Successful grafting of tissue-engineered fetal skin

Pediatr Surg Int. 2016 Dec;32(12):1177-1182. doi: 10.1007/s00383-016-3977-z. Epub 2016 Sep 20.


Purpose: Fetal repair of spina bifida results in improved outcomes and has therefore become a standard clinical procedure in some highly specialized centers. However, optimization of the procedure technique and timing is needed. Both might be achieved by facilitating the procedure using laboratory-grown fetal skin substitutes. The aim of this study was therefore to test in vivo the suitability of such a fetal skin substitute for an in utero application.

Methods: Collagen-based hydrogels containing fetal ovine fibroblasts were seeded with fetal ovine keratinocytes and transplanted on immuno-incompetent nu/nu rats. After 3 weeks, grafts were harvested and analyzed histologically and by immunohistochemistry.

Results: Laboratory-grown fetal ovine dermo-epidermal skin substitutes showed successful engraftment at 3 weeks. Histologically, grafts revealed a neo-dermis populated by fibroblasts and with ingrowth of vessels, and an epidermis with an adult-like, mature appearance depicting clearly basal, spinous, granular, and a corneal layer. Immunostaining confirmed a physiologically organized epidermis.

Conclusion: Fetal dermo-epidermal skin substitutes of ovine origin can successfully be grafted in vivo. In a next step, we will have to test whether favorable results can also be obtained when grafts are used in utero. If so, then human fetal spina bifida repair using laboratory-grown autologous fetal skin for defect closure may be envisaged.

Keywords: Fetal; Myelomeningocele; Skin; Spina bifida; Tissue engineering.

MeSH terms

  • Animals
  • Cells, Cultured
  • Collagen
  • Fetus / surgery
  • Hydrogels
  • Keratinocytes / transplantation
  • Models, Animal
  • Rats
  • Sheep
  • Skin Transplantation / methods*
  • Skin, Artificial*
  • Tissue Engineering / methods*


  • Hydrogels
  • Collagen