Table 1.
Example commercially available skin substitutes
| Name (manufacturer) | Composition | Advantages | Disadvantages | Refs |
|---|---|---|---|---|
| Epidermal: CEA | ||||
| Epicel (Vericel Corporation, Cambridge, MA, USA) | CEA from human keratinocytes embedded in fibrin mesh | Autologous coverage of epidermis | High cost; limited reliability; fragile; increased susceptibility to infections; complex postoperative care; tendency for blistering; poor healing | 268–270 |
| Epidermal: autologous skin suspension or cell spray | ||||
| ReCell (Avita Medical, Woburn, Massachusetts, USA) | Autologous skin suspension produced using minimal donor skin and applied as a cell spray. | Induces acceleration of re-epithelialization and wound healing; for wide meshes, most likely to improve appearance of scar | High cost; no dermal substitute; limited to more superficial burns | 271,272 |
| MySkin (Regenerys, Cambridge, UK) | Suspended CEA delivered as spray | Promotes re-epithelialization | No RCT data | 273,274 |
| SkinGun (RenovaCare, Inc., NY, USA) | Epidermal cells and stem cells | Expansion ratio of skin donor site to treatment surface area of ~1:20 | No RCT data | 275 |
| Keraheal (MCTT, Seoul, Korea) | Suspension formed of cultured epithelial cells plus fibrin glue | Facilitates epithelial cell attachment | No RCT data | 276 |
| Dermal | ||||
| OASIS Wound Matrix (Healthpoint Ltd, Ft Worth, TX, USA) | Derived from the submucosal layers of the porcine intestine; contains glycosaminoglycans and growth factors | Dermal element to improve scar appearance | Porcine composition; high cost | 277,278 |
| Matriderm (MedSkin Solutions Dr. Suwelack AG, Billerbeck, Germany) | Made of type I collagen fibre coated with 3% α-elastin hydrosylate matrix | Can be used as single-stage procedure with split-thickness skin grafts; very good outcomes in initial clinical trials | Possible increased susceptibility to infections | 279 |
| NovoSorb BTM (Biodegradable Temporizing Matrix) (PolyNovo, Melbourne, Australia) | Biodegradable polyurethane foam plus a temporary nonbiodegradable polyurethane seal; fully synthetic | Low cost; improves appearance; good results in initial clinical trials | No RCT data | 280 |
| MatriStem (ACell, Inc., Columbia, MD, USA) | Composed of extracellular matrix derived from porcine urothelium | Provides barrier protection | No RCT data | 281 |
| Integra (Integra LifeSciences, Plainsboro, NJ, USA) | Bovine collagen matrix with a silicone layer | Most-studied dermal replacement matrix; improves scarring and skin appearance; used in acute and reconstructive surgery; efficacy shown in RCT | High cost; possible increased susceptibility to infections | 282,283 |
| Alloderm (Allergan, Dublin, Ireland) | Human cadaveric acellular matrix | Improves scarring | High cost | 284 |
| SUPRATHEL (Polymedics Innovations GmbH, Denkendorf, Germany) | Synthetic copolymer >70% dl-lactide polymerized with ε-caprolactone and methylenecarbonate | Promising results in initial clinical studies | No RCT data | 280 |
| Composite | ||||
| Self-Assembled Skin Substitute (SASS) (Loex, Quebec, Canada) | Reconstruction of a fully autologous bilayered skin substitute | No exogenous scaffold or biomaterial needed; good scar development; autologous | Requires a 31-day production period; very high cost; limited clinical data | 279,285,286 |
| Epifix (MiMedx, Marietta, GA, USA) | Composed of dehydrated amniotic and chorionic membrane containing collagen, connective tissue, cytokines and growth factors | Improves wound healing and regeneration | Not a skin substitute per se; no RCT data | 287 |
| Cultured skin substitute (prepared at Shriners Hospitals for Children, Cincinnati, OH, USA) | Autologous keratinocytes and fibroblasts from patient biopsy, combined into a bilayer with bovine collagen matrix | Good scaring; epithelial and dermal elements | High cost; long production time; does not include melanocytes | 288 |
CEA, cultured epithelial autograft; RCT, Randomized controlled trial.