Improved Preservation of the Tissue Surrounding Percutaneous Devices by Hyaluronic Acid and Dermatan Sulfate in a Human Skin Explant Model

Cellular apoptosis and proliferation was analyzed in an in vitro culture system of organotypic human skin explants in the presence or absence of external fixator pins. The effect on the tissues of a mixture of hyaluronic acid and dermatan sulfate (HA + DS) delivered at the skin-pin interface was also studied. After 2 weeks in culture, skin specimens interfaced with fixator pins showed increased keratinocyte apoptosis and proliferation compared to specimens without fixator pins. Simultaneously, a relative reduction of apoptosis and proliferation was observed in specimens treated with the HA + DS mixture, regardless of fixation pin presence. In addition, the HA + DS mixture appeared to help in the preservation of the epidermal basal membrane. It is concluded that in this in vitro model, fixator pins induce keratinocyte apoptosis and hyperproliferation, which are reduced in the presence of the HA + DS mixture. These methods may be useful for a better maintenance of the soft tissue surrounding percutaneous devices in vivo.