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Novel Use of a Biologically Active-Prefabricated-Random-Three-Dimensional-Polymer Scaffold of Hyaluronic Acid (HYAFF) to Facilitate Complicated Wound Closure

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Burns, Infections and Wound Management

Part of the book series: Recent Clinical Techniques, Results, and Research in Wounds ((RCTRRW,volume 2))

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Abstract

Hyaluronic acid (HA) is a major extracellular matrix (ECM) glycosaminoglycan (GAG) polymer that has been shown to have differential signaling effects on the local cells and surrounding ECM. Hyaluronic acid (HA) is unique among glycosaminoglycans in that it is nonsulfated; forms in the plasma membrane, instead of the Golgi apparatus; and can become very large with its weight often reaching the millions of KDa. In a stabilized form, it provides a 3D-biopolymer scaffold that promotes endothelial cell migration, thus supporting neovascularization, a foundation of granulation tissue and extracellular matrix revitalization. Use of HYAFF, a commercially available stabilized HA scaffold, is presented in four varied case studies both in terms of wounding etiology and complications. The use of HYAFF in complicated integumentary wound closure is a relatively new technique, made available by the stabilization of hyaluronic acid through the use of benzyl esterification. The esterification prevents the rapid breakdown and turnover of HA, which can have a lifetime as short as several minutes.

The effect of the HYAFF is seen as a result of the controlled degradation of the core GAG, HA, and the resulting molecular weight. HA is important in the signaling and direction of wound resolution, with low molecular weight hyaluronic acid (LMWHA) associated with the inflammatory response and high molecular weight hyaluronic acid (HMWHA) associated with proliferation and granulation activity. The wound case studies presented here originate as a result of trauma, severe infection, as in the case of necrotizing fasciitis, or burns. Regardless the resulting full-thickness integumentary deficit poses a significant challenge to acceptable closure with both functional and cosmetic patient goals in mind. Here we present the biological, molecular, and chemical basis for the successful use of HA to complete the inflammatory process or expedite granulation in preparation for final closure. Final closure may include STSG or FTSG.

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Authors and Affiliations

  1. Las Vegas, NV, USA

    Tammy Luttrell, Samantha Rosenberry, Nancy Estacado & Jay Coates

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  1. Tammy Luttrell
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Correspondence to Tammy Luttrell .

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    Melvin A. Shiffman

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    Mervin Low

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Luttrell, T., Rosenberry, S., Estacado, N., Coates, J. (2018). Novel Use of a Biologically Active-Prefabricated-Random-Three-Dimensional-Polymer Scaffold of Hyaluronic Acid (HYAFF) to Facilitate Complicated Wound Closure. In: Shiffman, M., Low, M. (eds) Burns, Infections and Wound Management. Recent Clinical Techniques, Results, and Research in Wounds, vol 2. Springer, Cham. https://doi.org/10.1007/15695_2018_114

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  • DOI: https://doi.org/10.1007/15695_2018_114

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