The final aim of skin substitutes is to restore the anatomy and physiology of uninjured skin after treatment and healing of the burn wound. Currently, only autologous full-thickness skin graft, free flaps, and pedicle flaps restore all the structures and functions of uninjured skin, but donor sites and treatment sites must be the same size. Skin substitutes containing cultured cells can provide large quantities of grafts for wound treatment but they restore only a subset of the anatomical structures and physiological functions of skin. The full potential for the engineering has not yet been achieved. This article considers the anatomical, physiological, and surgical aspects of the problem, as well as the basic principles involved (cytogenesis, morphogenesis, histogenesis, and organogenesis). The clinical considerations and other assessment factors are discussed, and future trends are indicated.
Boyce S.T.
Burns, 27: 523-33, 2001
This article reviews latest developments in skin substitutes, listing product names, epidermal components, dermal components, and manufacturers’ names. Relative advantages and disadvantages are considered. Particular attention is paid to the use of animal proteins in skin substitutes. The emerging field of regenerative biology aims to stimulate regeneration of lost tissue rather than simple repair, with scarring. It is hoped that the miracle of regenerating damaged tissues in vivo will become reality before the end of this new century. The future is bright for the treatment of these dramatic wounds, with restoration of the aesthetic and functional performance of skin.
Balasubramani M., Kumar T.R., Babu M
Burns, 27: 534-44, 2001
The strategies of tissue engineering of skin are reviewed. There have been two major approaches to the provision of a cell-free matrix for replacement of the dermis component of skin. The first has been to manufacture a matrix with the required physical and chemical structure, while the second has been to use allogeneic human dermis rendered cell-free and preserved. Different types of cell-free matrix are considered (Integra, Alloderm). Cell-containing matrices are also presented (Dermgraft, Apligraf). Possible future developments are outlined. We can expect, in the not too distant future, tissue engineered skin grafts with a clinical performance equivalent to the current gold standard of skin autografts.
Kearny J.N.
Burns, 27: 545-51, 2001
Progress in the management of local wounds using early excisional therapy has reduced mobility and mortality in seriously injured burn patients. Not many studies made longitudinal determinations of regional blood flow in various layers of the burn wound. In our study on a conscious ovine model, the animals were subjected to a 40%-burn wound. The burned tissue was divided into the four layers (skin, panniculus carnosus, adipose tissue, skeletal muscle), and the regional blood flow was determined separately, using fluorescent microspheres, while measuring systemic haemodynamics and total burn tissue microvascular fluid flux. The sub-burn adipose tissue showed considerable biphasic alteration in regional blood flow, while the skin flow showed only reduced blood flow throughout the entire experimental period. The increased blood flow to the adipose tissue would appear to be related to a sustained fluid filtrate in the post-resuscitation period, leading to the formation of oedema, which is mainly located in the adipose tissue at the end point.
Sakurai H., Nozaki M., Traber L.D., Hawkins H.K., Traber D.L.
Burns, 28: 3-9, 2002
An investigation was made of the capacity of laser Doppler imaging (LDI) to assess burn depth in children. Over a 10-month period, 57 patients were prospectively studied. Each was clinically assessed, photographed, and independently scanned 36-72 h post-burn. The children continued to be reviewed until wound healing had occurred, within 12 days, or skin grafting had been performed. The median body surface area burned was 7.0% (range, 0.5-30%). The burns did not heal within 12 days in 30 of the patients, of whom 17 were grafted. The clinical examination correctly calculated 66% of deep partial- or full-thickness burns between 36 and 72 h after injury compared with 90% using LDI, which was much more specific and correctly diagnosed 96% of superficial partial-thickness burns compared with 71% on clinical examination.
Holland A.J.A., Martin H.C.O., Cass D.T.
Burns, 28: 11-17, 2002
Since Lewisite (dichloro [2-chlorovinyl]) arsine] was first synthesized in 1918, its potential use in war situations as a vesicant agent has been well known. It causes a blistering skin reaction with resultant full-thickness burns. Porcine skin has recently been used successfully as a model for the development and natural history of this type of burn injury. Six large white pigs were used to investigate the effectiveness of CO2 and Erbium-YAG lasers (EYL) in laser dermabrasion of Lewisite burns. These were subjected to treatment four days after exposure and assessed after a further one, two, and three weeks for the rate of epithelial healing. In the laser dermabrased groups, the re-epithelialization rate was accelerated by a factor of four compared with untreated controls by the first week. Ablation of the burn eschar may therefore accelerate the healing rate by causing partial debridement. This method, which has been defined as “lasablation”, marks a significant step forward in the clinical management of this type of injury.
Lam D.G.K., Rice P., Brown R.F.R.
Burns, 28: 19-25, 2002