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Article ; Online: Achieving self-sufficiency in skin allograft: A Singapore experience.

Chong, Si Jack / Low, Zhen Luan / Yick, Jialin / Khoo, Yik Cheong / Chua, Alvin Wen Choong

Burns : journal of the International Society for Burn Injuries

2024

Abstract: Aim: This paper describes how Singapore achieved skin allograft self-sufficiency in 2017 by adopting 5 key strategies in 2012.: Background: Singapore General Hospital (SGH) established its own allograft recovery programme in 1998 but was still ... ...

Abstract	Aim: This paper describes how Singapore achieved skin allograft self-sufficiency in 2017 by adopting 5 key strategies in 2012. Background: Singapore General Hospital (SGH) established its own allograft recovery programme in 1998 but was still dependent on overseas allograft procurement. Key strategies: RESULTS: The allograft recovery programme expanded from 4 to all 20 institutions. Donor referrals increased by 42.9% from 35 in 2014 to over 50 currently. Donor numbers increased by 210%, rising from 4.5 per year before 2015 to an average of 14 per year from 2015 to 2022. The total allografts recovered increased by 223%, climbing from 13,000 to 42,000 annually. Cryopreservation was adopted, extending shelf life to 5.5 years and doubling storage capacity to more than 140,000 cm Conclusion: Singapore achieved skin allograft self-sufficiency with no overseas procurement since 2017.
Language	English
Publishing date	2024-02-03
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	197308-3
ISSN	1879-1409 ; 0305-4179
ISSN (online)	1879-1409
ISSN	0305-4179
DOI	10.1016/j.burns.2024.01.025
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Article ; Online: Chemically defined and xenogeneic-free culture method for human epidermal keratinocytes on laminin-based matrices.

Tjin, Monica Suryana / Chua, Alvin Wen Choong / Tryggvason, Karl

Nature protocols

2020 Volume 15, Issue 2, Page(s) 694–711

Abstract: The basal keratinocyte progenitor cells in cultured epithelial autografts (CEAs) regenerate human epidermis after transplantation, a curative therapy for severe burns and, recently, diseases with epidermal loss, such as junctional epidermolysis bullosa ( ... ...

Abstract	The basal keratinocyte progenitor cells in cultured epithelial autografts (CEAs) regenerate human epidermis after transplantation, a curative therapy for severe burns and, recently, diseases with epidermal loss, such as junctional epidermolysis bullosa (EB). Although a culturing technique for skin keratinocytes was developed four decades ago, the xenogeneic nature of that conventional CEA culture system restricts its use to the treatment of critical and life-threatening cases, such as severe burns on >30% of total body surface area and EB. In the present protocol, we describe how to implement a defined, xeno-free culture system that supports long-term ex vivo expansion of functional human epidermal keratinocytes. Skin-specific basement membrane proteins called laminins play important roles in the maintenance of phenotypic integrity and in supporting the survival of keratinocytes that are adhered to them. This fully human keratinocyte culture system is 'regulatory friendly' and increases the potential of epithelial cellular therapy, which can be expanded to treat less severe burns and other skin defects, such as chronic diabetic wounds. It takes between 7 and 14 d to obtain an initial culture. Conservatively, a secondary culture from the primary culture can be expanded up to 20-fold within 4-5 d once cells reach confluency.
MeSH term(s)	3T3 Cells ; Animals ; Basement Membrane/metabolism ; Cell Culture Techniques/methods ; Epidermis/metabolism ; Feeder Cells/cytology ; Humans ; Keratinocytes/cytology ; Keratinocytes/metabolism ; Laminin/metabolism ; Mice
Chemical Substances	Laminin
Language	English
Publishing date	2020-01-15
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2244966-8
ISSN	1750-2799 ; 1754-2189
ISSN (online)	1750-2799
ISSN	1754-2189
DOI	10.1038/s41596-019-0270-3
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Article ; Online: Challenges in the management of extensive aplasia cutis congenita.

Ngeow, Alvin / Hui, Cheryl / Chua, Alvin Wen Choong / Koh, Mark / Ong, Yee Siang / Poon, Woei Bing

BMJ case reports

2022 Volume 15, Issue 2

Abstract: Aplasia cutis congenita (ACC) is a rare group of congenital disorders characterised by focal or widespread absence of skin, predominantly affecting the scalp. A Malay female infant was born at 37 weeks with extensive ACC, affecting 37% of total body ... ...

