Skin substitutes as treatment for chronic wounds: current and future directions

Vecin, Nicole M.; Kirsner, Robert S.

doi:10.3389/fmed.2023.1154567

Cited by 22 publications

(15 citation statements)

References 119 publications

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“…However, no universal categorization system has been established. Skin substitutes could be classified by their cellularity, the layer to reintegrate (epidermal, dermal, or both), or whether they originate from natural or synthetic sources [2,11]. Our study revealed the efficacy of BTM, a fully synthetic dermal matrix, in wound coverage.…”

Section: Discussionmentioning

confidence: 75%

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Strategic Use of Biodegradable Temporizing Matrix (BTM) in Wound Healing: A Case Series in Asian Patients

Chen,

Lin,

Chang

et al. 2024

JFB

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Skin and soft tissue reconstruction has long been based on the reconstructive ladder. However, a skin substitute has become popular due to its predictable outcomes, without donor-site morbidity. The biodegradable temporizing matrix (BTM; NovoSorb, PolyNovo Ltd., Port Melbourne, Australia) is a synthetic skin substitute that has recently gained its clinical application. Compared with those of other dermal templates, the clinical efficacy and performance of the BTM are not well established, especially among the Asian population. This study aims to share our experience and strategy of using BTM in various wound conditions. The data of patients who underwent skin and soft tissue reconstruction with BTM at a single institution between January 2022 and December 2023 were reviewed. The patient demographics, wound characteristics, surgical details, secondary procedures, and complications were recorded and analyzed. Postoperative 6-month photographs were collected and independently evaluated by two plastic surgeons and two wound care center nurses using the Manchester Scar Scale (MSS). This study included 37 patients, consisting of 22 males and 15 females with a mean age of 51.8 years (range, 18–86 years old). The wound etiologies included trauma (67.6%), necrotizing soft tissue infection (16.2%), burns (10.8%), toe gangrene (2.7%), and scar excision (2.7%). The average wound area covered by BTM was 50.6 ± 47.6 cm2. Among the patients, eight received concomitant flap surgery and BTM implantation, 20 (54.1%) underwent subsequent split-thickness skin grafts (STSG), and 17 had small wounds (mean: 21.6 cm2) healed by secondary intention. Infection was the most common complication, affecting six patients (n = 6 [16.2%]), five of whom were treated conservatively, and only one required debridement. Thirty-three patients (89.2%) had good BTM take, and only four had BTM failure, requiring further reconstruction. At the last follow-up, 35 out of the 37 patients (94.6%) achieved successful wound closure, and the total MSS score was 10.44 ± 2.94, indicating a satisfactory scar condition. The patients who underwent BTM grafting without STSG had better scar scores than those who received STSG (8.71 ± 2.60 vs. 11.18 ± 2.84, p = 0.039). In conclusion, the BTM is effective and feasible in treating various wounds, with relatively low complication rates, and it can thus be considered as an alternative for skin and soft tissue reconstruction. When combined with adipofasical flap reconstruction, it achieves a more comprehensive anatomical restoration.

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Section: Discussionmentioning

confidence: 75%

“…Therefore, it has prompted a paradigm shift toward innovative alternatives, such as artificial skin substitutes. Artificial skin substitute acts as a dermal regeneration template, providing a stable scaffold that promotes the synthesis of neodermal tissues and can protect the wound from infection and moisture loss [1,2].…”

Section: Introductionmentioning

confidence: 99%

Strategic Use of Biodegradable Temporizing Matrix (BTM) in Wound Healing: A Case Series in Asian Patients

Chen,

Lin,

Chang

et al. 2024

JFB

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“…Alternatively, from a theoretical viewpoint, scaffolds alone, scaffolds in which cells are seeded, or scaffolds containing growth factors can be constructed, although the first two types of scaffolds have been utilized in clinical settings. In this review, an outline of scaffolds used in clinical practice is described, and detailed information on scaffolds per se has been discussed elsewhere ( Qin et al, 2022 ; Vecin and Kirsner, 2023 ).…”

Section: Clinical Use Of Scaffolds For Skin Injuriesmentioning

confidence: 99%

“…Scaffolds made from bovine or porcine collagen cross-linking have been the first choice for impaired wound healing because animal collagen matrices have been reported to be useful for the formation of the neodermis in wounds ( Burke et al, 1981 ). Allograft acellular dermal matrices are currently available ( Yildirimer et al, 2012 ; Vecin and Kirsner, 2023 ). The application of animal collagen matrices allows myofibroblasts to migrate and synthesize ECM during deep injuries.…”

Section: Clinical Use Of Scaffolds For Skin Injuriesmentioning

confidence: 99%

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Plasticity of bone marrow-derived cell differentiation depending on microenvironments in the skin

Okano,

Nakagawa,

Kojima

2024

Front. Physiol.

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Bone marrow-derived cells (BMDCs) are heterogeneous populations in which not only pluripotent stem cells, namely, hematopoietic stem cells (HSCs), mesenchymal stem cells (MSC) but also endothelial progenitor cells (EPC) are involved. BMDCs contribute to the maintenance of homeostasis and recovery from disrupted homeostasis as the immune, endocrine, and nervous systems. The skin is the largest organ in which various tissues, such as the epidermis, dermis, skin appendages (i.e., hair follicles), fats, muscles, and vessels, are tightly and systematically packed. It functions as a physical barrier to block the invasion of harmful substances and pathogenic microorganisms and properly regulate water evaporation. The skin is exposed to injuries from external stimuli because it is the outermost layer and owing to its specificity. Recovery from physical injuries and DNA mutations occurs constantly in the skin, but medical treatments are required for impaired wound healing. Recently, conservative treatments utilizing scaffolds have attracted attention as alternatives to surgical therapy, which is highly invasive. Against this background, numerous scaffolds are available in a clinical setting, although they have not surpassed surgery because of their distinct disadvantages. Here, we discuss the plasticity of BMDCs in the skin to maintain homeostasis, in addition to their critical roles on recovery from disrupted homeostasis. We also share our perspective on how scaffolds can be developed to establish scaffolds beyond surgery to regenerate skin structure during wound healing by maximally utilizing the plasticity of BMDCs.

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Skin and Wound Healing Biomaterials

Suhag

2024

Biomedical Materials for Multi-Functional Applications

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Skin substitutes as treatment for chronic wounds: current and future directions

Cited by 22 publications

References 119 publications

Strategic Use of Biodegradable Temporizing Matrix (BTM) in Wound Healing: A Case Series in Asian Patients

Strategic Use of Biodegradable Temporizing Matrix (BTM) in Wound Healing: A Case Series in Asian Patients

Plasticity of bone marrow-derived cell differentiation depending on microenvironments in the skin

Skin and Wound Healing Biomaterials

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