Davison-Kotler E, Sharma V, Kang NV, García-Gareta E, et al.
Tissue engineering. Part B, Reviews. Date of publication 2018 Aug 1;volume 24(4):279-288.
1. Tissue Eng Part B Rev. 2018 Aug;24(4):279-288. doi: 10.1089/ten.TEB.2017.0477.
Epub 2018 Feb 12.
A Universal Classification System of Skin Substitutes Inspired by Factorial
Design.
Davison-Kotler E(1), Sharma V(1), Kang NV(2), García-Gareta E(1).
Author information:
(1)1 Regenerative Biomaterials Group, RAFT Institute , Mount Vernon Hospital,
Northwood, United Kingdom .
(2)2 Department of Plastic Surgery, Royal Free Hospital , London, United Kingdom
.
The complexity of the dermal layer of skin means that damage to this section can
result in permanent impairment of function. Partial or total dermal loss is a
feature of deep burns and chronic wounds such as pressure sores or diabetic
ulcers. The issues posed by traditional skin grafts have led to substantial
research being carried out in the fields of tissue engineering and biomaterials
science to develop a vast array of alternative skin substitutes. Given the large
number of different materials, manufacturing methods, and techniques for
implementation described for artificial skin substitutes, many classification
systems have been created to simplify their categorization. Some of these systems
are oriented toward clinicians while others toward researchers. However, none
address the needs of both groups and none are intuitive. The creation of an
effective classification system would be particularly helpful in the regulation,
distribution, organization, and selection of skin substitutes. The aim of this
review is to examine existing methods of classification of skin substitutes, and
to propose a new system that uses an algorithm that is inspired by factorial
design. Our system allows multiple factors to be simultaneously investigated or
in this case, described, since all skin substitutes possess multiple
characteristics: (1) cellularity (acellular or cellular), (2) layering (single
layer or bilayer), (3) replaced region (epidermis, dermis, or both), (4)
materials used (natural, synthetic, or both), and (5) permanence (temporary or
permanent). The factors and levels are combined into an algorithm where all the
possible combinations are shown. The multifactorial and palindromic structure of
our system should enable all users to quickly understand the makeup of a selected
skin substitute, or search for a skin substitute depending on their specific
requirements. We feel that our proposed classification can be used by clinicians
and biomedical researchers alike, which should be an advantage given the
multidisciplinary nature of the tissue engineering field and the science that
underpins the development of skin substitutes. We also touch upon some of the
state-of-the-art skin substitutes that are commercially available or under
development to demonstrate how our new method of classification might work.
DOI: 10.1089/ten.TEB.2017.0477
PMID: 29336231
