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Key Words skin structure, skin grafting, burn surgery, dermal replacement, tissue regeneration
* Abstract The skin is a complex organ that is difficult to replace when it is irreversibly damaged by burns, trauma, or disease. Although autologous skin transplantation remains the most common form of treatment in patients with significant skin loss, there are now a number of commercially available products that can be used to replace the skin temporarily or permanently. Here we describe several such products under the rubric "artificial skin," focusing on two types of technology that have been applied to the problem of permanent skin replacement.
INTRODUCTION
Twelve years ago, JF Burke coauthored a chapter using "artificial skin" in the title (1). At that time the term had limited application, being used to designate a bilayered dermal/epidermal replacement devised by Burke and Yannas (2). Today, the term artificial skin can be applied to several products that are either commercially available or in commercial development.
In approaching this topic a second time, we focus on bilayered products that have been engineered for permanent replacement of lost human dermis and that provide either a temporary or potentially permanent epidermis. Less attention is devoted to temporary skin substitutes, although some of the products now available have expanded the clinician's repertoire in temporary wound closure.
SIGNIFICANCE OF ARTIFICIAL SKIN
Although there are other uses for skin substitutes, bum injuries are probably the source of greatest potential utilization. The annual incidence of burn injuries in the United States is approximately 1.5 million. Each year 75,000 burned patients require inpatient care, and 5000-12,000 die of their injuries (3). For most patients who are burned over <40% of their total body surface area (TBSA), reconstitution of the skin can be done with split-thickness skin grafts (autografts), containing both dennis and epidermis, harvested from unburned sites. Potentially, burns as large as 60% TBSA can be covered in this manner by reharvesting donor sites after they have healed (epithelialized). Harvest of a split-thickness skin graft from a donor site, however, is not benign. In addition to the risk of infection, the donor site is subject to scarring and changes in pigmentation that vary directly with the thickness of dermis taken in the graft. A single split-thickness graft, even...