I understand it's in jest, but we just won't know until regeneration can occur. I would tend to think that moles and skin geography are genetically determined, but I don't know. We have to think about the possibility of regrowing foreskins and artistically perfected noses that parents paid good money to fix...yikes! In regeneration, I suppose what we want isn't going to be so much the issue. Our bodies will give us what we were destined to get originally. It would be ideal if we could turn it on and off by region.
I have taken breaks from the board in the past. Sometimes it is good to regain perspective, but this is as healthy a hobby as any.
We didn't actually know that Juvista wouldn't help existing scars (even after revision) until about a year ago. About five years ago the banner on Renovo's website and the come on in all their marketing to lure investors was that they were frontiering the future of "Scarfree Healing." There was no qualifing statement to suggest that it would only be helpful for pre-surgical care or new wounds. However it does turn out that in those cases it will (in all likelihood) lessen the densely collagenous surgical white lines. So, it will be helpful for excisions.
It WON'T allow true regeneration to occur though, as was the thought when we believed that simply blocking TGFB1 would allow it. If it DID allow regeneration then one would have to assume that any excised tissue (such as an unwanted mole) would simply regrow and that doesn't seem to be the case from looking at their website.
Anyway...we all keep plugging along don't we?
Really interesting hopeseed!
I need some time to go through all these articles...you've been BUSY!
I went through your post and here are my thoughts:
Scarcrash: People undergoing subscision have the scar tendrils that are tethering down their scars cut and released and most have had substantial results. The reason why their scars are then still visible is the fact that although the scar tissue has been cut from the subcutaneous structures, the distorted structure of the scar tissue itself remains, nonetheless.
Anna: When I performed my subcision I went from having an atrophic scar to having a scar that was level with my surrounding tissue. It is like the epidermis was saran wrapped so tightly over a hole in pudding that it conformed to the indentation. After the subcision blood pooled in the area and when it finished healing over six months later I was left with a level scar. The hole was pretty much filled in but the tissue that filled in to replace my healthy tissue is white and shiny. There is definitely new and different tissue.
Scarcrash: People talk about about needling and TCA "stimulating" collagen. I'm sure that is true to a degree, but I think that the therapeutic effect is truly created through the disruption (breaking up or dissolving, respectively) of the scar tissue. When I was needled, the skin all around my scars was needled as well, yet I did not develop any raised tissue. If the stimulation of collagen (to replace missing tissue) is the primary effect, then why doesn't needling on healthy skin produced new and extra collagen growth there. As we all know, needling healthy skin produces no change whatsoever to that skin. I asked the person who needled my skin if needling can alter normal skin in any way and he said no. It seems more likely that the improvement from needling is gained through breaking up of the distorted configuration of the scar tissue and allow the natural elasticity of the skin to revert back to a more normal structure.
Anna:Actually, this isnâ€™t true in all cases. There are people who develop keloids even with tattooing and the dermaroller is primarily sold as a rejuvenation tool. This is counting on the fact does produce new and extra collagen. This is not the supple and perfect collagen you had as a baby but a tighter and less resilient collagen, nonetheless, it still provides a rejuvenating result.
Scarcrash:TCA also is said to stimulate new collagen. If this is true and I TCA cross normal tissue, then I should have new extra collagen on top of the healthy tissue. People actually talk about TCA eating away at healthy tissue (true, it may caused raised scars in those prone to keloid scarring). So, it seems that the minute amounts of TCA placed directly on top of scar tissue (and only on scar tissue) works to dissolve the contorted tissue. When the scar tissue has been carefully dissolved, the distored structure is removed and the skin reverts back to a more normal structure.
