Download PDF
Semin Plast Surg 2022; 36(01): 003-007
DOI: 10.1055/s-0042-1742736
Review Article

Overview of Biologic Agents Used in Skin and Soft Tissue Reconstruction

Matthew J. Parham
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
2   Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
,
Andrew E. Grush
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
2   Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
,
Abel Smerica
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
2   Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
,
Y. Edward Wen
3   Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
,
Monal Depani
3   Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
,
Andrew M. Ferry
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
2   Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
,
Lloyd M. Jones
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
2   Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
,
James F. Thornton
3   Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Wound healing is a highly complex process mediated by cellular interactions at the microscopic level. Increased understanding of wound healing physiology has served as the foundation for translational research to develop biologic wound care technologies that have profoundly affected patient care. As the reader will see throughout this series in Seminars in Plastic Surgery, biologic wound technologies have broad applications and have greatly impacted the reconstructive ladder. Despite their frequent use, many surgeons lack familiarity with the myriad of products available on the market along with each product's relative advantages and shortcomings. This overview will discuss the classification of biologic wound agents used to reconstruct defects of the skin and soft tissue along with the advantages and disadvantages associated with their use.

Keywords

biologics - biocompatible materials - acellular dermis - wounds and injuries - plastic surgery


Publication History

Article published online:
15 February 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Boer M, Duchnik E, Maleszka R, Marchlewicz M. Structural and biophysical characteristics of human skin in maintaining proper epidermal barrier function. Postepy Dermatol Alergol 2016; 33 (01) 1-5
    PubMedSearch in Google Scholar
  • 2 Romanovsky AA. Skin temperature: its role in thermoregulation. Acta Physiol (Oxf) 2014; 210 (03) 498-507
    CrossrefPubMedSearch in Google Scholar
  • 3 Janis JE, Kwon RK, Attinger CE. The new reconstructive ladder: modifications to the traditional model. Plast Reconstr Surg 2011; 127 (Suppl. 01) 205S-212S
    CrossrefPubMedSearch in Google Scholar
  • 4 Ozhathil DK, Tay MW, Wolf SE, Branski LK. A narrative review of the history of skin grafting in burn care. Medicina (Kaunas) 2021; 57 (04) 380
    CrossrefPubMedSearch in Google Scholar
  • 5 Zhang Z, Lv L, Mamat M, Chen Z, Liu L, Wang Z. Xenogenic (porcine) acellular dermal matrix is useful for the wound healing of severely damaged extremities. Exp Ther Med 2014; 7 (03) 621-624
    CrossrefPubMedSearch in Google Scholar
  • 6 Ferry AM, Beh HZ, Truong LA. et al. Management of bilateral temporomandibular joint ankylosis and class 2 malocclusion in a patient with Nager syndrome. FACE 2021; 2 (04) 484-489
    CrossrefPubMedSearch in Google Scholar
  • 7 Fosnot J, Kovach III SJ, Serletti JM. Acellular dermal matrix: general principles for the plastic surgeon. Aesthet Surg J 2011; 31 (07) 5S-12S
    CrossrefPubMedSearch in Google Scholar
  • 8 Kim JJ, Evans GRD. Applications of biomaterials in plastic surgery. Clin Plast Surg 2012; 39 (04) 359-376
    CrossrefPubMedSearch in Google Scholar
  • 9 Banyard DA, Bourgeois JM, Widgerow AD, Evans GRD. Regenerative biomaterials: a review. Plast Reconstr Surg 2015; 135 (06) 1740-1748
    CrossrefPubMedSearch in Google Scholar
  • 10 Hughes OB, Rakosi A, Macquhae F, Herskovitz I, Fox JD, Kirsner RS. A review of cellular and acellular matrix products: indications, techniques, and outcomes. Plast Reconstr Surg 2016; 138 (03) 138S-147S
    CrossrefPubMedSearch in Google Scholar
  • 11 Recent Advances in Acellular Regenerative Tissue Scaffolds - ClinicalKey. Accessed January 4, 2022: https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0891842214000810?returnurl=null&referrer=null.
    PubMed
  • 12 Novitsky YWMD, Rosen MJMD. The biology of biologics: basic science and clinical concepts. Plast Reconstr Surg 2012; 130 (05, Suppl 2): 9S-17S
    CrossrefPubMedSearch in Google Scholar
  • 13 Facial Reconstruction After Mohs Surgery. Accessed January 10, 2022: https://www.thieme.com/books-main/dermatology/product/4647-facial-reconstruction-after-mohs-surgery.
