Observations on the development and clinical use of artificial skin--an attempt to employ regeneration rather than scar formation in wound healing.

Artificial skin, a bilaminar membrane, is grafted on an excised wound immediately following injury. This bilayer membrane, made of a dermal and epidermal portion, is populated in place on the wound bed by the patient's own fibroblasts and epidermal cells producing a permanent skin replacement with an anatomically functioning dermis and epidermis. The dermal portion is a porous collagen-chondroitin 6-sulfate fibrous matrix arranged in a three dimensional pattern closely resembling the fiber pattern of normal dermis. A thin silastic covering serves as a temporary epidermis immediately after grafting until the patient's epidermal cells, seeded on the "neodermis", grow into a confluent epidermal replacement. The autogenous "neodermis" is produced as fibroblasts and vessels migrate from the wound bed into the artificial dermal template and, using the artificial fibers as a scaffolding, synthesize new connective tissue in the collagen fiber pattern of normal dermis rather than the pattern of scar while slowly biodegrading the artificial fibers. This replacement dermis functions as normal dermis and not as scar tissue. The patient's epidermal cells seeded on the "neodermis" grow into a confluent normal appearing epidermis and with the neodermis produce a permanent skin composed of normal functioning dermal and epidermal components produced in situ by the patient's own cells. Artificial skin has been successfully used to permanently replace skin destroyed by burn injuries ranging from 10 to over 95% BSA. The long-term functional results in these patients have been excellent and the long term cosmetic results in preliminary studies tend to be superior to autograft. Artificial skin appears to provide a successful physiologic and cosmetic skin replacement in severe burn injury.