Anna:If you were prone to keloids you could have wound up with the wrong type of collagen forming over your healthy tissue. TCA CAN eat away at healthy tissue if it goes deep enough past the dermal/epidermal juncture. It is difficult to know where this juncture is in everybody. Think of the epidermis as the ocean and the dermis as the ocean floor (flat in some places and jagged and precipitous in other areas). On the surface a healthy skin is smooth and in some cases deep (as when we are young) and in some cases shallow as when we get older and our epidermis thins. When you breach the surface and injure the epidermis you donâ€™t know how deep the dermis is below. On those folks who have a thick epidermis they can have relatively deep treatments and not scar. If you have a thin epidermis you could easily wind up with scarring because the dermal/epidermal juncture is so close to the surface. This is one of the reasons in the past skilled dermabrasion doctors were so successful â€“ they were able to recognize the bleed point and thereby know when they had gone as deep as they could safely go.
The key would be getting rid of all of the scar tissue without causing new scar tissue. That is the balance that has yet to be acheived.
Anna:I used to think that this was true too. Iâ€™m not so sure now though. The reason my opinion has changed is that I was informed by Renovo that none of their products, neither Juvista nor Juvidex, will help with existing acne scars. If all it took was to suppress scar tissue from forming then Juvista should help with regeneration if it was used after a deep ablative treatment, but that isnâ€™t the case. It apparently isnâ€™t enough just to suppress TGFB1.
Scarcrash: So, I just feel that this is more evidence that supports the scar tissue distortion causing the appearance atrophic scarring.
Anna: I think there is definitely a component of distorted tissue, however I believe there is a type of table to address all scar types that consists of the type of tissue, the color, and the quantity.
You could have a hypopigmented scar like I have which is white, shiny, and level. In this case the color of tissue is wrong as is the type, but the quantity is now close to correct.
In the case of the icepicks on my nose, the type and color of tissue is correct, but the quantity is too little.
The immunization scar on my arm is somewhat raised, but my correct skin color. In this case the type of tissue is correct as is the color, but the quantity is excessive.
Scarcrash:Like I said, has anyone actually shown that there is, in actuality, a loss of tissue? Now I know that scar tissue distortion is greatly implicated, but I don't know to what degree tissue loss is.
Anna: It seems obvious to me that it is but if I am proven wrong I donâ€™t really care if it addresses the issue.
Scarcrash: It is probable that there is some degree of tissue loss involved, but I think it may be far less of a factor than scar tissue distortion.
Hey, that's just my guess. Everybody is guessing aren't they? Even the so called "experts" are guessing...obviously. They've been guessing for a long time and their guesses haven't accounted for a lot of progress.
Anna: I think that we all (not just the experts but everyone here as well) are doing more than guessing. We are all here to share our experiences and thoughts and that has built an objective body of knowledge. I AM hopeful that we will see true progress soon.
My understanding is that there is no difference between the powder and sheet form. It is just more efficient for a large wound to use the sheets. As I have imagined it in my head, when the body senses an open wound it goes into alert and tries to close the wound. The nutrients hit a roadblock. ACell (regardless of the form) act as a bio-electric patch. It tricks the body into thinking it doesn't have an open wound and it allows the nutrients drive along even though the road (tissue) isn't there, and thereby allowing the natural maintenance (and by accident) regeneration to occur.
You would probably know much more about why cortisone would maybe denature ACell than I do, hopeseed...I just don't know. If it were pure Emu (isn't Emu oild taken from the Emu bird?) I don't see why it would denature given that the bird is a living creature....and this is designed to work on animals.
That is correct. The vet version is not approved for human use. However, the version for human use is approved under the same approval as Integra.
Below is what I have put together on ACell (Vet). Anybody responding to this please don't quote as it is LONG. Thanks! Anna:
What is ACell
ACell is an acellular matrix harvested from the tissue layers surrounding the lamina propria of the urinary bladder mucosa of SPF pigs. Itâ€™s cell free composition ensure that there is no immunological tissue rejection. ACell contains naturally occurring structural and functionally active proteins such as fibronection and Type I, III and IV Collagens, as well as several potent growth factors. Large amounts of laminin, derived from the basal lamina, enhance cellular adhesion and intercellular communication. Additionally, ACell also contains hyaluron and proteoglycans. Specific tissue active peptides known as Magainins provide ACell with significant antimicrobial properties effective against most types of bacteria.
