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[Skin transplantation or artificial skin replacement?].

The closure of big skin defects is still a problem. Autologous skin is not unlimitedly available. Different skin substitutes are invented and available. All of them are suffering one problem. They can only be used for temporary closure. Even the immunological progress can not solve the problem of skin shortage. An interesting artificial skin was designed by Burke and Yannas. They designed an artificial dermis consisting of bovine collagen and chondroitin-6-sulfate. This is a fascinating possibility for solving the skin shortage problem especially in burn cases. But even this dermis needs autologous epithelial cells to create a complete skin coverage. So till now a complete skin substitute without autologous material seems not to be available.

Bandages↗

[Skin transplantation or artificial skin replacement].

Temporary cover of skin defects, using artificial material, cannot be a substitution for autologous material. Heterologous skin grafts may turn out to be sources of infection. A combination of artificial skin of collagen preparations with epithelial cell cultures is a new alternative to exclusive autologous transplantation. Only limited surfaces so far can be covered by means of epithelial cultures.

Bandages↗

3D-resolved investigation of the pH gradient in artificial skin constructs by means of fluorescence lifetime imaging.

PURPOSE: The development of substitutes for the human skin, e.g., artificial skin constructs (ASCs), is of particular importance for pharmaceutical and dermatologic research because they represent economical test samples for the validation of new drugs. In this regard, it is essential for the skin substitutes to be reliable models of the genuine skin, i.e., to have similar morphology and functionality. Particularly important is the barrier function, i.e., the selective permeability of the skin, which is strongly related to the epidermal pH gradient. Because the pH significantly influences the permeation profile of ionizable drugs such as nonsteroidal anti-inflammatory drugs, it is of major importance to quantitatively measure the epidermal pH gradient of the ASC and compare it to that of genuine skin. METHODS: Using three-dimensional fluorescence lifetime imaging combined with two-photon scanning microscopy, we measured with submicron resolution the three-dimensional pH gradient in the epidermis of ASCs stained with 2',7'-bis-(2-carboxyethyl)-5/6-carboxyfluorescein. RESULTS: Similar to genuine skin, the surface of the artificial epidermis has an acidic character (pH 5.9), whereas in the deeper layers the pH increases up to 7.0. Moreover, the pH gradient differs in the cell interior (maximally 7.2) and in the intercellular matrix (maximally 6.6). Apart from the similitude of the pH distribution, the genuine and the artificial skin prove to have similar morphologies and to be characterized by similar distributions of the refractive index. CONCLUSIONS: Artificial skin is a reliable model of genuine human skin, e.g., in permeability studies, because it is characterized by a similar pH gradient, a similar morphology, and a similar distribution of the refractive index to that of genuine skin.

Fluoresceins↗

Re-freeze dried bilayer artificial skin.

A bilayer artificial skin composed of a silicone sheet and a collagen sponge sheet was developed by us in 1986, modifying Yannas and Burke's technique. It was used in experimental animals and clinically, both with success; but the artificial skin was inconvenient for clinical use in terms of disinfection and preservation. In an attempt to reduce the drawbacks, we developed a re-freeze dried artificial skin. Experiments were conducted to examine whether the re-freeze dried material is equivalent to the prototype one. A significant difference between the two was found in tensile tests but not in experimental and clinical effects.

Adult↗

[An experimental study on the repair of full skin loss of rabbits with composite chitosan artificial skin].

OBJECTIVE: To investigate the practicability of repair of full skin loss of rabbits with composite chitosan artificial skin. METHODS: Dermal substitute was prepared aseptically by mixing fibroblasts with composite dermal matrix gel. Keratinocytes were then seeded on the substitute and submersion - cultured thereafter for 1 week in keratinocyte culture medium. The composite was further cultured for 1 approximately 2 weeks on the surface of the culture liquid to form artificial skin. The composite chitosan artificial skin was then grafted onto the full skin loss wound of rabbits. Histological changes were undertaken periodically by tissue sampling from the grafted wound. The systemic reaction of rabbits to the artificial skin was observed. RESULTS: All the grafted wounds healed very well without any suppuration, bleeding or infection under the grafted skin. No obvious immune rejection was seen. The artificial skin could cover the wounds for a long time with good elasticity and easy to be manipulation. CONCLUSION: The composite chitosan artificial skin could be an optimal biological dressing with good histocompatibility and easy to be manipulation.

