Tissue engineering for cutaneous wounds

Skin, the largest organ in the body, protects against toxins and microorganisms in the environment and serves to prevent dehydration of all non-aquatic animals. Immune surveillance, sensory detection, and self-healing are other critical functions of the skin. Loss of skin integrity because of injury or illness may result acutely in substantial physiologic imbalance and ultimately in significant disability or even death. It is estimated that, in 1992, there were 35.2 million cases of significant skin loss (US data) that required major therapeutic intervention. Of these, approximately 7 million wounds become chronic. Regardless of the specific advanced wound care product, the ideal goal would be to regenerate tissues such that both the structural and functional properties of the wounded tissue are restored to the levels before injury. The advent of tissue-engineered skin replacements revolutionized the therapeutic potential for recalcitrant wounds and for wounds that are not amenable to primary closure. This article will introduce the reader to the field of tissue engineering, briefly review tissue-engineered skin replacement from a historical perspective and then review current state-of-the-art concepts from our vantage point.