Abstract	Aplasia cutis congenita (ACC) is a rare group of congenital disorders characterised by focal or widespread absence of skin, predominantly affecting the scalp. A Malay female infant was born at 37 weeks with extensive ACC, affecting 37% of total body surface area, including her scalp and trunk. There is no consensus on the management of ACC given the rarity and variable presentation. A multi-disciplinary team comprising neonatologists, paediatric dermatologists, plastic surgeons and medical laboratory scientists at the skin bank, employed a more aggressive surgical approach with the aim of avoiding potentially catastrophic morbidity, including sagittal sinus haemorrhage and brain herniation. Out of several surgical options, the team used a staged artificial dermal matrix (Integra) and cultured epithelial autograft application, followed by regular wound dressing, and eventually allowed the child to achieve complete epithelialisation of her trunk, and most of scalp before she was discharged from hospital.
MeSH term(s)	Bandages ; Child ; Ectodermal Dysplasia/diagnosis ; Ectodermal Dysplasia/therapy ; Female ; Hemorrhage ; Humans ; Infant ; Scalp ; Skin
Language	English
Publishing date	2022-02-14
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2021-246627
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Article ; Online: Isolation and Culture of Hair Follicle Dermal Sheath Mesenchymal Stromal Cells.

Ma, Dongrui / Lee, Seng-Teik / Chua, Alvin Wen Choong

Methods in molecular biology (Clifton, N.J.)

2019 Volume 1993, Page(s) 61–70

Abstract: To date, little is published on the characterization and therapeutic potential of human mesenchymal stromal cells (MSCs) derived from hair follicle dermal sheath (DS). We present protocols for the isolation and culture of human DS-MSCs starting with the ... ...

Abstract	To date, little is published on the characterization and therapeutic potential of human mesenchymal stromal cells (MSCs) derived from hair follicle dermal sheath (DS). We present protocols for the isolation and culture of human DS-MSCs starting with the use of a dissecting microscope to separate out dermal sheaths from hair follicles for trypsin digestion. We also present the protocols for the adipogenic, osteogenic, and chondrogenic differentiation of these DS-MSCs as we seek to harness these cells for potential applications in stem cell therapy and tissue engineering.
MeSH term(s)	Adipogenesis ; Cell Culture Techniques/methods ; Cell Differentiation ; Cell Separation/methods ; Chondrogenesis ; Hair Follicle/cytology ; Humans ; Mesenchymal Stem Cells/physiology ; Osteogenesis
Language	English
Publishing date	2019-05-30
Publishing country	United States
Document type	Journal Article
ISSN	1940-6029
ISSN (online)	1940-6029
DOI	10.1007/978-1-4939-9473-1_5
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Article ; Online: Human Umbilical Cord Lining-Derived Epithelial Cells: A Potential Source of Non-Native Epithelial Cells That Accelerate Healing in a Porcine Cutaneous Wound Model.

Kua, Jonah Ee Hsiang / Siow, Chun Wei / Lim, Wee Keng / Masilamani, Jeyakumar / Tjin, Monica Suryana / Yeong, Joe / Lim, Tony Kiat Hon / Phan, Toan Thang / Chua, Alvin Wen Choong

International journal of molecular sciences

2022 Volume 23, Issue 16

Abstract: Human umbilical cord lining epithelial cells [CLECs) are naïve in nature and can be ethically recovered from cords that are routinely discarded. The success of using oral mucosal epithelial cells for cornea defects hints at the feasibility of treating ... ...