Animals↗

[Artificial skin cultured in vitro].

Artificial skin is a kind of skin which by using tissue engineering techniques, a skin-like material was formed by seeding epithelium cells and dermis fibroblasts on a good biocompatible material after proliferation. The trauma restoration and reconstruction were achieved by transplanting the skin graft an skin defects after the artificial skin graft cultured in vitro. Artificial skin research is a new active field in tissue engineering. It has wonderful prospect for clinics to radically settle the problem of restoration of skin defects. The recent studies on the models, cultured methods and influenced factors for epithium culture, dermis culture and artificial skin in vitro were reviewed in this paper.

Bioartificial Organs↗

Experimental study of a newly developed bilayer artificial skin.

A bilayer artificial skin composed of an outer layer of silicone polymer and an inner sponge layer of collagen containing chondroitin 6-sulphate was developed by modifying the technique proposed by Yannas et al. The artificial skin was placed on the skin defects on the backs of rats. Histological observation indicated that fibroblasts and capillaries infiltrated into the pores and filled in lattice spaces, resulting in synthesis of the connective tissue matrix and absorption of the original network of collagen and chondroitin 6-sulphate. Epidermal cells migrated from the edge of the wound between the two layers. Post-operative contracture in the wound with the artificial skin was significantly less than in the control.

Animals↗

[Biological evaluation of artificial skin substitute].

Multiple kinds of Artificial Skin Substitute are now available. However, except for the Homo Skin Graft there is no Artificial Skin Substitute that can be used as permanent Artificial Skin Substitute. During the past 20 years, more and more scholars around the world have expressed increased interests in the research and development of Artificial Skin Graft that can be utilized as satisfying permanent Artificial Skin Substitute. We conducted our research on the biological evaluation of medical devices of Collagen-Chitosan(C-C) Artificial Skin Substitute according to the National Standard (GB/T16886. 1-1997). The following experiments were conducted: (1)Cytotoxicity, (2)Systemic toxicity(acute toxicity), (3)Haemocompatibility, (4)Sensitization, (5)Intracutaneous reactivity, (6)Pyrogen test, (7)Genotoxicity. The experiment results demonstrate that all biological functional indexes of the Artificial Skin Graft meet the National Standards. Therefore, we conclude that C-C Artificial Skin Graft is characteristic of good biological compatibility. It is non-irritant and has no systemic and cellular toxicity, no genotoxicity, no pyrogen, and no allergen.

Animals↗

Further applications of "bilayer artificial skin".

A "bilayer artificial skin", composed of an inner layer of collagen sponge and an outer silicone layer, was developed by modifying the material reported by Yannas and Burke. Since our early results from experimental and clinical use of the original version of the "bilayer artificial skin" were reported, several improvements have been made in stages to eliminate some drawbacks related to disinfection and preservation and to reduce the primary cost of manufacture. The latest version of the material was successfully used in 27 sites on 23 patients. In this paper, the improvements in the material and the clinical results are described.

Adolescent↗

Influence of glycosaminoglycans on the collagen sponge component of a bilayer artificial skin.

A bilayer artificial skin composed of a silicone membrane and a collagen sponge layer containing glycosaminoglycans (GAGs) was first developed by Yannas and Burke. They reported that GAGs contained in the collagen sponge layer contributed to the function of the artificial skin. In an attempt to assess the effect of GAGs in the collagen sponge layer, the electron microscopic structure, mechanical strength of collagen sponges, and cell proliferation were examined in vitro, using four kinds of collagen sponges containing: no GAG, chondroitin 6-sulphate (C6S), dermatan sulphate (DER), and hyaluronic acid (HYA). The results indicated that: (1) addition of GAGs scarcely affected the mechanical structure of collagen sponges; (2) addition of C6S and DER reinforced mechanical strength, while addition of HYA did not; (3) addition of C6S and DER significantly decreased cell proliferation.

Artificial Organs↗

The 1999 clinical research award. Cultured skin substitutes combined with Integra Artificial Skin to replace native skin autograft and allograft for the closure of excised full-thickness burns.

