Burn reconstruction: Skin substitutes and tissue engineering
Skin, also known as the integument, is not only the largest laminar organ, but also the appropriate interface between the human organism and its environment. Beside other functions the skin represents the primary barrier of the immune system. Thus, an ext
- PDF / 1,522,179 Bytes
- 19 Pages / 595 x 785 pts Page_size
- 58 Downloads / 217 Views
Introduction Skin, also known as the integument, is not only the largest laminar organ, but also the appropriate interface between the human organism and its environment. Beside other functions the skin represents the primary barrier of the immune system. Thus, an extensive skin loss due to thermal trauma represents in the majority of cases a life-threatening situation and demands particular requirements from the Plastic and Burn surgery to provide a sufficient skin substitution. Development and improvement of innovative strategies concerning skin expansion and Tissue Engineering have contributed to the fact that burns affecting more than 80 % of the body surface (TBS) are survivable today [110]. Although the application of cultured epidermis and compound cultured skin analogues is approved as a life-saving method today, the indications for this novel approach have become more differentiated. Beside historical aspects the present chapter gives insights into both the conventional techniques and the application forms of current cultured skin substitutes.
History of skin transplantation Skin replacement by means of transplantation is one of the earliest approaches in the history of reconstructive surgery. Following Baronios early sheep skin ex-
periments (1804) it was Bünger who reported for the first time about the transplantation of a full-thickness human skin graft [1]. In 1869 Reverdin has set the gold standard for skin replacement with his landmark publication about the transplantation of the patients own skin [2]. Nevertheless, Reverdin noticed a frequent loss of the small transplanted islands related to a strong wound secretion. During the following decades the full thickness skin graft practice according to Krause has become the most established technique. Meanwhile, insufficient integration into the healing wound and too little skin resources of the patients own body have driven investigators to find other approaches. In 1895 it was the German surgeon Mangoldt who described the clinical application scraped endothelial cells, which are considered to be the precursors of the recent kerationcyte-suspensions [6]. The so called “epithelial cell seeding” were epithelial cells or cell clusters harvested by scraping off superficial epithelium from a patients forearm with a surgical blade, that were grafted together with the exudated serum to various wounds. Based on this technique an additional approach was established later on whereby mechanical hackled skin particles were plunged into the granulation tissue [3]. Up to the present day this modified technique is still useful for the therapy of chronic or problematic wounds and for the treatment of perianal burns [109]. Large-scale skin transplantation was first mentioned by Ollier [4] and subsequently improved by
149 L. -P. Kamolz el al. (eds.), Handbook of Burns © Springer-Verlag/Wien 2012
R. E. Horch, V. J. Schmidt
Thiersch. In this context he also designed the so called Thiersch knife, that allows to gain split-thickness skin grafts in a reliable manner via a
Data Loading...
