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Wound Healing: Biosynthetic Substitutes and The Future of Skin grafting

Have you ever accidentally grabbed a hot pan or scalded yourself with a hot iron and thought “oh no, this is going to form a scar!” Luckily for you, a superficial burn heals itself over time with the production of collagen, but what about people who suffer from severe second- or third-degree burns? The answer is called a skin graft.


Skin grafting is a medical technique used since ancient times to cure skin injuries such as burns, ulcers, cancers or traumas of the skin [6]. Ancient records of skin grafting date back to when man first discovered fire and reappeared as drawings or writings in several later cultures like ancient Egypt, ancient Greece, and Hindu cultures. However, the first record of a successful modern skin grafting procedure is attributed to the surgeon Jaques-Louis Reverdin in 1869. For a fascinating narrative on the history of skin grafting, please read dr. Ozhathil’s work here.

Reverdin’s procedure entails the debridement of damaged skin tissue, followed by the application of the prepared skin graft that is typically obtained from a secondary site on the patient’s skin (e.g., thigh skin) or from other donors’ skin [5].

Photo by publicdomainpictures.net


There are three main types of skin grafts, depending on the thickness of the graft used:

  • The split-thickness graft: this graft typically includes the epidermis and the superficial part of the dermis layer depending on the severity and needs of the patient. It is obtained by peeling the skin from the donor site using a dermatome [9].

  • The full-thickness graft: this graft includes both the full epidermis and dermis layers.

  • The composite graft: this graft goes even deeper to include both the epidermis and dermis layers along with the underlying tissue of fat or cartilage, e.g., grafts obtained from ear tissue.

Although traditional dermal grafts are still considered the go-to medical procedure for severe skin injuries, they can put the donor through severe pain, they can be difficult to heal, and not to mention costly. Fortunately, major advances in this field have shown great promise in substituting skin tissue in novel ways [2].


Photo by Ali Cardin on pinterest.com


Modern skin grafting techniques:

1- Spray-on skin: developed by Australian surgeon Fiona Wood, small skin biopsies are obtained to make solutions of skin stem cells and progenitors. The solution is then chemically treated and sprayed over the injured area. It has been shown to treat

second-degree burn sites as large as 50 square inches! [4]. To watch dr. Wood talk about her work, please click here.

2- 3-D printed skin: one of the major reasons why skin grafts may fail, is the difficulty of tissue revascularization. Using a combination of stem cell bio-inks, researchers at the Rensselaer Polytechnic Institute have successfully leveraged 3-D printing technologies to print skin grafts embedded with blood vessels. These grafts have shown great promise in preclinical studies and are expected to be present in clinics soon [1].

For more information on novel ways to restore skin tissue, please enjoy Carolina Serrano Larrea’s work here.







References:

1. 3D-printed living skin: The future of skin grafts? - medical technology: Issue 25: March 2020. 3D-printed living skin: the future of skin grafts? - Medical Technology | Issue 25 | March 2020. (2020, March 6). Retrieved from https://medical-technology.nridigital.com/medical_technology_mar20/3d-printed_living_s

kin_the_future_of_skin_grafts

2. Benjamin C Wood, M. D. (2021, June 18). Skin grafts and biologic skin substitutes. Overview, Relevant Anatomy, Graft Survival and Healing. Retrieved from https://emedicine.medscape.com/article/1295109-overview

3. Girdwain, J. (n.d.). The Future of Skin. todaysgeriatricmedicine. Retrieved from https://www.todaysgeriatricmedicine.com/archive/070912p18.shtml

4. Gravitz, L. (2020, April 2). Spraying on skin cells to heal Burns. MIT Technology Review. Retrieved from https://www.technologyreview.com/2009/11/05/264930/spraying-on-skin-cells-to-heal-bu rns/

5. LA;, F.-P. (n.d.). Jaques-Louis Reverdin (1842-1929): The surgeon and the Needle. Archivos espanoles de urologia. Retrieved from https://pubmed.ncbi.nlm.nih.gov/20508302/

6. Ozhathil, D. K., Tay, M. W., Wolf, S. E., & Branski, L. K. (2021, April 15). A narrative review of the history of skin grafting in burn care. Medicina (Kaunas, Lithuania). Retrieved from https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC8071142/

7. Shimizu, R., & Kishi, K. (2012). Skin graft. Plastic surgery international. Retrieved from https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC3335647/

8. StatPearls. (2021, September 14). Skin grafting. StatPearls. Retrieved from https://www.statpearls.com/ArticleLibrary/viewarticle/29098

9. Tania J. Phillips, M. B. (1988, July 1). Cultured skin grafts. Archives of Dermatology. Retrieved from https://jamanetwork.com/journals/jamadermatology/article-abstract/549618


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