Technology and product reviews T E C H N O L O G Y U P D A T E :


Advances in tissue-engineered skin substitutes


Authors:


Mayura Hanis Damanhuri, Jemma Megan Boyle, Stuart Enoch


Useful links and further reading


Acellular matrices for the treatment of wounds


Large skin defects resulting from burns, trauma, congenital giant nevi, and disease can lead to skin necrosis and represent a challenge to achieving skin coverage. This article summarises the development of tissue-engineered skin substitutes, identifies key clinical landmarks, reviews some critical aspects of cell and skin biology and highlights future developments that may foster progress in engineered skin.


References 1. Tannous ZS, Mihm Jr MC,


Sober AJ, Duncan LM. Congenital melanocytic nevi: clinical and histopathologic features, risk of melanoma, and clinical


management. J Am Acad Dermatol 2005; 52: 197–203.


2. Schiestl C, Stiefel D, Meuli M.


Giant naevus, giant excision, eleg(i) ant closure? Reconstructive surgery with Integra Artificial Skin1 to treat giant congenital melanocytic naevi in children. J Plast Reconstr Aesthet Surg 2009; 63(4): 610–15.


3. Loss M, Wedler V, Künzi W,


Meuli-Simmen C, Meyer VE.Artificial skin, split-thickness autograft and cultured autologous keratinocytes combined to treat a severe burn


injury of 93% of TBSA. Burns 2000; 26: 644–52.


4. Aarabi S, Longaker MT, Gurtner GC. Hypertrophic scar formation following burns and trauma: new


approaches to treatment. PLoS Med 2007; 4: e234.


5. Berman B, Viera MH, Amini S, Huo R, Jones IS. Prevention and


management of hypertrophic scars and keloids after burns in children. J Craniofac Surg 2008; 19: 989–1006.


INTRODUCTION The emphasis in managing burns and complex non-healing wounds has shifted from merely reducing morbidity and achieving satisfactory survival to ultimately improving the long-term prognosis, function and aesthesis of healed wounds. Large skin defects resulting from burns, trauma, congenital giant nevi and disease can lead to skin necrosis and represent a challenging clinical problem that necessitates a novel approach to achieving skin coverage [1,2]


. The primary problem in this type of wound


is usually a shortage of autologous skin. For example, in a patient with a 70% total body surface area (TBSA) burn, the remaining 30% of normal skin is insufficient to provide coverage[3]


with permanent wound coverage[6 . The


features of an ‘ideal’ skin substitute are shown in [Box 1]. Unfortunately, there are currently no


engineered skin substitutes that can completely simulate the complexity of human skin, either in form or function. However, with advances in tissue engineering and biotechnology, there are several skin substitutes, both being used and in development [Fig 1], that can be used for replacement or reconstruction of one or both layers of the skin.


. The secondary problem is scarring,


which often results at both the recipient and donor sites from the ‘gold standard’ of using an autologous split thickness skin graft (STSG) (epidermis and part dermis). In certain instances, this can result in hypertrophic or keloid scars that can be further disabling and disfiguring [See article on p7] [4,5]


. Although full-thickness skin grafting


(FTSG) (all of dermis) leads to less scarring, it can only be performed if the injured area is approximately 1% of the TBSA. Thus, its widespread use is limited by donor site availability. Theoretically, both of these issues could be


reduced or even eliminated if it were possible to culture a skin substitute that encompassed both epidermis and dermis. In deep wounds, an optimal skin substitute would provide immediate replacement of both these layers


27 Wounds International Vol 2 | Issue 1 | ©Wounds International 2011


FEATURES Able to resist infection


Able to prevent water loss Able to withstand shear forces Cost-effective Widely available Long shelf life and easy to store Lack of antigenicity Flexible thickness Durable with long-term wound stability Conformable to irregular wound surfaces Easily secured and applied


Box 1 – Ideal features of a skin substitute[7] .


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