessite une optimisation de la thérapie locale ainsi que systémique. Nous rapportons le cas d’une jeune femme qui a développé une nécrolyse épidermique toxique, causée peut-être par un traitement par la lamotrigine. Le traitement local a compris une combinaison d’une couverture biologique et de l’alginate avec une couverture en matière synthétique (Aquacel Ag®).

• Keywords
• Xe-Derma, toxic epidermal necrolysis,
• Publication type
• Journal Article MeSH

A number of implantable biomaterials derived from animal tissues are now used in modern surgery. Xe-Derma is a dry, sterile, acellular porcine dermis. It has a remarkable healing effect on burns and other wounds. Our hypothesis was that the natural biological structure of Xe-Derma plays an important role in keratinocyte proliferation and formation of epidermal architecture in vitro as well as in vivo. The bioactivity of Xe-Derma was studied by a cell culture assay. We analyzed growth and differentiation of human keratinocytes cultured in vitro on Xe-Derma, and we compared the results with formation of neoepidermis in the deep dermal wounds treated with Xe-Derma. Keratinocytes cultured on Xe-Derma submerged in the culture medium achieved confluence in 7-10 days. After lifting the cultures to the air-liquid interface, the keratinocytes were stratified and differentiated within one week, forming an epidermis with basal, spinous, granular, and stratum corneum layers. Immunohistochemical detection of high-molecular weight cytokeratins (HMW CKs), CD29, p63, and involucrin confirmed the similarity of organization and differentiation of the cultured epidermal cells to the normal epidermis. The results suggest that the firm natural structure of Xe-Derma stimulates proliferation and differentiation of human primary keratinocytes and by this way improves wound healing.

• MeSH
• Extracellular Matrix metabolism   MeSH
• Fibroblasts cytology   physiology   MeSH
• Wound Healing physiology   MeSH
• Keratinocytes cytology   physiology   MeSH
• Cells, Cultured MeSH
• Humans MeSH
• Cell Proliferation MeSH
• Guided Tissue Regeneration instrumentation   methods   MeSH
• Tissue Engineering instrumentation   methods   MeSH
• Tissue Scaffolds * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, N.I.H., Extramural MeSH