1、ARTIFICIAL SKINMaierdanjiang Wufuer 买尔旦江买尔旦江 吾甫尔吾甫尔Department of Plastic and Reconstructive Surgery,Institute of Human-Environment Interface Biology,College of Medicine,Seoul Natl University,Seoul,Republic of KoreaBiomedical Research Institute,Seoul Natl Univ.Hospital,Seoul,Republic of KoreaApligraf
2、 CountryObjectiveEpidermisDermis/Matrix graft?FDA&IndicationstoragUSA,Organogenesis,Inc.Epidermal/DermalreplacementKeratinocytes from human neonatal foreskin tissueBovine collagen I gel with allogeneicNOFDA1998,approved for use in the treatment of diabetic foot ulcers and venous leg ulcers.37 incuba
3、tor,viable for 2-3 daysdifferentiationApplicationAdvantagesDisadvantagesPriceMore infoReference10 days 1.Prepare wound2.Apply apligraf3.Dress woundWound dressing with two differentcell types,3 times faster healing in difficult wounds/Most expensive,short shelf-life$1,100./42 cm2a bilaminar structure
4、 formed by type I bovine collagen gel populated by live neonatal fibroblasts coated with a layer of epithelial cellsWilkins LM,Watson SR,Prosky SJ,et al.Development of a bilayered living skin construct for clinical applications.Biotechnol Bioeng.1994;43747-756.2.Parenteau NL,Nolte CM,Bilbo P,et al.E
5、pidermis generated in vitro:practical considerations and applications.J Cell Biochem.1991;45:245-251OrCelCountryObjectiveEpidermisDermis/Matrix STG?FDA&IndicationstoragUSA,Forticell Bioscience Inc.,NYEpidermal/dermal replacementkeratinocytes derived from neonatal foreskin,Bovine collagen sponge with
6、 allogeneic fibroblasts and keratinocytes）no2001,FDA approve,partial-thickness wounds37 incubator differentiationApplicationAdvantagesDisadvantagesPriceMore infoReference37 incubator 1.Prepare wound2.Apply orcel3.Dress woundwhere it provides a favourable matrix for host cell migration.expensive$1,20
7、0/44 cm2OrCel is a bilayer dressing resembling normal skin and was developed as a tissue-engineered biological dressing.https:/www.i- SG?FDA&IndicationstoragUSA,Integra Life Sciences Corp.,NJ,Dermal replacement silicone/Synthetic polysiloxanepolymer/that acts skin epidermis.It protects the wound fro
8、m infection and controls both heat and moisture loss.The dermal layer is made of a 3D porous matrix of cross-linked collagen(pure collagen from cows)and glycosaminoglycan.(glycosaminoglycan made from shark cartilage).yesFDA In 1996,treatment of life threatening bur injuries and 2014 the reconstructi
9、on of scar contractures.Each sheet of Integra template is stored in phosphate buffer within a foil pouch.Each sterile foil pouch is packaged in a sealed outer chevron-style pouch.flat at 2 30C.Protect from freezing.differentiationApplicationAdvantagesDisadvantagesPriceMore infoReferenceNO1.Day 21+:S
10、ilicone Removal2.Day 21+:epidermal autograft Has the some of the advantages of an autograft without a donor site.Once the silicone sheet begins to separate with vascularization of the collagen matrix,it is removed and engineered tissue placed over this bed or STSG usedIn the absence of living cells,
11、it is very difficult to see how one could create a permanent artificial dermal barrier.is a bi-layered extracellular matrix of fibers of cross-linked bovine collagen and chondroitin-6-sulfate(a component of cartilage)with silicone backing.Once an organized regeneration of dermal tissue is formed(neo
12、dermis),the disposable silicone sheet is removed and an ultrathin autograft is placed over the neodermis.1.-I.V.Yannas;Design of an artificial skin II:Control of chemical composition.Dermagraft CountryObjectiveEpidermisDermis/Matrix graft?FDA&IndicationstoragUSA,Organogenesis Inc.,MADermal replaceme
13、nt NOliving allogeneic fibroblasts on a polyglactin mesh.YESFDA-approved for diabetic ulcers,treat deeper wounds.In a box/pouch.Preserved at-70C with 6-month shelf-lifedifferentiationApplicationAdvantagesDisadvantagesPriceMore infoReferenceno1.Prepare wound2.Apply 3.Dress wound.The polyglactin mesh