Prompt and permanent closure of excised full-thickness burns remains a critical factor in a patient's recovery from massive burn injuries. Hypothetically, Integra Artificial Skin (Integra) may replace the need for allografts for immediate wound coverage, and cultured skin substitutes (CSS) that contain stratified epithelium may replace the need for autografts for definitive wound closure. To test this hypothesis, 3 patients with full-thickness burns of greater than 60% of their total body surface areas had their eschar excised within 14 days of admission. Integra was applied, and a skin biopsy was collected from each patient for the preparation of CSS. At 3 weeks or more after the application of the Integra and the collection of skin biopsies, the outer silastic cover of the Integra was removed and CSS were grafted. The CSS were irrigated with nutrients and antimicrobials for 6 days and then dressed with antimicrobial ointment and cotton gauze. Treated wounds were traced on days 14 and 28 after the grafting of CSS for determination of engraftment and wound closure, respectively. Cost analysis was not performed. Engraftment on postoperative day (POD) 14 was 98%+/-1% (mean +/- standard error of the mean), the ratio of closed:donor areas on POD 28 was 52.3+/-5.2, and no treated sites required regrafting. The histology of the closed wounds showed stable epithelium that covered a layer of newly formed fibrovascular tissue above the reticulated structure of the degrading Integra. The clinical outcomes of the closed wounds after POD 28 demonstrated smooth, pliable, and hypopigmented skin. Two patients who had received CSS grafts over Integra on their backs were positioned supine on air beds from POD 8 or POD 9 with minimal graft loss because of mechanical loading. One patient with a full-thickness burn of 88% of the total body surface area was covered definitively at 55 days postburn. These results demonstrate that the combination of CSS and Integra can accomplish functionally stable and cosmetically acceptable wound closure in patients with extensive full-thickness burns. This combination of alternatives to the conventional grafting of split-thickness skin permits the substitution of cadaveric allograft with Integra and the substitution of donor autograft with CSS. This approach to the closure of excised full-thickness burns is expected to reduce greatly the time to definitive closure of burn wounds and to reduce the morbidity associated with the harvesting of donor sites for split-thickness skin autografts.

Biocompatible Materials↗

Evaluation of dermal-epidermal skin equivalents ('composite-skin') of human keratinocytes in a collagen-glycosaminoglycan matrix(Integra artificial skin).

Integra artificial skin (Integra LifeSciences Corp., Plainsboro, NJ, USA) is a dermal template consisting of bovine collagen, chondroitin-6-sulphate and a silastic membrane manufactured as Integra. This product has gained widespread use in the clinical treatment of third degree burn wounds and full thickness skin defects of different aetiologies. The product was designed to significantly reduce the time needed to achieve final wound closure in the treatment of major burn wounds, to optimise the sparse autologous donor skin resources and to improve the durable mechanical quality of the skin substitute. The clinical procedure requires two stages. The first step creates a self neodermis, the second creates a self epidermis on the neodermis. However, it is desirable to cover major burn wounds early in a single step by a skin substitute consisting of a dermal equivalent seeded in vitro with autologous keratinocytes ('composite-skin') out of which a full thickness skin develops in vivo.The goal of this experimental study was to develop a method to integrate human keratinocytes in homogeneous distribution and depth into Integra Artificial Skin. The seeded cell-matrix composites were grafted onto athymic mice in order to evaluate their potential to reconstitute a human epidermis in vivo. We were able to demonstrate that the inoculated human keratinocytes reproducibly displayed a homogeneous pattern of distribution, adherence, proliferation and confluence. The cell-matrix composites grafted in this model exhibited good wound adherence, complete healing, minor wound contraction and had the potential to reconstitute an elastic, functional and durable human skin. Histologically we were able to show that the inoculated human keratinocytes in vivo colonised the matrix in a histomorphologically characteristic epidermal pattern (keratomorula, keratinocyte bubbling) and developed a persisting, stratified, keratinising epidermis which immunohistologically proved to be of human origin. These experimental results demonstrate the establishment of an effective cell cultivation process which may be suitable for scale-up production of the epidermal component as large-scale composite-skin grafts. When seeded into Integratrade mark and grafted onto the nude mouse a replacement skin with normal functioning dermal-epidermal components was developed. These results encourage the design of a clinical trial to assess the function of this composite graft in man.

Animals↗

Update on the use of collagen/glycosaminoglycate skin substitute-six years of experiences with artificial skin in 15 German burn centers.

