Whereas in severe
burns cultured human epithelial cells may well serve as a life saving method, the true value of tissue-engineered skin products in chronic
wound care has yet to be clearly defined. Among other well-known clinical problems, the engraftment rate of commercially available multilayered "sheet grafts" has been shown to vary extremely. Adherence of transplanted cells to the
wound bed--especially in the presence of potential
wound contamination-- is one of the crucial aspects of this technique. Keratinocyte
suspensions in a natural
fibrin sealant matrix can potentially treat a variety of skin defects. In acute
burn wounds, as well as in chronic
wounds the clinical application of this type of tissue-engineered
skin substitute demonstrates the capacity of cultured human autologous keratinocytes in a
fibrin sealant matrix to adhere to
wound beds, attach and spread over the
wound resulting in reepithelialization of both acute and chronic
wounds. In full thickness
burns the combination of this new tool with allogenic dermis is a promising option to achieve complete dermal-epidermal reconstitution by means of tissue engineering and guided tissue repair. When transferring this technique into the treatment of chronic
wounds we found an optimal preparation of such recipient
wound beds to be crucial to the success. The additional application of continuous negative pressure (vacuum
therapy) and preliminary chip
skin grafting to optimally prepare the recipient site may be helpful tools to achieve such well-prepared and graftable surfaces. Prospective controlled comparative studies should be designed to further assess the clinical efficacy of this technique.