Dermal Regeneration Template

Burns cause skin loss and post burn reconstuction needs quick replacement of the damaged skin so that the recovery can be hastened. The complete regeneration of adult skin has not been achieved experimentally so far but partial regeneration can be done using a biologically active scaffold called dermal regeneration template (DRT), these sponge-like scaffolds are usually made from animal collagen and with a thin silicon sheet on top and thus are biodegradable during the regenerative process.

The use of DRTs in the treatment of skin loss requires a two-step procedure. That is, after a wound is surgically debrided and prepared, a DRT is grafted into the area of skin loss (first step). When Template is placed on a wound where burned or scarred skin has been removed, it provides the needed framework for the blood vessels and dermal skin cells to re-grow into a new dermal skin layer. 2-3 weeks the outer silicon layer comes off and a split-thickness (autologous) skin graft is gently placed over the new tissue to provide wound coverage (second step.) For example Integra® Dermal Regeneration Template is an acellular, purely biosynthetic dermal substitute. The Integra is a two-layer skin regeneration system. The outer layer is made of a thin silicone film that acts as the skin's epidermis. It protects the wound from infection and controls both heat and moisture loss. The inner layer is constructed of a complex matrix of cross-linked fibers derived from bovine collagen. This porous material acts as a scaffold for regenerating dermal skin cells, which enables the re-growth of a functional dermal layer of skin. Once dermal skin has regenerated, the silicone outer layer is removed and replaced with a thin epidermal skin graft. Integra was the first skin substitute to be FDA-approved, and is approved for use in full- and partial-thickness burn wounds.

This type of dermal regeneration template offers multiple advantages: it allows immediate closure of the wound, thus avoiding fluid loss and restoring the functional barrier of the skin. Integra is indicated for the treatment of partial and full-thickness wounds, pressure ulcers, venous ulcers, diabetic ulcers, chronic vascular ulcers, surgical wounds, traumatic wounds. It is not indicated in patients who have allergies to bovine collagen or patients with third-degree burns. It can also be used for treatment of contractures and complex wounds. The real benefit of wounds treated with this dermal template and subsequent skin graft compared to skin graft alone include increased thickness and durability, improved mobility and cosmesis, reduced recurrence of contractures and keloids, and the ability to cover exposed tendons, muscles, and joints and thus avoiding the need for skin flaps. The application of Integra using VAC subatmospheric pressure has been suggested to be easier, faster healing of complex wounds. The use of negative pressure has allowed grafting as soon as a week after template placement with no interval dressing changes minimizing the morbidity of standard dressings.