Biomedical Engineering Reference
In-Depth Information
Fig. 5.4
Scar resurfacing in abdominal area with Integra™ (scaffold was identical to DRT). The
patient was burned in the abdominal area which became scarred and lost its compliance, pos-
ing a risk to successful termination of a future pregnancy. The patient was treated surgically and
acquired new compliant skin that replaced the scarred area. It led to a successful pregnancy.
Left
: 6
months after pregnancy.
Right
: 8 months after pregnancy. (Photo courtesy E. Dantzer, MD)
resulting from explosive devices (Foong et al. 2013) and traumatic injuries that
involve the junction between muscle and bone (degloving) (Graham et al. 2013).
By 2012 over 200,000 patients had been treated with this device (Tarca 2012). Over
5.3.3
Synthetic Potential and Limitations of the Cell-Free Dermis
Regeneration Template
The vast majority of observations described above have shown that DRT suppressed
contraction and scar synthesis. It induced synthesis of a dermis, a thick, richly vas-
cularized layer of loosely arranged collagen fibers with axes that were oriented
relatively randomly. There is incidental evidence that the newly synthesized dermis
matures over several months; however, appropriate extensive studies are lacking
to establish a timeline for remodeling of the neodermis. There is also relative lack
of long-term clinical studies of the functional properties of the skin resulting from
treatment with Integra™ together with the autoepidermal graft that is used to cover
the neodermis.
The most serious limitation of cell-free DRT is inability to simultaneously in-
duce synthesis of an epidermis. To account for this limitation, following synthesis
of the dermis, a thin autoepidermal graft is usually harvested from a donor site and
was applied on the neodermis (Burke et al. 1981; Heimbach et al. 1988). When the
defects were very small, of order a few millimeters, epithelial migration from the
dermal edges led to spontaneous closure within several days without need for an
epidermal graft.
The dermis synthesized using DRT has not been a perfectly physiological tis-
sue as skin adenexa (hair follicles, sweat glands etc.) were missing. Such deficien-