Abstract	Human umbilical cord lining epithelial cells [CLECs) are naïve in nature and can be ethically recovered from cords that are routinely discarded. The success of using oral mucosal epithelial cells for cornea defects hints at the feasibility of treating cutaneous wounds using non-native CLECs. Herein, we characterized CLECs using flow cytometry (FC) and skin organotypic cultures in direct comparison with skin keratinocytes (KCs). This was followed by wound healing study to compare the effects of CLEC application and the traditional use of human skin allografts (HSGs) in a porcine wound model. While CLECs were found to express all the epidermal cell markers probed, the major difference between CLECs and KCs lies in the level of expression (in FC analysis) as well as in the location of expression (of the epithelium in organotypic cultures) of some of the basal cell markers probed. On the pig wounds, CLEC application promoted accelerated healing with no adverse reaction compared to HSG use. Though CLECs, like HSGs, elicited high levels of local and systemic immune responses in the animals during the first week, these effects were tapered off more quickly in the CLEC-treated group. Overall, the in vivo porcine data point to the potential of CLECs as a non-native and safe source of cells to treat cutaneous wounds.
MeSH term(s)	Animals ; Epithelial Cells/metabolism ; Humans ; Keratinocytes ; Skin/metabolism ; Swine ; Umbilical Cord ; Wound Healing
Language	English
Publishing date	2022-08-10
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2019364-6
ISSN	1422-0067 ; 1422-0067 ; 1661-6596
ISSN (online)	1422-0067
ISSN	1422-0067 ; 1661-6596
DOI	10.3390/ijms23168918
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: The use of negative-pressure wound therapy over a cultured epithelial autograft for full-thickness wounds secondary to purpura fulminans in an infant.

Goh, Benjamin Kah Liang / Chua, Alvin Wen Choong / Chew, Khong Yik / Kang, Gavin Chun-Wui / Chiang, Li-Wei / Tan, Bien-Keem / Ramachandran, Savitha

Archives of plastic surgery

2020 Volume 48, Issue 3, Page(s) 338–343

Abstract: Purpura fulminans is a serious condition that can result in severe morbidity in the pediatric population. Although autologous skin grafts remain the gold standard for the coverage of partial- to full-thickness wounds, they have several limitations in ... ...

Abstract	Purpura fulminans is a serious condition that can result in severe morbidity in the pediatric population. Although autologous skin grafts remain the gold standard for the coverage of partial- to full-thickness wounds, they have several limitations in pediatric patients, including the lack of planar donor sites, the risk of hemodynamic instability, and the limited graft thickness. In Singapore, an in-house skin culture laboratory has been available since 2005 for the use of cultured epithelial autografts (CEAs), especially in burn wounds. However, due to the fragility of CEAs, negative-pressure wound therapy (NPWT) dressings have been rarely used with CEAs. With several modifications, we report a successful case of NPWT applied over a CEA in an infant who sustained 30% total body surface area full-thickness wounds over the anterior abdomen, flank, and upper thigh secondary to purpura fulminans. We also describe the advantages of using NPWT dressing over a CEA, particularly in pediatric patients.
Language	English
Publishing date	2020-11-20
Publishing country	Korea (South)
Document type	Case Reports
ZDB-ID	2694943-X
ISSN	2234-6171 ; 2234-6163
ISSN (online)	2234-6171
ISSN	2234-6163
DOI	10.5999/aps.2020.01032
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Keratin-Alginate Sponges Support Healing of Partial-Thickness Burns.

Moay, Zi Kuang / Nguyen, Luong T H / Hartrianti, Pietradewi / Lunny, Declan P / Leavesley, David / Kok, Yee Onn / Chong, Si Jack / Chua, Alvin Wen Choong / Tee, Shang-Ian / Ng, Kee Woei

International journal of molecular sciences

2021 Volume 22, Issue 16

Abstract: Deep partial-thickness burns damage most of the dermis and can cause severe pain, scarring, and mortality if left untreated. This study serves to evaluate the effectiveness of crosslinked keratin-alginate composite sponges as dermal substitutes for deep ... ...

Abstract	Deep partial-thickness burns damage most of the dermis and can cause severe pain, scarring, and mortality if left untreated. This study serves to evaluate the effectiveness of crosslinked keratin-alginate composite sponges as dermal substitutes for deep partial-thickness burns. Crosslinked keratin-alginate sponges were tested for the ability to support human dermal fibroblasts in vitro and to support the closure and healing of partial-thickness burn wounds in
MeSH term(s)	Alginates/chemistry ; Alginates/pharmacology ; Alginates/therapeutic use ; Animals ; Bandages, Hydrocolloid ; Burns/pathology ; Burns/physiopathology ; Burns/therapy ; Cells, Cultured ; Dermis/drug effects ; Dermis/pathology ; Dermis/physiopathology ; Humans ; Hydrogels/chemistry ; Hydrogels/therapeutic use ; Keratins/chemistry ; Keratins/pharmacology ; Keratins/therapeutic use ; Male ; Materials Testing ; Severity of Illness Index ; Skin/drug effects ; Skin/pathology ; Skin/physiopathology ; Swine ; Wound Healing/drug effects ; Wound Healing/physiology
Chemical Substances	Alginates ; Hydrogels ; Keratins (68238-35-7)
Language	English
Publishing date	2021-08-10
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2019364-6
ISSN	1422-0067 ; 1422-0067 ; 1661-6596
ISSN (online)	1422-0067
ISSN	1422-0067 ; 1661-6596
DOI	10.3390/ijms22168594
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: The use of negative-pressure wound therapy over a cultured epithelial autograft for full-thickness wounds secondary to purpura fulminans in an infant

