Figure - available from: Biomedical Optics Express
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Different phases of the blister formation process. During the first 15 minutes skin doming was observed (A to C). At 21 minutes the first cleft is observed (D) which grew in size (D to F). A steady-state phase is achieved at 45 minutes (G). A movie of the blister formation is shown in I with a speed factor of ~1000 × (see Visualization 1).
Source publication
Separation of skin epidermis from the dermis by suction blistering has been used with high success rate for autologous skin epidermal grafting in burns, chronic wounds and vitiligo transplantation treatment. Although commercial products that achieve epidermal grafting by suction blistering are presently available, there is still limited knowledge a...
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We use optical coherence tomography (OCT) to systematically study the dependence of the optical attenuation coefficient μt upon the applied pressure P in different depth regions of the human skin in vivo. We find that the same OCT data can be used to estimate thicknesses of the epidermis layer and the epidermis-dermis junction and obtain the thickn...
Optical coherence tomography (OCT) imaging of the skin is gaining recognition and is increasingly applied to dermatological research. A key dermatological parameter inferred from an OCT image is the epidermal (Ep) thickness as a thickened Ep can be an indicator of a skin disease. Agreement in the literature on the signal characters of Ep and the su...
Citations
... Whilst numerous studies have been carried out to evaluate and optimize both surgical and post-operative practices regarding skin transplantation (4)(5)(6)(7)(8)(9)(10)(11)(12), little research has been conducted to develop appropriate techniques to objectively and accurately evaluate skin graft health post-surgery. The studies that have assessed graft healing were typically invasive or employed the use of animal models (6,9,12), or measured superficial parameters, such as graft contraction (10), or re-epithelialization (11). ...
Background:
Skin autografting is a common clinical procedure for reconstructive surgery. Despite its widespread use, very few studies have been conducted to non-invasively evaluate and monitor the vascular and structural features of skin grafts. This study, therefore, aims to demonstrate the potential of optical coherence tomography (OCT) alongside OCT-based angiography (OCTA) to non-invasively image and monitor human skin graft health and integration over time.
Methods:
An in-house-built clinical prototype OCT system was used to acquire OCT/OCTA images from patients who underwent split-thickness skin graft surgery following severe burn damage to the skin. The OCT imaging was carried out at multiple locations over multiple time points with a field of view of ~9 mm × 9 mm and a penetration depth of ~1.5 mm. In addition to obtaining high-resolution qualitative images, we also quantitatively measured and compared specific structural and vascular parameters, such as identifiable layer thickness and corresponding vascular area density and diameter.
Results:
Two patients (patient #1 and #2) were enrolled for this preliminary study. Vascular and structural features were successfully imaged and measured in the graft tissue and integration layer immediately beneath at different time points. Revascularization, healing, and integration were monitored with patient-specific details. Results of the quantitative image analysis from patient #1 indicated that integration layer thickness 16-day post-surgery was significantly less (~50%) than that of 7-day post-surgery. Additionally, with patient #2, significant growth (~20%) was seen with the vascular area density of both the graft and corresponding integration layer beneath between 6 and 14 days post-surgery.
Conclusions:
Our preliminary studies show that OCT/OCTA has clinical potential to image and measure numerous features of human skin graft health and integration in the days and weeks following split-thickness surgery. For the first time, we demonstrate the applicability of non-invasive imaging technology for novel clinical uses that could eventually aid in the betterment of surgical practices and clinical outcomes.
... The principle behind the SB induction is simple: a light vacuum is applied to a small area of the skin. The negative pressure will eventually force the epidermis to separate from the dermis, creating a local blister filled with fluid and cells 1,2,9 . The blister fluid can be harvested by a fine needle aspiration and the content can be used for further study in vitro. ...
Cutaneous antigen-recall models allow for studies of human memory responses in vivo. When combined with skin suction blister (SB) induction, this model offers accessibility to rare populations of antigen-specific T-cells representative of the cellular memory response as well as the cytokine microenvironment in situ.
This report describes the practical procedure of a cutaneous recall, an SB induction, and a harvest of antigen-specific T-cells. To exemplify the method, the tuberculin skin test is used for antigenic recall in individuals who, prior to this study, underwent a Bacillus Calmette-Guérin vaccination against an infection with Mycobacterium tuberculosis. Finally, examples of multiplex and flow cytometric analyses of SB specimens are provided, illustrating high fractions of antigen-specific polyfunctional CD4+ T-cells available by this sampling method compared with cells isolated from the blood.
The method described here is safe and minimally invasive, provides a unique opportunity to study both innate and adaptive immune responses in vivo, and may be beneficial to a broad community of researchers working with cell-mediated immunity and human memory responses, in the context of vaccine development.
