Efficacy of dermal substitute on deep dermal to full thickness burn injury: a systematic review

Abstract

Current RCTs available are generally of small sample size with poor methodological reporting. Given the results of more recent RCTs, the risk associated with DRTs is low and it can be a useful alternative for immediate wound coverage post-burn excision. However, there is still no strong evidence to support that DRTs have significant impact on scaring.

Bioengineered Skin Substitutes: The Role of Extracellular Matrix and Vascularization in the Healing of Deep Wounds

“…Tissue engineering aims at developing strategies to allow tissue and organ regeneration [32] by two approaches: (i) In in vitro tissue engineering the patient's human skin is re-built in a laboratory using either endogenous or allogenic cell lines (keratinocytes and fibroblasts); after a period of cultivation in three-dimensional matrices [24] and bioreactors [10,38], the engineered skin is then implanted [32]; (ii) in in vivo tissue engineering a three-dimensional matrix is introduced in the wound bed; such matrices are bio-functionalized in order to attract both cells and growth factors supporting skin regeneration [38]. The use of de novo fabricated skin becomes necessary when skin self-regeneration is hindered by adverse conditions [10]; in particular, when severe burns (second-, third-, and fourth-degree burns), chronic ulcers, surgery or trauma lead to the destruction of the dermis and underlying tissues (fat, muscle or bone) are exposed [39,40].…”

“…In in vitro tissue engineering, such preformed structures (either porous or fibrous) are colonized by the cells after the preparation, since their fabrication techniques represent severe conditions for cell viability. This could represent a limitation because a homogenous cell seeding through the thickness of the scaffolds is difficult to achieve and sophisticated bioreactors need to be used [38,[47][48][49]. Hydrogels represent another class of fibrous scaffolds.…”

“…Tissue engineering aims at producing functional and living human tissue in vitro that can be implanted to restore and to replace damaged tissues and organs [32], or can be used in vitro as living testing platforms [68]. The classical approach involves the extraction of cells from humans (primary cells or stem cells), their expansion and seeding in a biomaterial [32], followed by a dynamic culture to promote the neo tissue growth [10,38,47,49]. After cell expansion, the skin tissue engineering process involves at least three steps.…”

“…One of the strengths of the tissue engineering approach is the possibility to have fine control over the properties of the final tissue. Indeed, by modulating the initial properties of the scaffold used to accommodate human fibroblasts and optimizing the culture conditions (culture media composition, mechanical stimulation, hydrodynamic stimulation) it is possible to obtain engineered skin with desired properties [10,38,[47][48][49]70]. It has been demonstrated that uniaxial and biaxial stretch can induce the alignment of the de novo synthesized collagen network [73].…”

“…As a long-term aim, the skin substitute should guide a correct regeneration avoiding the formation of scar tissue. It has been recognized that an ideal dermal substitute must satisfy the following requirements [38]:…”