The current treatment of chronic, therapy resistant wounds relies mainly on effective cleansing, local therapy with antimicrobials and wound cover, complemented with adequate compression therapy. Unfortunately standard treatments are not always as effective and there is continuous research for improved methods. Two important factors with a major impact on the efficacy of cultured skin replacing products are: 1. the origin of the skin tissue (cells), 2. the composition of the cultured product.
Autologous or allogeneic
Skin cells used for culturing skin tissues can originate from two kinds of sources: from the patient’s own body (autologous) or from a donor (allogeneic). In general, autologous skin replacement products have the benefit that these will not be rejected by the patient’s body. These also provide immediate wound cover and stimulation of the wound bed, and stimulate the healing process maximally.
Structure of the skin tissue product
Skin tissue products may consist of one (single layered) or two (bi-layered, also known as full-thickness skin) layers. Full-thickness skin contains two layers of skin, just like the natural human skin: the dermal and epidermal layer, connected by a basal membrane. The full thickness skin is stronger than a single-layered product and reduces the risk of recidivism. All currently available data indicates that the full-thickness skin product with an autologous origin, i.e. Tiscover®, is the most optimal skin replacement product for the treatment of chronic skin wounds (see also next page).
Aute wounds, such as burn wounds, are very active wounds, and require a different skin equivalent to achieve optimal cosmetic results. For this purpose, together with our collegues from Beverwijk, we developed KC-Matrix, which combines autologous cultured keratinocytes with autologous meshed autograft. The benefit of this treatment was recently confirmed by data from an early clinical trial (manuscript in preparation)
Patients with acute or chronic wounds for whom cultured full-thickness skin is not (yet) available may benefit from using the acellular matrix AS210 produced from donor skin obtained from the EuroSkin Bank in Beverwijk. The same product is also used for culturing the full-thickness skin equivalent Tiscover.