SKIN SUBSTITUTES

BY-Nilasish Pani Guide-Dr. Bibhuti Bhusan Nayak

Associate Professor Plastic Surgery

SCBMCH

AUTOGRAFTTissue taken from an individual

and grafted on himselfTaken from thigh region preferablyTill now the best method of

wound coverage

CLASSIFICATION

Skin Substitutes

Temporary-skin substitutes

BIOLOGIC

AL>

Human

allograft > Xenograft >

Amniotic

membrane

> Collagen

SYNTHETIC

> Duoderm

> Opsit

e>

Omniderm

BIO-SYNTHETIC

> Biobrane

> Integr

a

Permanent-skin substitutes

> CEA> ADM

> COMPOSITE GRAFT

ALLOGRAFTA surgical transplant of tissue from

genetically different individual of the species

Fresh or cadaver allograftHuman cadaver allograft-pre-requisite 1)Fresh 2)Refrigerated 3)Frozen

ALLOGRAFT EXPRESSIONA

llograft skin

Langerhans cell express class-2 Ag

Graft rejection within 2 to 3 wk

Decrease in graft rejection by- 1) uv irradiation 2)incubation in glucocorticoid 3)immunosuppresion

AUTOGRAFT

AUTOGRAFT + ALLOGRAFT

XENOGRAFTPORCINE SKIN XENOGRAFT 3 sterile forms- 1)fresh 2)refrigerated 3)liophylized (frozen)Only used for dressingBiological option but no vascularization & so rejection

XENOGRAFTFROG SKIN XENOGRAFTTemporary biological cover

preparation for autograftAdvantages- 1) thin 2)non-antigenic 3)easy to use

AMNIOTIC MEMBRANEBOVINE AMNIOTIC MEMBRANE

>thin & transparent with poresHUMAN AMNIOTIC MEMBRANE >How it is obtained? # from placenta

• # from sero -ve mothers with• no h/o PROM• # cleaned in NS

AMNIOTIC MEMBRANE

Advantages:Very thin/easily adherent/easy to spread/

conforms to contour↓ painMoist environmentHelps epithelialisationExudation of discharge can occur(pores)

Disadvantages:cumbersome to separate/prepare/storeinfection transmission

7th Day Day of Application

Auto-meshgrafts covered with amnion during the operation

Appearance at end of treatment

Same case

COLLAGEN

COLLAGEN (APCOLL )

derived from bovine/porcine/fish/human amnion sources

support cellular growth. Non - inflammatory, Non – immunogenic. Low antigenicity. Sterilized through GAMMA RADIATION Preserved in solution of Isopropyl alcohol

and water

Features & Properties

COMMERCIAL COLLAGEN

PRE OP

7TH DAY POST OP

AFTER CLEANING WITH NS

AFTER COLLAGEN APPLICN

BIOSYNTHETIC SKIN

SUBSTITUTES1.Biobrane :-• bilaminate

membrane → Nylon mesh + silicone rubber• Nylon mesh

coated with porcine peptides from type I collagen• silicone rubber

BIOBRANE

DERMAL REGENERATION TEMPLATE(INTEGRA)

inner biodegradable memb. [bovine collagen+ chondroitin SO4](dermal component)

Gets vascularised, Fibroblasts migrate

Outer silicone [temporary](epiderm. component)

Protects wound from desiccation/infectionRemoved after 3 wks

INTEGRA• After 2/3 wk outer silicone layer excised inner neodermis is biodegradable• Disadvantage:-1) very expensive 2)2 surgical procedures

SYNTHETIC SUBSTITUTES

• Duoderm (polyurethane and hydrocolloids)

• Opsite (polyurethane film)

• Omniderm (acrylamide film and

hydroxyethylmethyerylate with polyurethane).

SYNTHETIC SUBSTITUTES

• Indications: In intermediate-superficial burns

• acrylamide film has enabled to achieve healing in less time

• The additional advantage :reduction in the number of dressings.

SYNTHETIC SUBSTITUTES

PERMANENT SKIN SUBSTITUTES• CULTURED EPIDERMAL AUTOGRAFT(CEA)

• Cultured: in vitro culture of human keratinocyte

• Epidermal: No dermal component • Advantages:

Avoids donor site morbidity

CULTURED EPIDERMAL AUTOGRAFT(CEA)

Disadvantages:– culture process require 21 days– Fragile: difficult to handle– Unpredictable take rate– High cost– Poor quality of healing & frequent breakdown

(Epidermal component only)

ACELLULAR DERMAL MATRIX (ADM)• derived from cadaver homograft - after

removal of epithelial/dermal cellular component

• 3 PROPERTIES• very low antigenicity• capacity for rapid vascularization• stability as dermal template

EPIDERMAL-DERMAL COMPOSITE CULTURED GRAFTS (APLIGRAFT)

• BILAYERED LIVING SKIN EQUIVALENT• Composition: Type I Bovine collagen+ Allogenic

Keratinocyte + Neonatal fibroblast epidermal layer of autologus epidermal

cells dermal layer of allogenic fibroblasts &

collagen• Not available for general clinical use

END OF MY PRESENTATION, BEGINNING OF NEW POSSIBILITIES