    PubMed
  • 14 Gohari S, Gambla C, Healey M. et al. Evaluation of tissue-engineered skin (human skin substitute) and secondary intention healing in the treatment of full thickness wounds after Mohs micrographic or excisional surgery. Dermatol Surg 2002; 28 (12) 1107-1114 , discussion 1114
    PubMedSearch in Google Scholar
  • 15 Gurtner GC, Garcia AD, Bakewell K, Alarcon JB. A retrospective matched-cohort study of 3994 lower extremity wounds of multiple etiologies across 644 institutions comparing a bioactive human skin allograft, TheraSkin, plus standard of care, to standard of care alone. Int Wound J 2020; 17 (01) 55-64
    CrossrefPubMedSearch in Google Scholar
  • 16 Harding K, Sumner M, Cardinal M. A prospective, multicentre, randomised controlled study of human fibroblast-derived dermal substitute (Dermagraft) in patients with venous leg ulcers. Int Wound J 2013; 10 (02) 132-137
    CrossrefPubMedSearch in Google Scholar
  • 17 Tchanque-Fossuo CN, Dahle SE, Lev-Tov H. et al. Cellular versus acellular matrix devices in the treatment of diabetic foot ulcers: interim results of a comparative efficacy randomized controlled trial. J Tissue Eng Regen Med 2019; 13 (08) 1430-1437
    CrossrefPubMedSearch in Google Scholar
  • 18 Lev-Tov H, Li CS, Dahle S, Isseroff RR. Cellular versus acellular matrix devices in treatment of diabetic foot ulcers: study protocol for a comparative efficacy randomized controlled trial. Trials 2013; 14: 8
    CrossrefPubMedSearch in Google Scholar
  • 19 Vyas KS, Vasconez HC. Wound healing: biologics, skin substitutes, biomembranes and scaffolds. Healthcare (Basel) 2014; 2 (03) 356-400
    CrossrefPubMedSearch in Google Scholar
  • 20 Veves A, Falanga V, Armstrong DG, Sabolinski ML. Apligraf Diabetic Foot Ulcer Study. Graftskin, a human skin equivalent, is effective in the management of noninfected neuropathic diabetic foot ulcers: a prospective randomized multicenter clinical trial. Diabetes Care 2001; 24 (02) 290-295
    CrossrefPubMedSearch in Google Scholar
  • 21 Falanga V, Sabolinski M. A bilayered living skin construct (APLIGRAF) accelerates complete closure of hard-to-heal venous ulcers. Wound Repair Regen 1999; 7 (04) 201-207
    CrossrefPubMedSearch in Google Scholar
  • 22 Falanga V, Margolis D, Alvarez O. et al; Human Skin Equivalent Investigators Group. Rapid healing of venous ulcers and lack of clinical rejection with an allogeneic cultured human skin equivalent. Arch Dermatol 1998; 134 (03) 293-300
    CrossrefPubMedSearch in Google Scholar
  • 23 Marston WA, Hanft J, Norwood P, Pollak R. Dermagraft Diabetic Foot Ulcer Study Group. The efficacy and safety of Dermagraft in improving the healing of chronic diabetic foot ulcers: results of a prospective randomized trial. Diabetes Care 2003; 26 (06) 1701-1705
    CrossrefPubMedSearch in Google Scholar
  • 24 Frykberg RG, Marston WA, Cardinal M. The incidence of lower-extremity amputation and bone resection in diabetic foot ulcer patients treated with a human fibroblast-derived dermal substitute. Adv Skin Wound Care 2015; 28 (01) 17-20
    CrossrefPubMedSearch in Google Scholar
  • 25 Zelen CM, Serena TE, Gould L. et al. Treatment of chronic diabetic lower extremity ulcers with advanced therapies: a prospective, randomised, controlled, multi-centre comparative study examining clinical efficacy and cost. Int Wound J 2016; 13 (02) 272-282
    CrossrefPubMedSearch in Google Scholar
  • 26 Serena TE, Carter MJ, Le LT, Sabo MJ, DiMarco DT. EpiFix VLU Study Group. A multicenter, randomized, controlled clinical trial evaluating the use of dehydrated human amnion/chorion membrane allografts and multilayer compression therapy vs. multilayer compression therapy alone in the treatment of venous leg ulcers. Wound Repair Regen 2014; 22 (06) 688-693
