Bonnie C. Carneya,b,h , Mary A. Oliverb , Metecan Erdi c , Liam D. Kirkpatrickb , Stephen P. Tranchinab , Selim Rozyyevd , John W. Keylounb,e , Michele S. Saruwatarid,e , John L. Daristotlef , Lauren T. Moffatta,b,h , Peter Kofinasc , Anthony D. Sandlerd , Jeffrey W. Shuppa,b,g,h,⁎

a Department of Biochemistry and Molecular and Cellular Biology, Georgetown University Medical Center,Washington, DC, USA

b Firefighters’ Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA

c Department of Chemical and Biomolecular Engineering, University of Maryland, College Park, MD 20742, USA

d Sheikh Zayed Institute for Pediatric Surgical Innovation, Joseph E. Robert Jr. Center for Surgical Care, Children’s National Medical Center, Washington, DC 20010, USA

e Department of Surgery, MedStar Washington Hospital Center and MedStar Georgetown University Hospital, Washington, DC, USA

f David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA

g The Burn Center, Department of Surgery, MedStar Washington Hospital Center, Washington, DC, USA h Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA

article info

Keywords: Autologous skin cell suspension   Solution-blow spinning polymer   Wound dressings   Hypertrophic scarring  Skin grafting

abstract

      Autologous skin cell suspensions (ASCS) can treat burns of varying depths with the advantage of reduced donor site wound burden. The current standard primary dressing for ASCS is a nonabsorbant, non-adherent, perforated film (control) which has limited conformability over heterogeneous wound beds and allows for run-off of the ASCS. To address these concerns, a novel spray-on polymer formulation was tested as a potential primary dressing in porcine deep partial thickness (DPT) and full thickness (FT) wounds. It was Burn wound healing hypothesized that the polymer would perform as well as control dressing when evaluating wound healing and scarring.

      DPT or FT wounds were treated with either a spray-on poly(lactic-co-glycolic acid) (PLGA) and poly(lactide-co-caprolactone) (PLCL) formulation or control ASCS dressings. Throughout the experimental time course (to day 50), we found no significant differences between polymer and control wounds in % re-epithelialization, graft-loss, epidermal or dermal thickness, or % dermal cellularity in either model. Pigmentation, erythema, elasticity, and trans-epidermal water loss (TEWL), were not significantly altered between the treatment groups, but differences between healing wounds/scars and un-injured skin were observed. No cytotoxic effect was observed in ASCS incubated with the PLGA and PLCL polymers.

      These data suggest that the novel spray-on polymer is a viable option as a primary dressing, with improved ease of application and conformation to irregular wounds. Polymer formulation and application technique should be a subject of future research.

Jeffrey I. Mechanick, M.D.a,*, Adrienne Youdim, M.D.b , Daniel B. Jones, M.D., M.S.c,W. Timothy Garvey, M.D.d , Daniel L. Hurley, M.D.e , M. Molly McMahon, M.D.e,Leslie J. Heinberg, Ph.D.f , Robert Kushner, M.D.g , Ted D. Adams, Ph.D., M.P.H.h,Scott Shikora, M.D.i , John B. Dixon, M.B.B.S., Ph.D.j , Stacy Brethauer, M.D.k

a Co-Chair, Icahn School of Medicine at Mount Sinai, New York, New York

b Co-Chair, Cedars Sinai Medical Center, Los Angeles, California

c Co-Chair, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts

d Primary Writer, AACE, University of Alabama at Birmingham, Birmingham VA Medical Center, Birmingham, Alabama

e Primary Writer AACE, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota

f Primary Writer TOS, Cleveland Clinic Lerner College of Medicine, BMI Director of Behavioral Services, Cleveland, Ohio

g Primary Writer TOS, Northwestern University, Feinberg School of Medicine, Chicago, Illinois

h Primary Writer TOS, Health & Fitness Institute, Intermountain Healthcare and Cardiovascular Genetics Division,University of Utah School of Medicine, Salt Lake City, Utah

i Primary Writer ASMBS, Harvard Medical School, Center for Metabolic Health and Bariatric Surgery, Brigham and Women’s Hospital, Boston, Massachusetts

j Primary Writer ASMBS, Professor and Head of Clinical Obesity Research, Baker IDI Heart and Diabetes Institute, Melbourne, Australia

k Primary Writer ASMBS, Cleveland Clinic Lerner College of Medicine, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio Received December 23, 2012; accepted December 27, 2012

Abstract

      The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACETOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues. (Surg Obes Relat Dis 2013;9:159-191.) r 2013 American Society for Metabolic and Bariatric Surgery. All rights reserved.

Keywords: Bariatric surgery; Obesity; Metabolic surgery; Diabetes surgery; Metabolic syndrome; Clinical practice guidelines; Best practice guidelines; Weight loss surgery