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    Skin substitutes for wound management

    Because plastic surgeons are increasingly turning to skin substitutes to treat cutaneous defects, a team of Boston-based surgeons recently performed a literature review to examine their development and determine current use in the United States.

    The authors — from Brigham and Women’s Hospital and the medical schools of Harvard and Boston University — focused their work on identifying the types of skin substitutes most used in the US and describe a research pathway to improving outcomes and reducing complication rates.

    Reported skin substitute findings include semi-synthetic dermal scaffolds, allogenic cell constructs, and cellular and decellularized allogenic or xenogenic sources. Researchers also found that large clinical trials have been conducted to demonstrate the efficacy of semi-synthetic dermal scaffolds and allogenic cell constructs, and that there is wide interest in human-derived placental products — which, they add, will be the subject of a future review.

    As for improving outcomes and reducing skin substitute-related complication rates, the authors call for 2-part approach, first with the study, optimization and standardization of protocols. Second, for ongoing improvement to quality and availability of skin substitutes that better address major complications, including infection, and may include microbial barriers, antimicrobials or enhanced revasularization ability.

    “The ability to manufacture complex dermal matrix structures with living, bioactive cells represents the most advanced yet still nascent area within the greater field of skin substitutes. It remains to be seen how future developments in scaffold architecture, specific cell populations and the interplay between these components will further improve the effectiveness of skin-substitute products.”

    Full text of the review appears in the December issue of Plastic and Reconstructive Surgery

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