Tissue Engineering and Regenerative Medicine

, Volume 15, Issue 5, pp 629–638 | Cite as

Full Thickness Skin Expansion ex vivo in a Newly Developed Reactor and Evaluation of Auto-Grafting Efficiency of the Expanded Skin Using Yucatan Pig Model

  • Man-Il Huh
  • Soo-Jin Yi
  • Kyung-Pil Lee
  • Hong Kyun Kim
  • Sang-Hyun An
  • Dan-Bi Kim
  • Rae-Hyung Ryu
  • Jun-Sik Kim
  • Jeong Ok Lim
Original Article



Skin grafts are required in numerous clinical procedures, such as reconstruction after skin removal and correction of contracture or scarring after severe skin loss caused by burns, accidents, and trauma. The current standard for skin defect replacement procedures is the use of autologous skin grafts. However, donor-site tissue availability remains a major obstacle for the successful replacement of skin defects and often limits this option. The aim of this study is to effectively expand full thickness skin to clinically useful size using an automated skin reactor and evaluate auto grafting efficiency of the expanded skin using Yucatan female pigs.


We developed an automated bioreactor system with the functions of real-time monitoring and remote-control, optimization of grip, and induction of skin porosity for effective tissue expansion. We evaluated the morphological, ultra-structural, and mechanical properties of the expanded skin before and after expansion using histology, immunohistochemistry, and tensile testing. We further carried out in vivo grafting study using Yucatan pigs to investigate the feasibility of this method in clinical application.


The results showed an average expansion rate of 180%. The histological findings indicated that external expansion stimulated cellular activity in the isolated skin and resulted in successful grafting to the transplanted site. Specifically, hyperplasia did not appear at the auto-grafted site, and grafted skin appeared similar to normal skin. Furthermore, mechanical stimuli resulted in an increase in COL1A2 expression in a suitable environment.


These findings provided insight on the potential of this expansion system in promoting dermal extracellular matrix synthesis in vitro. Conclusively, this newly developed smart skin bioreactor enabled effective skin expansion ex vivo and successful grafting in vivo in a pig model.


Animal model Skin transplantation Tissue expansion devices Skin bioreactor 



This research was supported by 2017 Medical Cluster R&D Support Project through Daegu Gyeongbuk Medical Innovation Foundation funded by the Ministry of Health and Welfare, the Republic of Korea (HI16C2505), and ETRI R&D Program [15ZC3110, Local-based medical device/robot development and medical IT convergence for small and medium enterprises revitalization project].

Compliance with ethical standards

Conflicts of interest

The authors declare that there is no conflict of interest regarding the publication of this paper.

Ethical statement

Animal care and experimental procedures were approved by the Institutional Animal Care and Use Committee at DGMIF (DGMIF-16100301-01, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Korea).


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Copyright information

© The Korean Tissue Engineering and Regenerative Medicine Society and Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  • Man-Il Huh
    • 1
    • 2
  • Soo-Jin Yi
    • 1
    • 2
  • Kyung-Pil Lee
    • 1
    • 2
  • Hong Kyun Kim
    • 1
    • 2
  • Sang-Hyun An
    • 3
  • Dan-Bi Kim
    • 3
  • Rae-Hyung Ryu
    • 3
  • Jun-Sik Kim
    • 3
  • Jeong Ok Lim
    • 1
  1. 1.Biomedical Research Institute, Joint Institute for Regenerative Medicine, School of MedicineKyungpook National University, Kyungpook National University HospitalDaeguRepublic of Korea
  2. 2.School of MedicineKyungpook National UniversityDaeguRepublic of Korea
  3. 3.Daegu-Gyeongbuk Medical Innovation FoundationDaeguRepublic of Korea

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