Long‐term in vivo assessment of bioengineered skin substitutes: a clinical study

Abstract

The aim of the study was an objective in vivo assessment of skin properties after reconstruction with two artificial dermal substitutes, Integra ® and Hyalomatrix ® . Twenty-seven patients underwent reconstruction of 36 skin-loss sites with full-thickness skin graft, split-thickness skin graft, Hyalomatrix ® bioengineered skin substitute and sequential split-thickness skin graft and Integra ® bioengineered skin substitute and sequential split-thickness skin graft. Objective assessments were carried out using three instrumental devices: Multi Probe Adapter System MPA; 22 MHz ultrasound skin scan; and Primos Pico for a three-dimensional (3D) skin scan. The skin parameters under study in our sample were: corneometry, transepidermal water loss, elastometry, colorimetry, skin thickness and 3D skin surface pattern. A skin reconstruction with Hyalomatrix seemed to most closely approach the hydration, transepidermal water loss and skin surface 3D pattern of normal skin. A skin reconstruction with Integra seemed to demonstrate the best skin colour feature and elastic properties. Although no statistically significant differences were observed, the descriptive analysis of the outcomes might suggest a better cell regulation, regenerated extracellular matrix and neoangiogenesis with the use of Hyalomatrix, and the formation of a more elastic regenerated dermis, with overall better physical, mechanical and optical properties, with the use of Integra.

Methodologies in creating skin substitutes

“…The majority of skin grafts lead to hypopigmented skin compared to normal uninjured skin[146]. The addition of melanocytes into skin substitutes has been effective in being able to alter the healed skin’s natural colour[147].…”

“…These effects on cellular differentiation and mechanotransduction suggests that the matrix for skin substitutes should be similar in stiffness and elasticity as native skin and perhaps promotes the use of different matrices for different areas of human skin. However, although studies have shown skin post-wound healing can have different resulting elasticities when treated with different skin substitutes[146], it is still unknown whether the elasticity of the skin substitutes directly affects the final resulting skin elasticity or whether it is another component or characteristic of the skin substitute. The degree of swelling and elasticity of a hydrogels is dependent on the types of polymers in the hydrogel such as elastin which has previously been mentioned, cross-link density, and polymer concentration.…”

Engineered skin graft with stromal vascular fraction cells encapsulated in fibrin–collagen hydrogel: A clinical study for diabetic wound healing

“…Whole skin (epidermal and dermal) thickness and density with a 2‐mm‐diameter probe could visualize that the dermal layer contained more vessels compared with the control group after transplantation, along with healthy skin. (Nicoletti et al, ).…”

An Exploratory Clinical Trial of a Novel Treatment for Giant Congenital Melanocytic Nevi Combining Inactivated Autologous Nevus Tissue by High Hydrostatic Pressure and a Cultured Epidermal Autograft: Study Protocol

“…Regarding skin reconstruction, the regeneration of the epidermis by a cultured epidermal autograft (CEA) using Green’s method was established in the 1970s [10]. A method of dermal regeneration that achieves sufficient strength and elasticity has not yet been established [11,12]. …”