Efficacy and Safety of a Nanofat-seeded Biological Scaffold in Healing Lower Limb Surgical Defects

NCT ID: NCT03548610

Last Updated: 2020-02-11

Basic Information

• Recruitment Status: WITHDRAWN
• Clinical Phase: NA
• Study Classification: INTERVENTIONAL
• Study Start Date: 2019-01-30
• Study Completion Date: 2021-07-31

Brief Summary

Large full-thickness skin defects, such as those resulting from trauma, large and giant congenital nevi, disfiguring scars, or tumor resection remain major clinical problems to patients and physicians. Skin flaps and grafts represent the current standard of care (SOC), but often present limitations associated with surgical morbidity and donor site availability. The investigators will enroll 64 patients who have their skin cancer surgically removed and require reconstructive procedure such as a skin flap/graft.

To objective of this study is to assess the efficacy and safety of a nanofat-seeded biological scaffold versus the SOC in healing larger surgical defects (>1.5cm) involving the lower limb that cannot be closed by direct suture and thus need a reconstructive procedure such as a skin flap/graft.

Detailed Description

Large full-thickness skin defects, such as those resulting from trauma, large and giant congenital nevi, disfiguring scars, or tumor resection remain major clinical problems to patients and physicians. Skin flaps and grafts represent the current standard of care (SOC), but often present limitations associated with surgical morbidity and donor site availability. To overcome these limitations, cultured epidermal autografts consisting of keratinocytes were developed to provide enough autologous skin. However, the routine use of these cultured epidermal autografts was hampered by its high risk of recurrent wound opening, long-term fragility, and increased rates of scar contractures.

Tissue-engineered dermal skin substitutes containing complex dermal layers have also been developed to produce large, near-natural skin substitutes. They promote healing and avoid scar contracture; however, the healing times are long as they lack the active cellular and paracrine components of healing, and they often need a second delayed surgical procedure, a split-thickness skin graft, to obtain complete epithelization.

The term "nanofat grafting" was first used by Tonnard et al. and constitutes a rich reservoir of regenerative precursor cells (including stromal vascular fraction cells, among which adipose-derived stem cells) with pro-angiogenic capabilities. The many proprieties of nanofat and the stromal vascular fraction in regenerative and aesthetic surgery are just being discovered. In particular, numerous in vitro and in vivo studies have demonstrated the ability of these cells to differentiate into various skin cell lineages. Moreover, they are recognized as a powerful source for tissue regeneration because of their capability to secrete paracrine factors, initiating tissue repair and accelerating wound closure by skin regeneration instead of fibrotic scar formation.

Few anecdotal reports have documented the efficacy of the stromal vascular fraction in acute as well as chronic wounds. However, no observation has explored the efficacy of nanofat in healing surgical defects. Of note, nanofat is substantially easier, faster, and remarkably less expensive to obtain when compared to the mechanically- or enzymatically-isolated stromal vascular fraction. At present, there is a noticeable lack of randomized-controlled evidence in the international literature. Thus, this would represent the most comprehensive and the first randomized, controlled experience documenting the use of nanofat for wound healing.

Conditions

Wound of Skin; Non-melanoma Skin Cancer; Skin Graft Complications; Wound of Lower Leg; Wound of Knee

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Nanofat-seeded biological scaffold on surgical defect

Nanofat is obtained via lipoaspiration of 10cc of fat from abdomen under moderate local tumescent anesthesia w/ saline. Cannula access point is anesthetized by local lidocaine infiltration. Lipoaspirate is processed into nanofat using the Tonnard method, after 3-minute decantation. Aspiration is performed using a multihole 3mm cannula. Wound margin + bed is treated w/ topical \& local injections of nanofat, then covered w/ a biological scaffold, the inferior surface of which is soaked in nanofat; scaffold is fixed w/ external dressings or resorbable sutures; external covering includes polyurethane film \& 3 layers of dressings. Topical application creates a fine \<1mm nanofat layer. Scaffold (Puracol Plus) is left in place to integrate w/ surrounding skin, while external dressings changed at 7 \& 15 days. Lipoaspirate donor site needs mild to moderate compression for 24 hours \& suture removal (if not absorbed) at 7 days.