How does ACell work
ACell works as a natural biological tissue template, enhancing biological signaling from structurally damaged tissue to the bone marrow, from which large amounts of stem cells are recruited to the site of trauma. This unique stem cell migration is initiated by a factor called Fraction 4, one of the most important components of ACell. Local growth factors present within each specific tissue type activate and regulate the recruited stem cells resulting in their differentiation in situ thereby regenerating the damaged tissue to site specific cells. The ACell Template is dissolved within 1-3 days after administration, whereas the biological effect remains for up to two weeks post treatment.
ACell is indicated in chronica cases where there are ultrasonographic signs of hypo - or anecchogenic spaces in the structures.
Recent work in human and veterinary medicine using growth stimulants, bone marrow implants and stem cells have stirred interest in regenerative medicine as a technique for tissue repair. Extracellular matrix or ECM has been tested and proposed as an agent for tissue reconstruction.1 ECMâ€™s have been derived from several tissues including the submucosa of pig small intestine and urinary blader. The objective of this retrospective study was to assess the therapeutic value of ACell Vet Urinary Bladder Matrix Powder (UBM) for tissue regeneration and return to function in tendon and ligament injuries of the equine limb. Assessment of response was by review of lameness evaluation, physical characteristics of involved structures, and visible improvement of identified ultrasound lesions in affected structures. < /P>
Q1. Does the wound need any treatment before placing the ACell Vetâ„¢ product? A1. Simply wash the wound with sterile saline. Almost all other cleaning or disinfectant solutions will de-nature (i.e., kill) the proteins in the ACell Vetâ„¢ product, and therefore should be avoided if at all possible. The concomitant use of other products may interfere with the efficacy of the ACell Vetâ„¢ material. If other products are used to clean and/or debride the wound, it is very important that they be very thoroughly rinsed from the wound site prior to placement of the ACell Vetâ„¢ material.
The following is a list of some common solutions that may denature the proteins in the ACell Vetâ„¢ material:
Alcohol or any alcohol based solution Detergents and soaps (e.g., Zepharin) Iodine containing products (e.g., Betadine) Any product with Silver nitrate (e.g., Silvadiene or other metalo bases) Hydrogen peroxide, Dakin's Soln. (bleach) Chlorine Cortisone based products (e.g., topical anti-inflammatory medications) Also, try to avoid direct contact between the ACell Vetâ„¢ bioscaffold and topical antibiotics, particularly amino glycosides and products that contain sulfa, etc. There should not be any need for additional antibiotics unless gross contamination and infection are present.
Q2. Does the wound need to be debrided? A2. Only dead tissue, eschar, scarring along the edge of a wound, or flesh which has a foreign body(ies) imbedded (e.g., dirt, stones, gravel, etc.) need to be debrided. All animals which have dead tissue and/or a foreign body in the wound will produce enzymes to break down that material. Those enzymes also kill protein, including the ACell Vetâ„¢ material. If there is exudate, it should be washed away or manually removed with saline and forceps.
Q3. What about debriding the wound between dressings or during the dressing change? A3. Any residual ACell Vetâ„¢ material should be left alone. Do not remove it. Residual ACell Vetâ„¢ material in the center of the wound can look like a non-infectious purulent discharge. Do not debride this material, as it supports new cells growing at the site. Any spots of remaining dead tissue or scar should be removed before placing the second sheet of the ACell Vetâ„¢ product on the wound. Only sterile saline should be used for cleansing the wound. Place a new piece of the ACell Vetâ„¢ bioscaffold directly over the old piece and cover to the edge of the wound.
Q4. What kind of dressing should be used over the ACell Vetâ„¢ material? A4. We currently advise placing saline soaked gauze over the ACell Vetâ„¢ material to keep the site moist. Over the gauze, place Opsiteâ„¢, Telfaâ„¢ or another relatively impervious film (we also recommend Silasticâ„¢). However, do not place these films in direct contact with the ACell Vetâ„¢ scaffold. If the wound needs a pressure dressing, use gauze fluffs and then some kind of wrap material to hold in place.