14、is biodegradable and is reabsorbed after 3 to 4 weeks.include a lack of host immune response,ease of application and resistance to tearing As Dermagraft has no epidermal component,clinicians have used it with a subsequent application of a split thickness skin graft.2*3CM,$1500 per application The fi
15、broblasts come from neonatal foreskin and remain viable after implantation,continuing to secrete matrix proteins and growth graft?FDA&IndicationstoragUSA,GenzymeCorporation,Cambridge MA,Epidermal coverCultured substitute:autologous keratinocytes with murine fibroblastsN0NOsuperficial wounds.37 incub
16、ator differentiationApplicationAdvantagesDisadvantagesPriceMore infoReferenceThe product is made from a biopsy of the patients own skin,which is subsequently cultured for three weeks.Epicel consists of sheets of autologous keratinocytes attached to a petrolatum gauze support,which is removed approxi
17、mately 1 week after graftingThe ability to expand epidermal cells in vitro and produce autologouscultured epithelium was an important breakthrough in burn therapyinclude cost and delay of application due to the three-week graft cultivation.It has no dermal component and is accordingly suited for mor
18、e superficial wounds.The patients own skin cells are grown or cultured from a postage stamp sized sample of the patients own healthy skin.The skin cells are grown on a layer of irradiated mouse cells,making Epicel a xenotransplantation product.TransCyteCountryObjectiveEpidermisDermis/Matrix graft?FD
19、A&IndicationstoragUSADermal replacementOuter epidermal analog is a thin nonporous silicone mesh-like material with barrier functions Inner dermal analog is layered with human fibroblast products mainly collagen type 1,fibronectin and Glycosaminoglycan YESIt is typically used to treat second degree b
20、urn frozendifferentiationApplicationAdvantagesDisadvantagesPriceMore infoReferenceHuman Fibroblast Derived Temporary Skin Substitute Temporary wound covering for surgically excised full thickness and partial thickness burns.This cryopreserved matrix contains high levels of proteins and growth factor
21、s with no viable cells.Need to store frozen till use Relatively expensive requirement of multiple applications Human Fibroblast Derived Temporary Skin Substitute Temporary wound covering for surgically excised full thickness and partial thickness burns.an outer silicone layer(with no pores)AllodermC
22、ountryObjectiveEpidermisDermis/Matrix graft?FDA&IndicationstoragUSA,LifeCell Corporation,Bridgewater,NJDermal replacement NONon-living dermal replacement composed of human cadaveric skin in which the epidermis has been removed by salt processing.yesboth acute and chronic wounds.freeze-drieddifferent
23、iationApplicationAdvantagesDisadvantagesPriceMore infoReferenceNO1.Prepare wound2.Apply 3.Dress wound.of Alloderm include a long shelf life because it is freeze dried,immediate availability and minimal risk for host immunologic response.of this product include the risk of disease transmission.There
24、is no epidermal component so clinicians commonly use the product with a split-thickness skin graft.AlloDerm supports tissue regeneration by allowing rapid revascularization,white cell migration and cell population-ultimately being transformed into host tissue for a strong,natural repair.http:/ graft
25、?FDA&IndicationstoragUSA,Cook Biotech,Inc.Dermal replacementNOintact matrix naturally derived from porcine small intestinal submucosa(SIS),YES partial-and full-thickness wounds,pressure ulcers,venous ulcers,chronic vascular ulcers,Room temperature and on-the-shelf storage/Long 2-year shelf lifediffe
26、rentiationApplicationAdvantagesDisadvantagesPriceMore infoReference1.Prepare2.Apply3.Anchor4.Rehydrate5.Dress6.Cover7.Reassess8.Reapplyevery 7 daysReapply OASIS Wound Matrix every 7 days or as needed,If a gel forms on the wound surface,do not attempt to forcibly remove.Gently rinse the wound surface
27、,leaving the extracellular matrix(ECM)gel intact.Long 2-year shelf life Minimally processed and sterilized using a proprietary method that allows long-term storage of the structure without compromising its ability to support the bodys own tissue repair mechanisms2http:/ graft?FDA&IndicationstoragGer