Group Type: EXPERIMENTAL

Nanofat-seeded biological scaffold on surgical defect

Intervention Type: OTHER

Nanofat-seeded biological scaffold in healing larger surgical defects (\>1.5cm) involving the lower limbs

Standard of Care dressings

Immediately after surgical resection, each patient will be treated following the SOC, therefore with a local skin flap, rather than with a skin graft, based on surgeon assessment. Sutures, and moulage, if present, will be removed at 7 days and patient instructed to apply a daily silicone cream and sunscreen for 2 months.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Nanofat-seeded biological scaffold on surgical defect

Nanofat-seeded biological scaffold in healing larger surgical defects (\>1.5cm) involving the lower limbs

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Subjects who need to undergo a surgical intervention resulting in complex lower limb surgical defects that cannot be closed primarily, and thus need a reconstructive phase
• Willing to undertake all study procedures, including nanofat harvesting from stomach site
• Willing to sign an informed consent form

Exclusion Criteria

• Age less than 18 years of age
• Pregnant women
• Any contraindications to use of nanofat or collagen scaffold

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Brigham and Women's Hospital

OTHER

Sponsor Role: lead

Responsible Party

Abigail Waldman,M.D.

MOHS Physician

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Chrysalyne D Schmults, MD, MSCE

Role: PRINCIPAL_INVESTIGATOR

Brigham and Women's Hospital

Locations

Mohs and Dermatologic Surgery Center, Brigham and Women's Hospital

Boston, Massachusetts, United States

Countries

United States

References

Klar AS, Zimoch J, Biedermann T. Skin Tissue Engineering: Application of Adipose-Derived Stem Cells. Biomed Res Int. 2017;2017:9747010. doi: 10.1155/2017/9747010. Epub 2017 Feb 27.

Reference Type: BACKGROUND

PMID: 28337463 (View on PubMed)

Tonnard P, Verpaele A, Peeters G, Hamdi M, Cornelissen M, Declercq H. Nanofat grafting: basic research and clinical applications. Plast Reconstr Surg. 2013 Oct;132(4):1017-1026. doi: 10.1097/PRS.0b013e31829fe1b0.

Reference Type: BACKGROUND

PMID: 23783059 (View on PubMed)

Cervelli V, Gentile P, De Angelis B, Calabrese C, Di Stefani A, Scioli MG, Curcio BC, Felici M, Orlandi A. Application of enhanced stromal vascular fraction and fat grafting mixed with PRP in post-traumatic lower extremity ulcers. Stem Cell Res. 2011 Mar;6(2):103-11. doi: 10.1016/j.scr.2010.11.003. Epub 2010 Nov 30.

Reference Type: BACKGROUND

PMID: 21195687 (View on PubMed)

You HJ, Han SK. Cell therapy for wound healing. J Korean Med Sci. 2014 Mar;29(3):311-9. doi: 10.3346/jkms.2014.29.3.311. Epub 2014 Feb 27.

Reference Type: BACKGROUND

PMID: 24616577 (View on PubMed)

Konstantinow A, Arnold A, Djabali K, Kempf W, Gutermuth J, Fischer T, Biedermann T. Therapy of ulcus cruris of venous and mixed venous arterial origin with autologous, adult, native progenitor cells from subcutaneous adipose tissue: a prospective clinical pilot study. J Eur Acad Dermatol Venereol. 2017 Dec;31(12):2104-2118. doi: 10.1111/jdv.14489. Epub 2017 Sep 4.

Reference Type: BACKGROUND

PMID: 28750144 (View on PubMed)

Brett E, Chung N, Leavitt WT, Momeni A, Longaker MT, Wan DC. A Review of Cell-Based Strategies for Soft Tissue Reconstruction. Tissue Eng Part B Rev. 2017 Aug;23(4):336-346. doi: 10.1089/ten.TEB.2016.0455. Epub 2017 Apr 27.

Reference Type: BACKGROUND

PMID: 28372485 (View on PubMed)

Klinger A, Kawata M, Villalobos M, Jones RB, Pike S, Wu N, Chang S, Zhang P, DiMuzio P, Vernengo J, Benvenuto P, Goldfarb RD, Hunter K, Liu Y, Carpenter JP, Tulenko TN. Living scaffolds: surgical repair using scaffolds seeded with human adipose-derived stem cells. Hernia. 2016 Feb;20(1):161-70. doi: 10.1007/s10029-015-1415-0. Epub 2015 Nov 6.

Reference Type: BACKGROUND

PMID: 26545361 (View on PubMed)

Uyulmaz S, Sanchez Macedo N, Rezaeian F, Giovanoli P, Lindenblatt N. Nanofat Grafting for Scar Treatment and Skin Quality Improvement. Aesthet Surg J. 2018 Mar 14;38(4):421-428. doi: 10.1093/asj/sjx183.

Reference Type: BACKGROUND

PMID: 29365061 (View on PubMed)

Other Identifiers

2018P001086

Identifier Type: -

Identifier Source: org_study_id