Optimization of a polyurethane dermal matrix and experience with a polymer-based cultured composite skin.

The aims were to (1) describe the in vivo studies leading to an optimized model of the biodegradable temporizing matrix (BTM), (2) describe our efforts in effecting closure over this optimized matrix after integration with a cultured composite skin (CCS), and (3) reexamine the ability of the CCS to definitively close fresh wounds (without BTM). Foam scaffolds of biodegradable polyurethane were created to allow in vivo tissue ingrowth or in vitro co-culture. Using the porcine surgical model, multiple BTM optimization studies took place before the BTM-CCS main study was conducted. For the CCS study, optimized sealed 2 mm matrices were implanted into 6-mm deep, 8 × 8 cm wounds (three per pig) and allowed to integrate for 21 days, whereas collected blood and harvested skin tissue were used to prepare autologous composite skins in similar (unsealed) 1 mm matrices. These were then applied at day 21 either over the integrated BTMs or into a freshly created fourth wound. All of the optimized matrices integrated fully, without loss, and were found to resist wound contraction effectively until the composites were ready for application at day 21. The composites demonstrated the ability to generate a bilayer repair with robust epidermis anchored by a basement membrane visible from day 7 after application. The final optimized sealed BTM delaminates easily to produce a clean, temporized wound bed and will be used in the upcoming burn clinical trial. Although the CCS is a magnitude away from human trials, it is still capable of generating a bilayer repair in both BTM-integrated and fresh wounds (onto fat), and with further refinement and optimization of foam structure, seeding densities, and timing, consistent success should be possible.