28、many,MedSkin Solutions Dr.Suwelack AG,BillerbeckDermal replacementNO matrix containingI,II,and V-type collagen extracted from bovine ligamentand dermis,and alpha-elastin hydrolysates.IYESacute burn wounds and scar reconstruction procedures.Room temperaturedifferentiationApplicationAdvantagesDisadvan
29、tagesPriceMore infoReferenceIt can be applied concurrentlywith the split-thickness skin graftIt can be applied concurrentlywith the split-thickness skin graftapplied together witha split skin graf,secondary surgery is not requiredThe matrix serves as a support structure for the ingrowth of cells and
30、 vessels.BiobraneCountryObjectiveEpidermisDermis/Matrix graft?FDA&IndicationstoragUSADermal replacementOuter epidermal analogultrathin silicone film;innerdermal analog3D nylon filament with type I collagenpeptidesYESThe treatment is specific to noninfected partial-thickness burn wounds and donor sit
31、e wounds,RTdifferentiationApplicationAdvantagesDisadvantagesPriceMore infoReferenceBiobrane is appliedand held in place with special glue.Biobrane will take between 10-14 days.Biobrane has been shown to reduce the pain and discomfort felt when the skin is scaled Temporary wound dressing that is remo
32、ved when wound is healed or whenautograft skin is availableBiobrane was first introduced for the treatment of burn wounds and donor sites in 1979 11.Smith DJ.Use of Biobrane in wound management.JBCR May/June 1995:16(3)Supplement;317-320.TheraskinCountryObjectiveEpidermisDermis/Matrix graft?FDA&Indic
33、ationstoragUSAEpidermal/dermal replacementhuman skin allograft,composed of living cells,keratinocytes human skin allograft,fibroblasts and a fully developed extra cellular matrix(ECM)in its epidermis and dermis layers.NOnon-healing chronic woundTheraSkin is cryopreserved(-70 C)differentiationApplica
34、tionAdvantagesDisadvantagesPriceMore infoReferenceLandsman,A.(2010).A retrospective clinical study of consecutive patients to examine the effectiveness1.Prepare wound2.Apply 3.Dress wound.Provides a broad spectrum of the major growth factors for wound healing a biologically active,cryopreserved huma
35、n skin allograft with both epidermis and dermis layers.Its cellular and extracellular composition provides a supply of growth factors,cytokines and collagen to promote wound healing.https:/www.inova.org/upload/docs/Healthcare%20Services/Wound-Healing/retrospective-study2.pdfEpicel(Genzyme Tissue Rep
36、air).Epicel is a cultured autograft composed of living keratinocytes.The product is made from a biopsy of the patients own skin,which is subsequently cultured for three weeks.It has no dermal component and is accordingly suited for more superficial wounds.In addition to serving as a permanent skin r
37、eplacement.It can also cover a large wound area.Disadvantages include cost and delay of application due to the three-week graft cultivation.14Alloderm(Life Cell)Alloderm is an acellular,Non-living dermal replacement composed of human cadaveric skin in which the epidermis has been removed by salt pro
38、cessing.The product is freeze-dried and has been used in both acute and chronic wounds.There is no epidermal component so clinicians commonly use the product with a split-thickness skin graft.Advantages of Alloderm include a long shelf life because it is freeze dried,immediate availability and minim
39、al risk for host immunologic response.Disadvantages of this product include the risk of disease transmission.15MatridermIs an acelular dermal substuitutesis a structurally intact matrix of bovine I,II,and V-type collagen with elastin.It is utilised for dermal regeneration.Its indications are full thickness or deep dermal burn wounds and chronic wounds.The matrix serves as a support structure for the ingrowth of cells and vessels.Its elastin component improves the stability and elasticity of the regenerating tissue.(Skin and Health Care AG,Billerbeck,Germany)
