New prospects for cutaneous wound healing and keloid treatment

The early steps of skin tissue repair are sustained by fibroblast proliferation, collagen deposition, and re-epithelization. On the contrary, injury or surgery in predisposed individual can result in hypertrophic scar. Keloid is characterized by an increased number of fibroblasts, mast cells and a greater collagen synthesis with irregular bundles conformation which contributes to the formation of a disordered repair tissue. However some medical-grade chitosans seem to have a reparative action on wounded tissues, inducing the formation of ordered repair tissue where collagen bundles had a regular direction. In this way, wounds did met slow evident scar formation or the wound contraction proper of the keloid. The aim of this study was to control the activity of a gel based on a new patented hydrosoluble chitosan derivative of medical grade to repair and improve the cutaneous microenvironment on wounded tissues. Dermo-epidermal grafts were performed with the aid of a dermotome on the frontal part of the thighs of 10 patients aged 30 to 50 years. In every patient a donor site was dressed with N-carboxybutylchitosan pads, the other was treated with phytostimuline gauze. On day 10 and 30, when the surgical wounds were clinically healed, bioptie fragments were obtained from both areas. Ultrastructural analysis of the areas treated by our chitosan derivative, showed a regular distribution of the collagen network and the general aspect of the derma gave an overall impression of histoarchitecture order which was more evident than in controls. Overall, the epithelium was organized and citologically normal. The studied chitosan derivative seems to favour the cell proliferation, the rapid re-epitheliazation of the tissue and optimizing the cutaneous repair, limitating the process of wound contraction. It seems this gel could be considered as an innovative cosmeceutical or medical device able to speed up the tissue repair and to avoid the keloid formation.