Body on Fire: Can Biologic Skin Substitutes Improve Burn Care?
You might be surprised to learn that burn injuries are the most common type of skin trauma, with approximately 130,000 individuals in the United States hospitalized each year due to burns.1 Though the majority of these burn victims will live, 4,500 will die from the burns themselves, and 10,000 will die of burn-related infections.2 Reducing the number of deaths, and burn-related infections in particular, will require the ability to quickly restore the skin’s protective and metabolic functions after burn trauma.
Biologic Skin Substitutes Can Help Protect Vulnerable Burn Victims
Biologic skin substitutes are being used more and more to protect wounds from infection and speed healing. Polyethylene plastic wraps, which minimize evaporation from open wounds, are one type of skin substitute, but researchers today have a unique opportunity to develop substitutes that can actively assist in wound healing instead of passively protecting, as polyethylene does.3 Skin substitutes that have biological properties can dramatically improve front-line burn treatment and patient recovery. Some of these properties include:
Antibacterial components: Adding antimicrobial elements to skin substitutes could save lives by reducing the risk of infection for burn victims. For people with high percentage burns, who are at the most risk of infection, researchers and physicians can produce biologic skin replacements with very high levels of the strongest antibiotics, which would be applied directly to the skin and could remain there. This would help prevent a forgotten dose or the accidental removal of a dressing. When used this way, biologic dressings could act as a substitute for skin, and could provide deep penetration of the antimicrobial elements.
Immunological “pan-compatibility”: Biologic skin replacements could create a revolution in the field of burn treatment by allowing a patient’s own epithelial cells to be grown in culture and harvested. While cadaveric skin substitutes are sometimes used in burn recovery efforts, they are often rejected due to incompatibility. A patient’s own cells could be grown in a biologic matrix that includes antimicrobial elements. Physicians would no longer need to worry about introducing foreign cells into a patient’s body, which is potentially dangerous given the weakened state of burn victims. Ideally, biologic skin alternatives could even be mass-produced once engineered to lack recognizable antigens.
Metabolic requirements: The skin is the largest producer of Vitamin D, but it also expresses a number of enzymes including monooxygenases, alcohol and aldehyde dehydrogenases, and many others that play an important role in how xenobiotics and other substances enter the body’s systemic circulatory system.4 By creating biologic skin substitutes that more actively support these functions (e.g., express certain transporters known to be important in different metabolic events), researchers have an opportunity to improve metabolism in burn patients and even aid in certain metabolic events in order to increase the pace of recovery.
Physical scaffolding control: Biologic skin substitutes would be easier to control than traditional grafts, letting doctors fine-tune how tightly they adhere to the skin and their thickness in different locations, ultimately improving patient outcomes. While large, cumbersome traditional grafts can allow vessels, nerves and tendons to desiccate and possibly compromise patients’ functionality and motility, biologic substitutes protect wounds while remaining customizable to the patient’s needs.
Biologic skin substitutes are ushering in a new era of burn treatment and recovery. By incorporating the components discussed, these therapies have the ability to improve survivors’ healing and quality of life, while decreasing the number of individuals who die due to burn-related illnesses. In order to manage the creation of biologic skin substitutes, however, research organizations must overcome innovation barriers by carefully managing the assays that will test for metabolic events, for example. They must also deal with regulations involved in working with human tissues such as cultured stem cells and must document experimental results in an easily accessible way.
- “Skin Injuries,” 2015, http://www.traumaburn.org/who/skinbank/injuries.shtml ↩
- “Trauma, Burn, and Injury,” 2015, http://www.caregiverslibrary.org/caregivers-resources/grp-disabilities/hsgrp-infections-wounds/trauma-burn-and-injury-article.aspx ↩
- “Biologic and synthetic skin substitutes: An Overview,” September 2010, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038402/ ↩
- “In vitro Assessment of Skin Metabolism,” June 25, 2015, http://www.cyprotex.com/blog/in-vitro-assessment-of-skin-metabolism/ ↩