    CrossrefPubMedSearch in Google Scholar
  • 27 Lavery LA, Fulmer J, Shebetka KA. et al; Grafix Diabetic Foot Ulcer Study Group. The efficacy and safety of Grafix(®) for the treatment of chronic diabetic foot ulcers: results of a multi-centre, controlled, randomised, blinded, clinical trial. Int Wound J 2014; 11 (05) 554-560
    CrossrefPubMedSearch in Google Scholar
  • 28 Jeschke MG, Rose C, Angele P, Füchtmeier B, Nerlich MN, Bolder U. Development of new reconstructive techniques: use of Integra in combination with fibrin glue and negative-pressure therapy for reconstruction of acute and chronic wounds. Plast Reconstr Surg 2004; 113 (02) 525-530
    CrossrefPubMedSearch in Google Scholar
  • 29 Driver VR, Lavery LA, Reyzelman AM. et al. A clinical trial of Integra Template for diabetic foot ulcer treatment. Wound Repair Regen 2015; 23 (06) 891-900
    CrossrefPubMedSearch in Google Scholar
  • 30 Cazzell SM, Lange DL, Dickerson Jr JE, Slade HB. The management of diabetic foot ulcers with porcine small intestine submucosa tri-layer matrix: a randomized controlled trial. Adv Wound Care (New Rochelle) 2015; 4 (12) 711-718
    CrossrefPubMedSearch in Google Scholar
  • 31 Mostow EN, Haraway GD, Dalsing M, Hodde JP, King D. OASIS Venus Ulcer Study Group. Effectiveness of an extracellular matrix graft (OASIS Wound Matrix) in the treatment of chronic leg ulcers: a randomized clinical trial. J Vasc Surg 2005; 41 (05) 837-843
    CrossrefPubMedSearch in Google Scholar
  • 32 Kelechi TJ, Mueller M, Hankin CS, Bronstone A, Samies J, Bonham PA. A randomized, investigator-blinded, controlled pilot study to evaluate the safety and efficacy of a poly-N-acetyl glucosamine-derived membrane material in patients with venous leg ulcers. J Am Acad Dermatol 2012; 66 (06) e209-e215
    CrossrefPubMedSearch in Google Scholar
  • 33 Groeber F, Holeiter M, Hampel M, Hinderer S, Schenke-Layland K. Skin tissue engineering–in vivo and in vitro applications. Adv Drug Deliv Rev 2011; 63 (4-5): 352-366
    CrossrefPubMedSearch in Google Scholar
  • 34 Halim AS, Khoo TL, Mohd Yussof SJ. Biologic and synthetic skin substitutes: an overview. Indian J Plast Surg 2010; 43 (Suppl): S23-S28
    Thieme ConnectPubMedSearch in Google Scholar
  • 35 Schwartz JD. Use of a bioabsorbable implant-acellular dermal matrix construct to facilitate oncoplastic breast-conserving surgery. Plast Reconstr Surg Glob Open 2021; 9 (01) e3356
    CrossrefPubMedSearch in Google Scholar
  • 36 Ferry AM, Sarrami SM, Hollier PC, Gerich CF, Thornton JF. Treatment of non-melanoma skin cancers in the absence of Mohs micrographic surgery. Plast Reconstr Surg Glob Open 2020; 8 (12) e3300
    CrossrefPubMedSearch in Google Scholar
  • 37 Reynolds M, Kelly DA, Walker NJ, Crantford C, Defranzo AJ. Use of Integra in the management of complex hand wounds from cancer resection and nonburn trauma. Hand (N Y) 2018; 13 (01) 74-79
    CrossrefPubMedSearch in Google Scholar
  • 38 Hughes LP, Forman S, Krieg JC, Hughes WB. The use of Integra dermal regeneration templates and cortical bone fenestrations over exposed tibia. Plast Reconstr Surg Glob Open 2021; 9 (02) e3340
    CrossrefPubMedSearch in Google Scholar
  • 39 Cigerim L. Treatment of exposed bone with acellular dermal matrix in a smoker patient after dental implant surgery: a case report. J Oral Implantol 2020; 46 (03) 245-249
    CrossrefPubMedSearch in Google Scholar
