What is the role of bioengineered skin substitutes in surgical wound care?

Updated: Apr 24, 2020
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Zubin J Panthaki, MD, CM, FACS, FRCSC  more...
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AlloDerm (Allergan, Inc) is tissue from cadavers that is used create an acellular dermal matrix that has been freeze-dried. The collagen framework acts as a strengthening scaffold for normal tissue remodeling. Since it contains no cells or cellular components, it does not cause rejection or irritation. It can often be used for burns or full-thickness wounds.

Apligraf (Organogenesis; Novartis) is a bilayered skin substitute produced by combining bovine collagen and living cells derived from tissue-cultured human infant foreskins. One study of diabetic foot ulcers demonstrated 12-week healing rates of 39% for patients who received only standard wound care versus 56% for those who were treated by application of an Apligraf after a period of standard wound care.

Dermagraft (Smith & Nephew, Inc) is human fibroblast-derived dermal substitute manufactured by seeding dermal fibroblasts onto a 3-dimensional bioabsorbable scaffold. It has been marketed for use in the treatment of diabetic foot ulcers, venous ulcers, and pressure sores. A clinical trial showed improved healing rates in diabetic foot ulcers.

Integra (Integra Lifesciences Corp) is a dual-layered membrane system with a porous matrix that cross-links bovine tendon collagen and glycosaminoglycans. The epidermal substitute layer is made of a thin polysilicone layer that acts to control moisture. It can be used for deep partial-thickness and full-thickness burns owing to the good barrier function of the system, but operative removal of the silicone layer is required.

Oasis (Healthpoint, Ltd) is a xenogeneic acellular collagen matrix derived from porcine small intestinal submucosa in such a way that an extracellular matrix and natural growth factors remain intact. This provides a scaffold for inducing wound healing. [63] Do not use this in patients with allergies to porcine materials.

EZ Derm (Brennan Medical, Inc) is a porcine derived xenograft of collagen that has been chemically cross-linked with aldehyde to provide strength and durability. It can be used for venous stasis ulcers, diabetic ulcers, pressure ulcers, and partial-thickness burns. However, it does have the capacity to cause a potential immune response or disease transmission.

Cultured epithelial autograft (Epicel; Genzyme Tissue Repair, Cambridge, Mass) is an epidermal replacement that is grown in a tissue culture from a skin biopsy taken from the recipient and is cocultured with mouse cells. Preparation of the graft requires about 2 weeks of culture time.

EpiFix (MiMedex, Inc) is a relatively new matrix scaffold used in wound healing. It is composed of dehydrated human amnion/chorion membrane (dHACM). EpiFix is a bioactive tissue matrix allograft, and the dHACM preserves and contains multiple extracellular matrix proteins, cytokines, growth factors, and other specialty proteins.

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