Tissue Engineered Wound Matrix Products (continued)

Description:

Integra^® is an acellular, biodegradable collagen-glycosaminoglycan (CG) copolymer matrix coated with a thin polysiloxane (silicone) elastomer.  Bovine type I collagen and chondroitin-6-sulfate, one of the major glycosaminoglycans, are co-precipitated, freeze-dried and cross-linked.  The collagen structure is manufactured.   The pore size has been determined to maximize in-growth of cells, and the degree of cross-linking as well as GAG composition, is designed to control the rate of matrix degradation.   

This extracellular matrix analog incorporates in about 2-3 weeks forming a neodermis with  new vasculature. In animal studies, when this matrix was seeded with auto-genous keratinocytes, collagen fiber orientation and elastin fiber structure resembled native dermis.  The response in humans as to dermal quality remains to be determined.

The Integra acellular cryo-preserved allodermis is clinically used in conjunction with ultra thin (0.003 to 0.006 inch) meshed split-thickness autografts in large burn wounds.  Several clinical studies have been performed, reporting an equivalent fourteen day graft take rate of this dermal matrix with traditional split-thickness autografting. Follow-up to six months demonstrated equivalent clinical assessments to Alloderm – ultra thin autograft combination.   This product is currently not being used in chronic wounds. 

Description:

DERMAGRAFT^® is a cryo-preserved human fibroblast derived dermal substitute.  It is compared of fibroblasts, extracellular matrix (produced by the neonatal foreskin), cultured fibroblasts.  The cultured fibroblasts are seeded onto a bio-absorbable polyglactin mesh scaffold.  The fibroblasts proliferate to fill the interstices of this scaffold.  Human dermal collagen, matrix proteins, growth factors and cytokines, are produced.  A human dermal substitute is produced containing metabolically active, living cells.  It is assumed that these cells produce biologically active proteins such as growth factors.  The product is used primarily for clean diabetic ulcers.  It is typically used for small chronic wounds.  There is no indication for use in large traumatic wounds or partial thickness burns.

Description:

OrCel^® is comprised of a bilayer reconstituted collagen sponge that contains cultured living human dermal and epidermal skin cells.  Allogeneic human cells from neonatal foreskin are seeded into the collagen sponge.  It is stated that these cells release growth factors and other active dermal proteins which then stimulate healing.  The epidermal and dermal fibroblasts are cultured in two separate layers on a type I bovine collagen sponge.   The collagen lattice is manufactured.

An open sponge structure permits dermal cells to migrate into and throughout the sponge and to deposit human collagen and glycosaminoglycans (human skin “biomatrix”).  The open pores allow the patient’s wound bed fibroblasts to regenerate the dermis and endothelial cells to revascularize the tissue to migrate in and rebuild the tissue.

The collagen sponge is porous.  It serves to absorb the wound fluid in an exudating wound.  Additionally, the porosity allows the exudating wound fluid passage into the outer dressing.  This prevents the OrCel^® from lifting off the wound bed.

Description:

EZ Derm is a porcine derived xenografts which has been chemically modified to provide durability and storage.  The dermal elements from the original pig dermis are likely all deactivated in the chemical process, unlike the frozen pig dermis which is still available.  It appears that the product is a collagen scaffold.  There is no data to indicate that this dressing stimulates healing. The product is not incorporated and must be removed.

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