Biomedical Engineering Reference
In-Depth Information
limitations of autologous tissue engraftment and a growing understanding of the
complex biologic and biochemical properties of skin tissue. Successful, long-term
allogeneic skin transplantation will evolve as the ability to induce stable
immunogenic tolerance and mosaicism expands. Important advancements in the
improvement of skin engraftment will include the employment of fibrin sealants.
Future research will aim to create skin substitutes, probably using cultured
epidermis which under appropriate circumstances may provide a wound cover that
is as durable and cosmetically acceptable as conventional skin grafts. Current skin
substitutes appear to fall short of reconstituting the normal skin architecture and
long-term durability.
5.7
Summary
The history of wound closure with skin grafts parallels the history of transplant
immunology and the evolution of the profession of plastic surgery. Despite an
increase in the knowledge and understanding of skin engraftment and immunol-
ogy, the durable coverage of extensive and complex burns and wounds remains a
challenge. Given that optimal closure of full-thickness wounds requires the
replacement of both the epidermal and dermal component of skin, no material to
date has been developed that will restore the skin in its entirety. However, nearly
three millennia after the writing of the
Sushruta samhita
, skin grafts remain the
ideal replacement for skin lost from injury. Extensive wounds with limited donor
sites often may be temporarily closed with biological dressings such as allograft
and xenograft.
5.8
References
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widely meshed skin autograft and meshed skin allograft overlay'.
J Trauma
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xenografts to split-graft donor sites'.
J Trauma
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16
(4), 280-3.
Auchincloss H Jr and Sachs DH (1998) 'Xenogeneic transplantation'.
Annu Rev Immunol
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16
, 433-70.
Auffray C and Strominger JL (1986) 'Molecular genetics of the human major histocompat-
ibility complex'.
Adv Hum Genet
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15
, 197-247.
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(5), 487-96.
Bhishagratna K (1963)
The Sushrute Samhite
. Cosmo Publications, India.
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Ann N Y Acad Sci
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59
(3), 409-16.
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