title: A New Form of Artificial Skin to Promote Permanent Wound Coverage: A Preliminary Report.
abstract: BACKGROUND
  Although tendon-exposed or bone-exposed wounds can be resurfaced with flaps, such surgeries may not be feasible in patients with poor general or local conditions. Biosynthetic artificial skin is an alternative for critical wound coverage. We designed a new artificial skin bilayer to close difficult wounds permanently.
  
  
  OBJECTIVE
  This study compares incorporation and wound contraction between silicone acellular porcine dermis (SAPD) and the Integra graft (Integra Life Sciences Corp., Billerica, Mass) in a rat model.
  
  
  METHODS
  The SAPD was manufactured according to our previously described standard procedures. Integra grafts were obtained commercially. We included 24 male adult Sprague-Dawley rats and divided them into 2 groups. After creating a 3 × 4-cm full-thickness wound on the back, we transplanted the same-sized SAPD and Integra grafts onto the rat wounds. Autologous full-thickness skin (FTS) was grafted onto the acellular porcine dermal matrix (APDM) of the SAPD and the Integra dermal matrix (IDM) 2 weeks later. We measured the wound size and contraction rate of recipient wounds, studied the incorporation of FTS on the dermal matrix, and did pathological examination. Generalized estimating equations were used to assess the data from repeated wound and scar contraction measurements using SAS v9.2.
  
  
  RESULTS
  The sizes of wounds of both groups decreased over time. No difference in wound contraction was observed between the SAPD and Integra groups at weeks 2, 4, or 6 after grafting. However, the contraction rates in both groups increased significantly. The pathological examination showed that the FTS was well incorporated in the APDM and IDM. The recipient wounds showed new vessels and cell infiltration in the new matrix, but no severe inflammation. Skin appendages were regenerating in the FTS. There was no rejection sign.
  
  
  CONCLUSIONS
  Both SAPD and Integra are double-layered artificial skin products. Our results demonstrate that APDM and IDM are good templates and show excellent incorporation with autologous FTS graft. The results also demonstrated gradual wound contraction over time, but the contraction rate was not different between SAPD and Integra 6 weeks after grafting in a rat model.
authors.affiliation: From the *Department of Plastic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei; †Division of Plastic Surgery, Department of Surgery, ‡Department of Pathology, Taoyuan Armed Forces General Hospital; §School of Healthcare and Management, Kainan University, Taoyuan; and ∥School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors.forename: Hsian-Jenn
authors.initials: HJ
authors.lastname: Wang
authors.forename: Lin-Gwei
authors.initials: LG
authors.lastname: Wei
authors.forename: Chi-Hsien
authors.initials: CH
authors.lastname: Wang
authors.forename: Ya-Chen
authors.initials: YC
authors.lastname: Cheng
authors.forename: Junn-Liang
authors.initials: JL
authors.lastname: Chang
authors.forename: Tai-Li
authors.initials: TL
authors.lastname: Tsou
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Ku
authors.forename: Chun-Chang
authors.initials: CC
authors.lastname: Li
authors.forename: Wen-Kuan
authors.initials: WK
authors.lastname: Chiu
authors.forename: Chieh-Feng
authors.initials: CF
authors.lastname: Chen
mesh_terms: D062088:Acellular Dermis; D000818:Animals; D002809:Chondroitin Sulfates / Q000494:pharmacology*; D002921:Cicatrix / Q000473:pathology; D003094:Collagen / Q000494:pharmacology*; D003286:Contracture / Q000473:pathology; D004195:Disease Models, Animal; D008297:Male; D051381:Rats; D017207:Rats, Sprague-Dawley; D016038:Skin Transplantation / Q000379:methods*; D013552:Swine; D014182:Transplantation, Autologous; D058106:Wound Closure Techniques; D014945:Wound Healing / Q000502:physiology*
chemical_list: C114835:integra artificial skin; D002809:Chondroitin Sulfates; D003094:Collagen