--Engineered skin substitutes practices and potentials.pdf

Engineered skin substitutes: practices and potentialsDorothy M. Supp, PhDa,*, Steven T. Boyce, PhDbaResearch Department, Shriners Hospitals for Children, Cincinnati Burns Hospital, Cincinnati, OH 45229, USA bDepartment of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USAAbstract Wound healing can be problematic in several clinical settings because of massive tissue injury (burns), wound healing deficiencies (chronic wounds), or congenital conditions and diseases. Engineered skin substitutes have been developed to address the medical need for wound coverage and tissue repair. Currently, no engineered skin substitute can replace all of the functions of intact human skin. A variety of biologic dressings and skin substitutes have however contributed to improved outcomes for patients suffering from acute and chronic wounds. These include acellular biomaterials and composite cultured skin analogs containing allogeneic or autologous cultured skin cells. D 2005 Elsevier Inc. All rights reserved.Introduction Wound coverage can be problematic in several different clinical settings. In one extreme example, massive burn injuries can require replacement of skin covering nearly the entire body surface area. Burns are an important medical problem in the United States, where greater than 1 million burn injuries occur each year.1 Fires and burns result in 45,000 hospitalizations and 4500 deaths annually. Many advances in burn care have however caused a decline in burn mortality rates. In 1952, only half of all pediatric patients with greater than 50% total body surface area (TBSA) burns survived. Currently, most survive a 50% TBSA burn, and half of children who receive 98% TBSA burns survive.2 Advances in burn care contributing to the decline in mortality include early excision, improved fluid resuscitation, infection control, nutritional support, and aggressive physical therapy.2- 4 Because most patients survive the initial resuscitation phase, even a