User:Mnm894/Dermal equivalent

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Purpose
Autotransplantation has been common practice for treating individuals who have a need for skin transplants. However, there is the issue of needing repeated grafts or transplants for patients with serious injuries such as burn victims, leading to numerous problems including lack of supply of the skin, preservation, and the possibility if disease transmission. Thus, this prompted for the development of various techniques to create artificial skin, including dermal equivalents.

History
The development of artificial skin and dermis began in the 20th century as the first discovery of the ability to isolate and culture cells in vitro was in 1907 by American embryologist Ross Granville Harrison when he was able to isolate and grow embryonic tissues from frogs in his laboratory. In 1975, keratinocytes, which are cells that account for the majority epidermal skin cells, were first isolated and successfully cultured in vitro by James G. Rheinwald and Howard Green. Afterwards, in 1981, bilayer artificial skin or dermal graft was developed by John F. Burke and others, which was successful in covering “physiologically close to 60% of the body surface.”

Burke’s dermal graft was one of the earliest developments of the dermal equivalent, or “neodermis”. Years later, Integra artificial skin, which is now called Integra Dermal Regeneration Template (IDRT) by Integra LifeSciences, was developed from Burke et al.'s innovation. It became the first commercial product approved by the FDA for dermal replacements and listed as one of the "Significant Medical Device Breakthroughs" in 1996. The primary use of Integra was to treat burn victims.

Commercial products and applications
There are a variety of dermal equivalents from how they are developed and what they are used for.

Integra Dermal Regeneration Template
The initial research of dermal equivalent leading to the Integra product resulted in a bilayer structure consisting of a dermal portion and epidermal portion. The dermal portion is composed of bovine hide collagen and chondroitin 6-sulfate that is crosslinked with glutaraldehyde. The epidermal portion is composed of Silastic covering the dermis. For application, the bilayer structure is placed on the wound after removal of the burn eschar and left for several days. Then, the epidermal layer is removed and replaced with artificial epidermis. The dermal equivalent, or neodermis layer, is not removed as it is suitable for growth of cells and vessels.

Formerly known as Integra artificial skin, it was the first FDA approved product for dermal replacements. The Integra Dermal Regeneration Template’s bilayer structure is composed of bovine tendon collagen and chondroitin-6-sulfate for the dermal layer, and polysiloxane for the epidermal layer.

AlloDerm
AlloDerm is the first type of acellular dermal matrix (ADM) derived from the skin of cadavers. It is widely used in dental surgeries for gingival grafting, abdominal hernia repair, and breast surgeries.

Dermagraft
Dermagraft is a human fibroblast–derived dermal replacement. It is derived from neonatal dermal fibroblasts implanted into a bioabsorbable polyglactin mesh scaffold along with extracellular matrix proteins that are secreted by the fibroblasts. Dermagraft is mainly used for the treatment of chronic wounds such as various ulcers including diabetic foot ulcers and venous foot ulcers.

External links[edit]

 * Integra
 * AlloDerm
 * Dermagraft