Try to avoid dressings that will stick to the wound. It is important when removing the dressing to avoid removing any of the ACell Vetâ„¢ material or new cells at the wound site. The following is a list of some dressings that should be avoided:
Orthopaedic felt Foam padding (rubber or synthetic) Rubber sheeting Cellophane Any cellulose based product Q5. How often should a new piece of the ACell Vetâ„¢ material be placed on an open surface wound? A5. A new dressing of saline soaked gauze should be applied 3-4 days after the initial treatment, taking care not to remove any of the ACell Vetâ„¢ material with the original dressing. The dressing should be changed again in another 4-5 days with consideration given for a second application of ACell Vetâ„¢ material. If the healing of the wound is progressing (see Q6) simply re-dress with saline soaked gauze and continue this procedure every 4-5 days. A second application of ACell Vetâ„¢ material should be considered 2-3 weeks following the initial treatment, if not applied during a previous change of dressing.
Q6. How do I know if the ACell Vetâ„¢ treatment is working? A6. Animals become comfortable within first 24 hours and stop licking or agitating the wound. Localized heat, swelling and redness decrease markedly at the first dressing change. Exudate slows down or stops. Epithelization begins to be apparent in the center of the wound rather than just at the edges.
Q7. How long will it take for the wound to heal? A7. There is no typical wound. Such issues as size, species, chronicity of the wound, infection, depth, and other medical co-morbid conditions such as diabetes play a role in the time it takes to heal. Fresh wounds treated before infection occurs may heal in 2-3 weeks. Older chronic wounds may take 2-3 months. How long the ACell Vetâ„¢ product is used depends on progress, not time. If the wound is healing, then treatment should continue.
Jan31, You know, outside of the TCA treatments you might want to hold off doing any more excisions. If Renovo's products are able to greatly reduce surgical scars that would be great for excisions!
Let me know how you like the green smoothie! It has done wonders for my skin. Just a warning though...they are NOT low calorie. I gained five pounds with these as I started having them in the morning. I've never been a breakfast girl so this extra food in the morning has porked me out a little bit. I'm only 5'5" and I went from 120 to 125...the skirts are just a little tight dang it! Oh well, I'll just have to figure it out...
Yep, all very interesting. If you take the time to read through all the literature you will find that it is Badylak himself that proposed integrating ACell with Restylane. Restylane is Hyaluronic Acid (naturally occuring) and actually will not impede the efficacy or signalling ability.
"What about ReCell? Is this the same thing as Acell and has it been approved yet?"
ReCell is very different from ACell. My understanding of both is below:
ReCell is a method of taking a piece of your skin and quickly propogating it to create a "spray on" skin. It is used after dermabrasion or laser treatment (C02 I assume) and then spraying your skin cells over the wounded area to reduce scarring. It is also used on burns at the the time of initial injury.
ACell is an acellular powder derived from the outer membrane of the pig bladder. It acts as a matrix or scaffold allowing your regenerative signals to continue to bring nourishment to the wounded area and hopefully allow the closest thing to true regeneration currently available.
Juvesta, ACell, and ReCell all would need to be used at the time of initial wounding or revision, so if you already have a scar it would need to be excised. I'm not sure what the approval status is of ReCell. There is some talk of integrating ACell into Restylane or some type of filler to perhaps turn it into a more permanent solution for sunken defects or scars.
Exactly hopeseed. Excisional scars are the scar model we need to refer to when assessing treatment efficacy. Of course this would be in the form of scar revision, unless they come up with a TGFB3 cream that people use on any active blemish or wound, to prophylactically prevent any wound from scarring.
The theory behind ACell is that it is a matrix (think of an electrical patch wire) which allows the bodys regenerative signal to carry nutrients to rebuild lost tissue.
ACell does come in both a powder and sheet form, but in either form it is an extremely sensitive material that requires very precise care in terms of bandaging and cleansing. A lot of common cleansers will denature it.