Types and Uses of Skin Substitutes

Skin substitutes are used to aid in wound closure, control associated pain and replace the skin
function to promote healing of the wound. A skin substitute can be either temporary or
permanent:

Temporary substitutes are used as a short-term wound covering to protect the wound area
from risks posed by the outside environment (such as bacterial contamination or external
trauma), and provide a clean healthy and moist environment to promote wound healing. It is
usually removed after three to four weeks. Temporary skin substitutes can be categorized as
follows:

Natural substitutes, formed from live cells that require proper processing and preparation
before usage, such as:

 Human allograft: The best choice among temporary skin substitutes, it is human skin
taken from human cadavers, consisting of both epidermal and dermal skin layers. It is
used for temporary coverage of large excised wounds.
 Pig skin xenograft: This is pig skin that has been specially treated and contains only
the dermis layer. It is mainly used in the coverage of partial thickness burns and
excised wounds prior to skin grafting.
 Human amnion: This is a thin transparent membrane that covers a fetus inside the
mother's womb. Because this is made from human placenta, it is one of the most
effective substitutes to be used in healing or covering partial thickness burns, as well
as covering some other types of superficial wounds.
 Oasis wound matrix®: This skin substitute is a natural product derived from mucosal
cells found in the small intestinal walls. It is used mainly in hard to heal non-burn
wounds, but can also be used for superficial burn wounds and skin graft sites in
donors.

Synthetic substitutes, formed from synthesized materials that are made on demand with
specific characteristics required in each case, such as:

 Biobrane™: Is a synthetic substitute made up of a thin layer of silicone with small

pore-like holes (that allow exudate material to come out and topical antibiotics to go
in), and an inner nylon triple layer with a thin water layer in between to provide a
moist environment for wound healing. It’s mainly used for closing clean superficial
burns and excised wounds.
 TransCyte™: Is a double-layered skin substitute with an outer silicone layer (with no
pores) and an inner layer lined with human neonatal foreskin fibroblast. This is used
to close or cover clean superficial to moderately deep burn wounds, especially in
children. It is also used for temporary closure of wounds before skin grafting.

Permanent skin substitutes are used to replace the full thickness of skin layers and improve
the quality of skin at the wound or burn sites permanently. These skin substitutes include:

 Epicel: Also known as cultured epithelial autograft (CEA), it only provides the
epithelial (outermost) layer of skin. It is made from the patient’s own skin cells by
taking a small skin biopsy and culturing it for two to three weeks to "grow" the
 necessary graft size. It’s mainly used for very large burn wounds that cover more than
30 percent of the total body surface area.
 Alloderm: This permanent substitute consists of a treated dermis layer of human
cadavers skin, which is mainly used as a dermal implant to replace soft tissue defects.
It also can be used for deep partial and full thickness burn wounds. It cannot be used
on large areas. This substitute still requires a thin epithelial layer to cover it. It has a
long shelf life and requires re-hydration before applying.
 Integra: This synthetic permanent substitute is made of an inner dermal analog layer
(similar to skin dermis) with material that joins the wound's existing cells, promotes
cell growth and helps in the formation of new blood vessels. It provides an outer
epithelial layer that covers and protects the wound until the dermal analog layer is
well incorporated. This process takes about two to three weeks, and then the outer
layer must be replaced with either CEA or a skin graft from the patient.

Advantages of Skin Substitutes

Using skin substitutes has been shown to accelerate wound healing with fewer complications
from infection and dehydration. Additionally, skin substitutes are more cosmetically
attractive and provide more functionality and flexibility to wound sites.

Who Is a Candidate for Skin Substitutes

Skin substitutes are mainly used in burned patients with superficial, partial and deep burn
wounds and other chronic and non-healing wounds, as well in donors skin graft areas.

Precautions When Skin Substitutes are Used

Whenever skin substitutes are used precautions should be taken to avoid movement of the
wound area, especially in the first two to three weeks of healing. When skin substitutes are
still fresh, they are fragile and can be easily broken from any pressure or movement. Proper
wound care, healthy diet and compliance with medication and treatment can help promote the
healing process.

Recovery
Recovery of wounds with skin substitutes depends on the wound site, size, depth, patient’s
medical history and overall condition. Each case is unique, but it usually takes several weeks
for a wound to regenerate and replace lost tissue and regain acceptable function and
flexibility.