Table 1.
Examples of commercially created skin substitutes.
| commercial product name and manufacturer | epidermal component | dermal component | advantages | disadvantages | |
|---|---|---|---|---|---|
| epidermal substitutes | Epicel Genzyme Tissue repair Corporation | cultured epidermal autograft grown from patient skin biopsy | none | large area of permanent wound coverage with little risk of rejection | three weeks required to produce fragile confluent sheets, susceptible to blistering post-grafting |
| Laserskin Fidia Advanced Biopolmers | cultured autologous keratinocytes from skin biopsy in a perforated hyaluronic acid membrane | none | a less fragile delivery system for keratinocytes. Hyaluronic acid/cell interaction properties improve mechanical stability | minimum of three weeks required to expand keratinocyte population | |
| EpiDex Modex Therapeutiques | cultured autologous outer root sheath hair follicle cells | none | cells have increased proliferative capacity and can be cryopreserved for repeat applications. Success in chronic ulcer treatment | substitute takes up to six weeks after harvesting to produce. Product fragile | |
| Myskin CellTran | cultured autologous keratinocytes on a PVC polymer coated with a plasma-polymerized surface | Myskin with dermal fibroblasts under development | PVC encourages keratinocyte attachment and proliferation, providing a more stable delivery platform. Keratinocytes can be thawed for repeated application | up to 14 days required for cell expansion. Repeated application needed for good clinical outcome | |
| dermal substitutes | Alloderm Life Cell Corporation | none | processed cadaver allograft skin | processing helps reduce antigenic components. Successful in resurfacing full-thickness burns | problems of graft rejection and disease transfer |
| Dermagraft Advanced Biohealing, Inc. | none | allogeneic neonatal fibroblasts on a three-dimensional bioabsorbable scaffold | neonatal fibroblast rapidly proliferate to produce collagen, GAGs and growth factors to aid wound healing | potential risk of rejection and disease risk from fibroblasts, although none reported | |
| Integra Johnson & Johnson | synthetic polysiloxane polymer | bovine type I collagen and GAGs | encourages ingrowth of fibroblasts and epithelial cells. Epidermal equivalent replaced after 14 days with an autograft | bovine collagen presents and antigenicity and disease risk. Three weeks required to expand the dermal autograft | |
| Transcyte Advanced Biohealing, Inc. | thin silicone layer (Biobrane) | collagen-coated nylon mesh seeded with neonatal allogeneic fibroblasts | successfully used to treat second- and third-degree burns. Dermal fibroblasts secrete collagen, GAGs and growth factors to aid wound healing | nylon mesh not biodegradable. Rejection and disease risk from fibroblasts | |
| Permacol Tissue Sciences Laboratories | none | porcine-derived acellular dermal matrix | non-immunogenic due to processing to remove non-collagenous and cellular material. Supports host fibroblast infiltration and revascularization | revascularization sometimes inefficient to support overlying epidermal graft | |
| composite substitutes | Apligraf Organogenesis | human allogeneic neonatal keratinocytes | human allogeneic neonatal foreskin fibroblasts in bovine type I collagen, ECM proteins and cytokines | graft take comparable to autografts with good cosmetic results. Improves granulation tissue deposition and no signs of rejection observed | risk of chronic graft rejection and disease from allogeneic keratinocytes and fibroblasts. Requires repeated applications |
| OrCel Ortec International | human allogeneic neonatal keratinocytes | human allogeneic neonatal foreskin fibroblasts in a bovine collagen sponge | provides a favourable environment for host cell migration and provides a source of cytokines and growth factors | not intended for use as a permanent skin replacement. Designed as a biological dressing. Risk of rejection and disease from bovine collagen and other cells. |