Goh, Benjamin Kah Liang / Chua, Alvin Wen Choong / Chew, Khong Yik / Kang, Gavin Chun-Wui / Chiang, Li-Wei / Tan, Bien-Keem / Ramachandran, Savitha

Archives of Plastic Surgery

2021 Volume 48, Issue 03, Page(s) 338–343

Abstract	Purpura fulminans is a serious condition that can result in severe morbidity in the pediatric population. Although autologous skin grafts remain the gold standard for the coverage of partial- to full-thickness wounds, they have several limitations in pediatric patients, including the lack of planar donor sites, the risk of hemodynamic instability, and the limited graft thickness. In Singapore, an in-house skin culture laboratory has been available since 2005 for the use of cultured epithelial autografts (CEAs), especially in burn wounds. However, due to the fragility of CEAs, negative-pressure wound therapy (NPWT) dressings have been rarely used with CEAs. With several modifications, we report a successful case of NPWT applied over a CEA in an infant who sustained 30% total body surface area full-thickness wounds over the anterior abdomen, flank, and upper thigh secondary to purpura fulminans. We also describe the advantages of using NPWT dressing over a CEA, particularly in pediatric patients.
Keywords	Negative-pressure wound therapy ; Autografts ; Epithelium cells ; Child ; Skin
Language	English
Publishing date	2021-05-01
Publisher	Thieme Medical Publishers, Inc.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2694943-X
ISSN	2234-6171 ; 2234-6163 ; 2234-6171
ISSN (online)	2234-6171
ISSN	2234-6163 ; 2234-6171
DOI	10.5999/aps.2020.01032
Database	Thieme publisher's database

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Article ; Online: From skin allograft coverage to allograft-micrograft sandwich method: A retrospective review of severe burn patients who received conjunctive application of cultured epithelial autografts.

Chua, Alvin Wen Choong / Khoo, Yik Cheong / Truong, Thi Thu Ha / Woo, Evan / Tan, Bien Keem / Chong, Si Jack

Burns : journal of the International Society for Burn Injuries

2018 Volume 44, Issue 5, Page(s) 1302–1307

Abstract: A 12-year retrospective review of severe burn patients who received cultured epithelial autografts (CEA) at the Singapore General Hospital Burns Centre from January 2005 to December 2016 was carried out. During this period, two different surgical ... ...

Abstract	A 12-year retrospective review of severe burn patients who received cultured epithelial autografts (CEA) at the Singapore General Hospital Burns Centre from January 2005 to December 2016 was carried out. During this period, two different surgical modalities were employed to manage these burn injuries. In the earlier period, following early excision of the burn wounds, exposed surfaces were covered with a combination of split thickness skin autografts (STSG) and allografts. Surfaces covered with skin allografts were subsequently debrided of the allo-epidermis in about 3 weeks later, exposing the allodermis with granulating tissues for grafting of CEA; a technique known as the Cuono's method. In the later period, allograft-autologous micrograft sandwich technique was used to graft on the early excised burns with subsequent CEA grafting. The former and latter groups represented by STSG/C (n=10) and M/CEA (n=14) respectively, were compared in terms of clinical profiles, outcomes, allograft/CEA usage and total graft cost. No significant differences were found based on mean age and presence of inhalation burns between the two treatment methods However, percentage total body surface area (TBSA) and Revised Baux Score were significantly higher (p<0.05) in the M/CEA group compared to the STSG/C group. Differences in clinical outcomes of mortality and length of hospital stay between the 2 groups were statistically insignificant. The average area amount of skin allografts used per patient in the M/CEA group was significantly lower compared to the STSG/C method group which contributed to lower total average cost of grafts used per % TBSA in the M/CEA method group. This might be attributed to the presence of micrografts which seemed to improve stabilization of the wound bed resulting in less operating procedures and improving CEA take. To conclude, the M/CEA method introduced was able to treat more severe burn patients at lower graft costs without compromising critical clinical outcomes significantly.
MeSH term(s)	Adult ; Burns/mortality ; Burns/surgery ; Cells, Cultured ; Debridement ; Epithelial Cells/transplantation ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Retrospective Studies ; Singapore ; Skin/cytology ; Skin Transplantation/methods ; Transplantation, Autologous ; Trauma Severity Indices ; Young Adult
Language	English
Publishing date	2018-02-21
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	197308-3
ISSN	1879-1409 ; 0305-4179
ISSN (online)	1879-1409
ISSN	0305-4179
DOI	10.1016/j.burns.2018.01.021
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Zs.A 1250: Show issues

