Bioengineered skin
Authors: Michelle Muhart, Susan McFalls, Robert Kirsner, Francisco Kerdel, William H Eaglstein
Journal: The Lancet (1997)

Advances in tissue bioengineering, such as the development of biologically useful cells, tissue, and organs, are expected to revolutionise the practice of medicine.1McCarthy M Bio-engineered tissues move towards the clinic.Lancet. 1996; 348: 466Summary Full Text Full Text PDF PubMed Scopus (12) Google Scholar Living skin equivalent (LSE), a bioengineered skin, is composed of an epidermis and dermis made of type I bovine collagen and cultured allogeneic cells (keratinocytes and fibroblasts) isolated from human neonatal foreskin. In controlled studies, LSE improved healing in venous ulcers2Meszaros L Manufactured living tissue helps heal venous ulcers.Dermatol Times. 1995; July: 15Google Scholar and in open studies it seemed to improve healing in thermal burns and acute wounds created by excision of skin cancer.3Eaglstein WH Iriondo M Laszlo K A composite skin substitute for surgical wounds: a clinical experience.J Derm Surg. 1995; 21: 1-5Google Scholar We report a prospective, randomised, paired comparison of SEL split-thickness autograft, and polyurethane film (PUF) occlusion dressing for the treatment of split-thickness skin graft donor sites. Three 2·5 cm×4·0 cm donor sites were created on the anterior thigh of 11 patients who required split-thickness skin grafts. Each patient's donor sites were randomly treated with meshed LSE, meshed autograft, or PUF. Evaluations were on day 7, every 2–3 days thereafter until healing of all three donor sites, and at 1 and 2 months. Endpoints were time to healing, pain, and cosmetic outcome (pigmentation, vascularity, and height). The mean time to healing was 7·4 days (SD O.9) for LSE, 7·9 days (1·5) for autograft, and 10·4 days (1·7) for PUF (p=0·0006). In addition to rapid healing, LSE and autograft reduced the pain associated with healing donor sites. No patients experienced pain with LSE or with autograft compared with PUF which was associated with mild pain in six often patients. LSE and autograft afforded a more desirable cosmetic result. At 2 months all sites were hyperpigmented, but the vascularity was different. LSE was pink, autograft was normal, and PUF was purple. The PUF sites were evaluated in eight of 19 patients at 2 months. There was a 90% incidence of clinical take and no signs of toxicity or clinically detectable rejection to LSE in the patients enrolled in this study. Our observations are consistent with those reported using LSE for the treatment of acute wounds after Mohs surgery.4Mechcatie E FDA expedites review of synthetic skins.Skin and Allergy News. Aug 1995; : 4Google Scholar The use of LSE avoids obtaining tissue from the patient and in the case of donor sites avoids reapplying a portion of the graft. At present, LSE and other bioengineered tissues are costly. For this reason most studies are aimed at diabetic,4Mechcatie E FDA expedites review of synthetic skins.Skin and Allergy News. Aug 1995; : 4Google Scholar venous,2Meszaros L Manufactured living tissue helps heal venous ulcers.Dermatol Times. 1995; July: 15Google Scholar and pressure ulcers for which the costs of treatment are high.