Permanent Skin Replacement

To be an effective and acceptable permanent skin replacement or regeneration full-thickness burns, the skin covering material must provide adequate protection against infection and heat loss. It must also enable the regeneration
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of blood supply and dermal skin cells while resisting rejection. The most important result from the permanent skin replacement is that it needs to grow with natural skin in order to prevent scarring and contractures.

Types of Permanent Skin Replacement

Acellular Matrices

Acellular matrices purpose is to regenerate dermal tissue by applying a chemically treated cadaver skin to burns. Even though the human skin has been cleansed of all living material, it still possesses the cellular framework that enables dermal skin to regenerate.

Acellular matrices are often used in conjunction with split-thickness skin grafts. Dermal tissue begins to live in the underlying matrix with living cells as the skin graft successfully closes the wound. Eventually, the wound site will maintain attributes of a growing and flexible skin. Due to the fact that the matrices are resulting from cadaver skin, concerns about contamination and availability remain.

Cultured Epidermal Autograft

An Autograft is a skin graft that uses the patient's own tissues. When the individual is lacking donor skin, surgeons can perform a cultured skin Augograft using cells that have grown in a laboratory. Originally used in 1981, Autograft treat severely burned patients. Cultured Epidermal Autograft (CEA) has been

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publicly available since 1988. A disadvantaged is that there is a need to grow a sufficient quantity of epidermal skin for full burn coverage. Also CEA is difficult to handle in fragile sheets and has a short-term stability and lack a dermal layer.

INTEGRA® Dermal Regeneration Template

INTEGRA Dermal Regeneration Template is an innovative replacement product that actually regenerates dermal skins. INTEGRA Template consists of two layers. First a silicone outer layer that acts as a person's epidermis. The second layers is a porous matrix that replaces the dermis. When applied to an burn, the dermal element acts as "scaffolding" and stimulates skin regeneration. The silicone layer protects the burn from infection and heat loss. Once the dermal cells have grown back through the template, the silicone layer is removed and a thin

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epidermal skin graft is applied to the surface. INTEGRA Template slowly biodegrades, resulting in the individuals having flexible, pliable and growing skin.

In 1996, INTEGRA Template was first approved by the FDA for the treatment of burns. Since then INTEGRA Template has been used successfully on over 10,000 patients. In April 2002, INTEGRA Template was permitted by the FDA to be used as a skin replacement treatment for the reconstruction of scar contractures resulting from burn injuries. INTEGRA Template is the only treatment proven to regenerate functional dermal tissue, which is the inner layer of skin.

Comparison:
INTEGRA® Dermal Regeneration Template vs. Skin Grafts

Traditional Skin Graft
INTEGRA® Dermal Regeneration Template
Skin graft from the patient surgically applied to the burn area.
Two-layer template composed of a porous matrix inner layer and a silicone outer layer applied to the wound.
Grafted dermis does not regenerate, resulting in scars that contract.
Dermis is regenerated and grows as the individual grows.
Larger donor sites are needed to compensate for graft shrinkage.
Regenerated dermis maintains its shape and strength.
Harvested donor sites are painful, itchy and red.
Thin epidermal graft do not create lasting donor site wound.
Scaled, rough, dry appearance in skin at the wound site.
A smoother and evenly healed site.
Stiffness of graft area
Flexible skin

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