  • 40 Tavin E. Abstract: meshed acellular dermal matrix with overlying split thickness skin graft for scalp reconstruction. Plast Reconstr Surg Glob Open 2016; 4 (0S): 214-215
    CrossrefPubMedSearch in Google Scholar
  • 41 Chang DK, Louis MR, Gimenez A, Reece EM. The basics of Integra dermal regeneration template and its expanding clinical applications. Semin Plast Surg 2019; 33 (03) 185-189
    Thieme ConnectPubMedSearch in Google Scholar
  • 42 Lagus H, Sarlomo-Rikala M, Böhling T, Vuola J. Prospective study on burns treated with Integra®, a cellulose sponge and split thickness skin graft: comparative clinical and histological study–randomized controlled trial. Burns 2013; 39 (08) 1577-1587
    CrossrefPubMedSearch in Google Scholar
  • 43 Lima Júnior EM, de Moraes Filho MO, Costa BA. et al. Nile tilapia fish skin-based wound dressing improves pain and treatment-related costs of superficial partial-thickness burns: a phase III randomized controlled trial. Plast Reconstr Surg 2021; 147 (05) 1189-1198
    CrossrefPubMedSearch in Google Scholar
  • 44 Mustoe TA, Han H. The effect of new technologies on plastic surgery. Arch Surg 1999; 134 (11) 1178-1183
    CrossrefPubMedSearch in Google Scholar
  • 45 Sarrami SM, Ferry AM, Buchanan EP, Gerow FT, Koshy JC. Reconstructing severe lower extremity skin necrosis in a pediatric patient. Adv Skin Wound Care 2021; 34 (07) 1-6
    CrossrefPubMedSearch in Google Scholar
  • 46 Shahrokhi S, Arno A, Jeschke MG. The use of dermal substitutes in burn surgery: acute phase. Wound Repair Regen 2014; 22 (01) 14-22
    CrossrefPubMedSearch in Google Scholar
  • 47 Sbitany H, Langstein HN. Acellular dermal matrix in primary breast reconstruction. Aesthet Surg J 2011; 31 (07) 30S-37S
    CrossrefPubMedSearch in Google Scholar
  • 48 Chronic Wound Healing. A Review of Current Management and Treatments / SpringerLink. Accessed January 11, 2022: https://link.springer.com/article/10.1007/s12325-017-0478-y.
    PubMed
  • 49 Gonzalez SR, Wolter KG, Yuen JC. Infectious complications associated with the use of Integra: a systematic review of the literature. Plast Reconstr Surg Glob Open 2020; 8 (07) e2869
    CrossrefPubMedSearch in Google Scholar
  • 50 Integra® Dermal Regeneration Template. Accessed January 11, 2022: https://www.integralife.com/integra-dermal-regeneration-template/product/wound-reconstruction-care-inpatient-acute-or-integra-dermal-regeneration-template
    PubMed
  • 51 Chun YS, Verma K, Rosen H. et al. Implant-based breast reconstruction using acellular dermal matrix and the risk of postoperative complications. Plast Reconstr Surg 2010; 125 (02) 429-436
    CrossrefPubMedSearch in Google Scholar
  • 52 Management of Complex Abdominal Wall Defects Using Acellular Porcine Dermal Collagen - ProQuest. Accessed January 10, 2022: https://www.proquest.com/docview/194003527/fulltextPDF/51756817B4AB4189PQ/1?accountid=7034
    PubMed
  • 53 Brigido SA. The use of an acellular dermal regenerative tissue matrix in the treatment of lower extremity wounds: a prospective 16-week pilot study. Int Wound J 2006; 3 (03) 181-187
    CrossrefPubMedSearch in Google Scholar
  • 54 Shaikh FM, Giri SK, Durrani S, Waldron D, Grace PA. Experience with porcine acellular dermal collagen implant in one-stage tension-free reconstruction of acute and chronic abdominal wall defects. World J Surg 2007; 31 (10) 1966-1972 , discussion 1973–1974, 1975
    CrossrefPubMedSearch in Google Scholar
  • 55 Hur J, Han HH. Outcome assessment according to the thickness and direction of the acellular dermal matrix after implant-based breast reconstruction. BioMed Res Int 2021; 2021: 8101009
    PubMedSearch in Google Scholar