Controlled Comparison of a Traditional Dressing Versus a Biologic Dressing Composed of Fetal Fibroblasts and Keratinocytes in Association With a Collagen Matrix on Skin Donor Sites (CICAFAST)
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|ClinicalTrials.gov Identifier: NCT03334656|
Recruitment Status : Recruiting
First Posted : November 7, 2017
Last Update Posted : June 1, 2020
Cell-based engineered skin substitutes are promising to treat difficult-to-heal acute and chronic wounds such as large/deep burns, ulcers resistant to conventional therapies or surgical wounds. Cultured autologous epidermal cell-based therapy is used for more than two decades as permanent wound coverage for large burns. Although this technique has been shown to improve outcomes in patients with large burn injuries, its clinical use is limited by the creation of a second wound at the donor site, the three-week delay needed to obtain sufficient amounts of cells, and the absence of a dermal component resulting in low graft take and wound contraction.
Concurrently, allogeneic cell-based engineered skin substitutes have been proposed. Where they offer off-the-shelf temporary wound coverage acting as biologically active dressings releasing growth factors, cytokines and extra cellular matrix components essential for proper wound healing, they are susceptible of immune rejection that is their major weakness Fetal skin, before the third trimester of gestational age, heals rapidly without scar formation conversely to adult skin. Minimal inflammation, specific cytokine and growth factor profiles, and faster and organized deposit and turnover of Extra Cellular Matrix (ECM) components during fetal wound healing have been proposed to explain the absence of scar formation. Because of their low immunogenicity, and their unique regeneration properties, fetal skin cells represent an attractive alternative to the commonly used autologous and allogenic cutaneous grafts.
The investigators developed a new healing dressing constituted by a collagen sponge seeded with a specific ratio of active fetal fibroblasts and keratinocytes producing a variety of wound healing growth factors and cytokines which increase the speed of wound healing, induce an immunotolerant state, with a low inflammatory reaction.
This prospective randomized controlled study aims to compare wound healing of CICAFAST versus conventional treatment (JELONET®) in the treatment of split-thickness skin graft donor site at D8. The patient will be his own control.
|Condition or disease||Intervention/treatment||Phase|
|Split Thickness Skin Graft Wound Healing||Biological: biological dressing Other: Paraffin gauze dressing||Phase 1 Phase 2|
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||38 participants|
|Intervention Model:||Crossover Assignment|
|Masking:||None (Open Label)|
|Official Title:||Controlled Comparison of a Traditional Dressing Versus a Biologic Dressing Composed of Fetal Fibroblasts and Keratinocytes in Association With a Collagen Matrix on Skin Donor Sites|
|Actual Study Start Date :||May 16, 2018|
|Estimated Primary Completion Date :||May 30, 2022|
|Estimated Study Completion Date :||November 16, 2022|
Experimental: Biological Dressing
It is a cellularized dressing of 100 cm² composed of fetal skin cells associated to a bovine collagen matrix:
Biological: biological dressing
to test a biological dressing on the wound healing of the split-thickness skin graft donor site
Active Comparator: Paraffin Gauze Dressing
It is a low-adherent, sterile paraffin Tulle Gras dressing made from open weave gauze. The gauze has interlocking threads which minimize fraying when the dressing is cut to shape. JELONET® dressings are non-medicated and are used as a primary wound contact layer with paraffin present to reduce the adherence of the product to the surface of a granulating wound.
JELONET® is a product of Smith-Nephew, it has the CE-mark (n°0086) and the class of this medical device is IIa.
The features of this dressing are: Soft paraffin base, Sterile leno weave presentation, Comprehensive size range.
Other: Paraffin gauze dressing
standard intervention : Paraffin gauze dressing on the wound healing
- wound healing [ Time Frame: Day 8 ]The number of complete healing at D8 judged by physician observer. Healing is defined as 80% or more wound closure.
- concordance between the healing at D8 (or D11 and D15) judged by physician observer and by another physician using photographs [ Time Frame: Day 8 (or D11 and D15 if the healing is not completed) ]The healing at D8 (or D11 or D15 if the healing is not completed) judged by an expert physician on picture. Healing is defined as 80% or more wound closure.
- wound healing's rapidity of CICAFAST versus conventional treatment (JELONET®) in the treatment of STSG donor site. [ Time Frame: D8 And D11 (if the healing is not completed) and D15 (if the healing is not completed) ]Time to healing (in days) judged by physician observer
- tolerance of CICAFAST versus the conventional treatment (JELONET®) [ Time Frame: 6 months ]• AE notification: case of infection: patients with grade 1 or 2 infections may be controlled by antibiotherapy. Patients with grade 3 or 4 infection or with biological dressing (CICAFAST) rejection will have CICAFAST dressing removed. However they will stay in the study. Immunological monitoring will be performed to follow a CICAFAST reject of the patient at donor site level.
- pain of the wound healing with CICAFAST versus conventional treatment (JELONET®) [ Time Frame: Day 8 And D11 (if the healing is not completed) and D15 (if the healing is not completed) ]Number of painful day/wound from the surgery until the complete healing
- quality of the wound healing with CICAFAST versus conventional treatment (JELONET®) [ Time Frame: 6 months ]Evaluation of the quality of the wound healing by an observer (physician who will not do the patient surgery) at M3 and M6, OSAS (observer scar assessment scale ; 1= normal skin, 10= worst imaginable scar) will be used. By the patient PSAS (patient scar assessment scale ; 1= normal skin, 10= very different) will be used and expertise on picture by 2 external experts (Visual Analogue Scale 10 the worst scar to 1 like normal skin). A second evaluation of complete healing will be performed by two exterior independent experts evaluating the photographs taken until complete healing (Healing is defined as 80% or more wound closure)
- quality of the wound healing with CICAFAST versus conventional treatment (JELONET®) for the patient who will have confocal microscopy [ Time Frame: 3 months ]Results of scars confocal microscopy at M3
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03334656
|Contact: Brigitte Dréno, Premail@example.com|
|Principal Investigator:||Brigitte Dréno, Pr||CHU de Nantes|