The clinical use of an artificial skin substitute (Integra) has been celebrated enthusiastically as an improvement in burn therapy over a period of more than 10 years. Many case-reports have shown the positive effects of the treatment with Integra as a skin substitute. In this study we examine the alterations of Integra-usage in Germany. Fifteen German burn centres have been interviewed respectively over a time period of 6 years with interviews in the years 1999, 2001, and 2003. The goal of this study is to focus on the problems associated with the use of artificial skin and to create a manual for Integra-therapy including indication, pre-, intra-, and postoperative treatment. Since the first Integra Users seminar in Germany in 1999 repeated interviews have been conducted with fifteen German burn centres. The collected results of the last 6 years were evaluated. These results show a change in the indication for the therapy with artificial skin towards extensive full thickness burned patients and as extended indication especially for posttraumatic reconstruction. This article gives our guidelines for the usage and handling of Integra and shows that Integra is an important reconstructive dermal substitute for the severely burned or posttraumatic patient if handled by a skilled surgeon in a correct way.

Anti-Infective Agents, Local↗

Effects of heparin on vascularization of artificial skin grafts in rats.

Artificial skin is a recent development in the clinical care of the severely burned patient. Its manufacture entails the covalent bonding of collagen and polysaccharide, followed by the coating of one surface with a thin layer of silicone rubber. Artificial skin was grafted onto rats and examined for neovascularization at 7 days. Vascular patency was shown by perfused yellow latex casts. Five percent of the patent vessels grew into the graft soaked in physiological buffered saline (PBS). When the graft was soaked in heparin, 1 mg/ml buffered saline solution, before grafting, 54% of the patent vessels in the grafted area had grown into the matrix. These experiments show that the local application of heparin promotes early ingrowth of blood vessels into the healing site. The vascularity of artificial skin can be modified by heparin, which promotes angiogenesis, and leads to earlier deposits of greater amounts of new connective tissue.

Animals↗

The use of "artificial skin" for burns.

An artificial skin composed of epidermal and dermal analogues has been successfully used in animal models and in severely burned patients. The development of skin substitutes, the clinical use of artificial skin, and future physiologic skin replacements are discussed.

Animals↗

Combination of a new composite biocampatible skin graft on the neodermis of artificial skin in an animal model.

INTRODUCTION: There have been very limited and inconsistent attempts at combining the cultured epidermal autograft (CEA) with the neodermis of artificial skin (Integra). The reasons for this remain unknown. The basement membrane proteins of conventional CEA sheets are easily damaged by the dispase treatment during the harvesting of the CEA from the culture flask. The damage of the basement membrane proteins may affect the anchorage of CEA onto the neodermis of Integra. A new Composite Biocompatible Skin Graft (CBSG) was recently developed. METHODS: Composite biocompatible skin graft consists of autologous keratinocytes cultivated on a pliable hyaluronate-derived membrane (Laserskin)which has been pre-seeded with allogenic dermal fibroblasts. Basement membrane proteins of CBSG are protected from the dispase treatment because the keratinocytes are directly seeded onto Laserskin. The engraftment of CBSG was evaluated on 20 wounds of 10 rats. Integrawas grafted on two freshly excised full-thickness wounds (3cm in diameter) in the dorsum of each animal. A polypropylene ring was applied to each wound to prevent the migration of epithelium from the edges. Composite Biocompatible Skin Graft was used to cover the neodermis of Integra after the silicone membrane was removed 14-21 days postgrafting. RESULTS: Fourteen (70%) of 20 skin biopsies taken at day 21 from the centre of the grafted wounds revealed regenerated epithelium. CONCLUSION: A feasible delivery system of cultured keratinocytes onto theneodermis of Integra is demonstrated in this animal -experiment.

Animals↗

[The character and clinical application of glutaraldehyde cross-linked collagen artificial skin].

The glutaraldehyde cross-linked collagen artificial skin was made with the modified Burke's method. It is an ideal artificial skin in that animal tests proved that it has the effect of bacteriostasis with strong adhesiveness and good porosity, is capable of decreasing vaporization and the loss of protein and electrolyte, and without rejection reaction. Clinical use of the artificial skin in 30 patients resulted in an average healing time of 24 +/- 3 days of the eschar-excised wound covered with the artificial skin and autograft of skin seeds. It is especially effective in Pseudomonas aeruginosa infected wound and chronic ulcer.

Burns↗