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Article ; Online: In vitro characterization of human hair follicle dermal sheath mesenchymal stromal cells and their potential in enhancing diabetic wound healing.

Ma, Dongrui / Kua, Jonah Ee Hsiang / Lim, Wee Keng / Lee, Seng Teik / Chua, Alvin Wen Choong

Cytotherapy

2015 Volume 17, Issue 8, Page(s) 1036–1051

Abstract: Background aims: Little is published on the characterization and therapeutic potential of human mesenchymal cells derived from hair follicle (HF) dermal sheath (DS). In this study, we isolated and characterized HF DS-mesenchymal stromal cells (DS-MSCs) ... ...

Abstract	Background aims: Little is published on the characterization and therapeutic potential of human mesenchymal cells derived from hair follicle (HF) dermal sheath (DS). In this study, we isolated and characterized HF DS-mesenchymal stromal cells (DS-MSCs) with respect to the bone marrow mesenchymal stromal cells (BM-MSCs). We further tested if DS-MSC-conditioned medium (CM), like what was previously reported for BM-MSC CM, has superior wound-healing properties, in both in vitro and in vivo wound models compared with skin fibroblast CM. Methods: DS-MSCs were isolated from HF and cultured in vitro to assess long-term growth potential, colony-forming efficiency (CFE), expression of CD surface markers and differentiation potential. The cytokine expression of DS-MSC CM was determined through an antibody-based protein array analysis. The wound-healing effects of the CM were tested in vitro with the use of human cell cultures and in vivo with the use of a diabetic mouse wound model. Results: In vitro results revealed that DS-MSCs have high growth capacity and CFE while displaying some phenotypes similar to BM-MSCs. DS-MSCs strongly expressed many surface markers expressed in BM-MSCs and could also differentiate into osteoblasts, chondrocytes and adipocytes. DS-MSCs secreted significantly higher proportions of paracrine factors such as interleukin-6 (IL-6), IL-8 and growth-related oncogene. DS-MSC-CM demonstrated enhanced wound-healing effects on human skin keratinocytes, fibroblasts and endothelial cells in vitro, and the wound-healing time in diabetic mice was found to be shorter, compared with vehicle controls. Conclusions: Human HF DS stromal cells demonstrated MSC-like properties and might be an alternative source for therapeutic use in wound healing.
MeSH term(s)	Adipocytes/cytology ; Adult ; Animals ; Cell Differentiation/drug effects ; Cell Proliferation ; Cells, Cultured ; Chondrocytes/cytology ; Culture Media, Conditioned ; Diabetes Mellitus/therapy ; Endothelial Cells/drug effects ; Female ; Fibroblasts/drug effects ; Hair Follicle/cytology ; Humans ; Interleukin-6/metabolism ; Interleukin-8/metabolism ; Keratinocytes/drug effects ; Male ; Mesenchymal Stem Cells/cytology ; Mice ; Middle Aged ; Osteoblasts/cytology ; Skin/cytology ; Stromal Cells/drug effects ; Wound Healing ; Young Adult
Chemical Substances	Culture Media, Conditioned ; IL6 protein, human ; Interleukin-6 ; Interleukin-8
Language	English
Publishing date	2015-05-13
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2039821-9
ISSN	1477-2566 ; 1465-3249
ISSN (online)	1477-2566
ISSN	1465-3249
DOI	10.1016/j.jcyt.2015.04.001
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