Hyaluronic acid three-dimensional scaffold for surgical revision of retracting scars: a human experimental study

Abstract

An observational study was carried out at the Plastic and Reconstructive Surgery Unit of the University of Pavia - Salvatore Maugeri Research and Care Institute, Pavia, Italy, to assess the clinical and histological long-term outcomes of autologous skin grafting of fresh surgical wounds following previous repair with a hyaluronic acid three-dimensional scaffold (Hyalomatrix®). Eleven fresh wounds from surgical release of retracted scars were enrolled in this study. A stable skin-like tissue cover was observed in all of the treated wounds in an average 1 month's time; at the end of this study, after an average of 12 months' time, all of the reconstructed areas were pliable and stable, although an average retraction rate of 51·62% was showed. Histological observation and immunohistochemical analysis displayed integration of the graft within the surrounding tissues. A regenerated dermis with an extracellular matrix rich in type I collagen and elastic fibres and with reduced type III collagen rate was observed. The epidermis and dermoepidermal junction featured a normal appearance with well-structured dermal papillae, too. Although the histological features would suggest regeneration of a skin-like tissue, with a good dermis and no signs of scarring, the clinical problem of secondary contracture is still unsolved.

Figure 1

Right axillar posterior pillar scar retraction pre‐operative view.

Figure 2

Scar release intra‐operative view.

Figure 3

One year post‐operative view after scar release and serial grafting with Hyalomatrix® and split skin graft.

Figure 4

Scar biopsy. (A) Haematoxylin–eosin staining for tissue morphology. (B) Orcein staining for elastic fibres. (C) Immunostaining for type III collagen and haematoxylin counterstaining.

Figure 5

Regenerated dermis 20 days after Hyalomatrix® application. (A) 200× magnification haematoxylin–eosin staining. (B) 400× magnification type I collagen immunostaining; biomaterial remnants are still present in the dermis.

Figure 6

One year after autologous skin graft biopsy. (A) 100× magnification haematoxylin–eosin staining for tissue morphology. (B) 100× magnification orcein staining for elastic fibres and (C) 400× magnification type VII collagen immunostaining show a good integration within the surrounding tissues. (D) 100× magnification immunostaining for type I collagen. (E) 100× magnification immunostaining for type III collagen.