Effective Management of Difficult Surgical Defects Using Tissue-Engineered Skin

Abstract

Graftskin is an excellent alternative for difficult surgical wounds not amenable to other therapies. Graftskin results in a shortened healing time and decreased morbidity. It should be considered for wounds in which healing by secondary intention is preferably avoided.

Evaluation of Tissue-Engineered Skin (Human Skin Substitute) and Secondary Intention Healing in the Treatment of Full Thickness Wounds after Mohs Micrographic or Excisional Surgery

“…Leffell et al recently demonstrated the advantages of using HSS over large defects of the bone or cartilage, and in areas where hypertrophic scarring, banding, or fibrosis are likely to occur 35 . It has also been shown to be useful in areas where secondary intention healing is slow and the wound is otherwise difficult to close, such as the shin 36 …”

Biologic Dressings

“…The major limitations of this study were small sample size and lack of follow‐up beyond 6 months, a short time to evaluate scar outcome. Another report in two patients treated with Apligraf in a single application to repair complex Mohs micrographic surgery defects showed complete healing in both cases in 9 weeks without complications 19 …”

“…Another report in two patients treated with Apligraf in a single application to repair complex Mohs micrographic surgery defects showed complete healing in both cases in 9 weeks without complications. 19 There have been multiple other case reports of the use of Apligraf in other dermatologic disease, including epidermolysis bullosa, 20,21 after carbon dioxide laser for hypertrophic scar, 22 aplasia cutis congenita of the trunk, 23 and bullous morphea 24 and for ectropion in a patient with harlequin ichthyosis. 25 Overall, the majority of randomized controlled studies of Apligraf have been in the setting of chronic leg ulcers, although there have been case series and small controlled trials evaluating its use in acute surgical wounds (Table 2).…”

Human Cadaveric Dermal Matrix for Management of Challenging Surgical Defects on the Scalp

“…One such allograft, Apligraf (Organogenesis, Canton, MA), is a bilayered skin equivalent consisting of living keratinocytes on a matrix of bovine-derived collagen. 15 Apligraf originally gained Food and Drug Administration approval for the treatment of venous ulcers after demonstrating a superior percentage of healed ulcers at 6 months than controls (63% vs 49%), as well as a significantly faster healing times (61 vs 181 days). 16 In acute partial-thickness wounds, Apligraf demonstrated equivalence to meshed autografts in speed of healing and pain reduction.…”