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The Role of Advanced Biologics (Skin Substitutes) in Wound Healing
For a long time now, limb amputation has affected the mobility of African Americans living with chronic diseases. Worse still, studies have shown that limb amputation among diabetes and peripheral arterial disease significantly reduces their quality of life and life expectancy. Diseases such as diabetes often result in foot ulcers, which may necessitate amputation if not properly managed. However, the battle against lower limb amputation is not lost yet. Advanced biologics, particularly skin substitutes, promise better wound care and patient results, which are crucial to amputation prevention.
What are Advanced Biologics?
Advanced biologics refer to a group of regenerative medicine techniques that use the body’s growth factors and stem cells to enhance the healing process. In addition to lowering the risk of infection and related complications, advanced biologics help accelerate recovery, prevent inflammation, and promote health and vitality.
Among the various types of advanced biologics is skin substitutes. These refer to a heterogeneous group of biological, synthetic, or biosynthetic materials that can be used to temporarily or permanently cover open skin wounds. Ideally, they possess the composition and function of the skin. Otherwise, they have the potential for autologous regenerative healing when used for wound treatment.
Classification of Skin Substitutes
Skin substitutes may be classified based on their composition. However, they are best classified as biological or synthetic and temporary or permanent.
Biological Skin Substitutes
These skin substitutes act temporarily like the skin and are characterized by an intact and native extracellular matrix (ECM) structure. This potentially allows for the construction of a new dermis close to the natural one. Biological skin substitutes, which are inexpensive and relatively abundant in supply, also allow for great re-epithelialization given the presence of a basement membrane. Some of the most widely used biological skin substitutes include cadaveric skin allograft, amnion, and porcine skin xenograft.
Synthetic Skin Substitutes
These are made out of non-biological molecules and polymers. They are made to be stable and biodegradable to provide a suitable environment for tissue regeneration. Besides their make-up, they are constructed to maintain a three-dimensional structure for at least three weeks to allow coverage of epithelial cells and support ingrowths of blood vessels and fibroblast.
Temporary Skin Substitutes
Temporary skin substitutes allow for short-term wound closure. This protects the wound from mechanical trauma, bacteria entry, and creates a moist environment for the wound. In addition to providing temporary physiological closure of deep wounds, temporary skin substitutes are also used to control pain and facilitate epithelialization.
Permanent Skin Substitutes
As the name suggests, permanent skin substitutes are meant to achieve permanent wound closure. They also play the role of replacing the components of the skin and providing better quality skin replacement compared to the thin autologous skin graft.
Role of Skin Substitutes in Wound Healing
Wounds are disruptions of the skin’s functional and structural integrity. Normally, they transition through hemostasis, inflammation, proliferation, and remodeling – the four distinct phases of wound healing. By going through all these phases, the skin’s structure and function are restored.
Chronic wounds fail to go through these phases in an orderly and timely manner, often remaining in the inflammation phase. Wounds that have not entered the proliferation phase after four weeks of therapy are considered chronic.
Reduce Bacterial Count
One of the functions of normal healthy skin is to protect underlying tissues from the entry of microbes. With chronic wounds like diabetic foot ulcers, the entry of microorganisms attracts inflammatory immune cells, prolonging the inflammatory phase. Temporary skin substitutes are therefore essential in the treatment of chronic wounds as they provide transient physiologic closure of wounds.
Minimize Loss of Water, Protein, and Electrolytes
Maintaining a moist environment facilitates the wound healing process. It prevents dehydration of tissues and enhances angiogenesis and the synthesis of collagen, as well as increased breakdown of fibrin and dead tissue. Since skin substitutes are created to mimic the functions of the skin, they play a significant role in preventing loss of moisture and electrolytes.
Facilitate Early Motion
Patients with chronic wounds suffer wound recurrence, loss of function, significant morbidity, and loss of mobility. Chronic wounds like diabetic foot ulcers also result in pain, which further limits patients’ movement. Normally, podiatrists begin the treatment of chronic wounds with a standard of care regimen. However, these common principles of wound care management don’t always suffice. In such cases, skin substitutes are used to achieve early motion among patients.
Provide Vessel and Nerve Coverage
Chronic wounds are characterized by damage of nerves, blood vessels, and other components of the ECM. Elevated matrix metalloproteinases in chronic wounds often break down the growth factors and other components responsible for enhancing the production of granulation tissue in the wound bed. By covering blood vessels and nerves, skin substitutes ensure proper blood flow and tissue growth, which is crucial for the successful healing of chronic wounds.
Leveraging Advanced Technology for Amputation Prevention
The Wound Docs is a nationwide network of Black physicians who are at the fore in the battle against lower limb amputations in Black and African American communities. Besides bringing together various medical professionals, The Wound Docs leverage the power of technology such as AI and skin substitutes to achieve better wound care results among Black and African American patients.
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