Successful Use of a Physiologically Acceptable Artificial Skin in the Treatment of Extensive Burn Injury

Abstract

A bilayer artificial skin composed of a temporary Silastic epidermis and a porous collagen-chondroitn 6-sulfate fibrillar dermis, which is not removed, has been used to physiologically close up to 60% of the body surface following prompt excision of burn wounds in ten patients whose total burn size covered 50--95% body surface area (BSA). Following grafting, the dermal portion is populated with fibroblasts and vessels from the wound bed. The anatomic structure of the artificial dermis resembles normal dermis and serves as a template for the synthesis of new connective tissue and the formation of a "neodermis," while it is slowly biodegraded. This artificial skin has physiologically closed excised burn wounds for periods of time up to 46 days before the Silastic epidermis was removed. At the time of election when donor sites are ready for reharvesting, the Silastic epidermis is removed from the vascularized artificial dermis and replaced with 0.004 autoepidermal graft in sheet or meshed form. Clinical and histologic experience in a relatively short follow-up period (2--16 months) indicates that "neodermis" retains some of the anatomic characteristics and behavior of normal dermis, thus promising improvement in the functional and cosmetic results, as well as providing physiologic function as a skin substitute. The artificial skin is easily sterilized and stored at room temperature, capable of large scale production, and immediately available for grafting, indicating its potential for easy and relatively economic use in the burn patient.

Crosslinking and Mechanical Properties Significantly Influence Cell Attachment, Proliferation, and Migration Within Collagen Glycosaminoglycan Scaffolds

“…[1][2][3][4][5][6][7] Collagen is particularly attractive for tissue engineering due to its excellent biocompatibility, degradation into physiological end-products, and suitable interaction with cells and other macromolecules. 8 Despite these advantages, the relatively weak mechanical properties of collagen may limit their use as a scaffold.…”

Vascularization of the Dermal Support Enhances Wound Re-Epithelialization by In Situ Delivery of Epidermal Keratinocytes

“…Several polymeric or natural biomaterials can be employed as dermal substrates, including fibroblast-containing nylon, 7 fibroblast-containing biodegradable polyglactin matrix, 15,18 collagen/chondroitin-6-sulfate composite (Integra), [19][20][21] and decellularized dermis (Alloderm/Xenoderm). 22,23 However, vascularization of the dermal support remains a major challenge limiting the survival and take rate of the multilayered epithelial component.…”

Advanced Trends in Treatment of Wounds

“…They are known to provide sustained release of the drug and they do not require change like the other dressings 53 . Polymeric dressings which are synthetic, semisynthetic, bio-adhesive and of natural origin, have a good potential in topical infections as they increase the concentration of antibiotics locally without causing systemic toxicity 54 . They can be easily washed-off once the action is exerted and are biodegradable 55 .…”