1 Regenerative Biomaterials Group, RAFT Institute , Mount Vernon Hospital, Northwood, United Kingdom .
2 Department of Plastic Surgery, Royal Free Hospital , London, United Kingdom .
Tissue Eng Part B Rev. 2018 Aug;24(4):279-288. doi: 10.1089/ten.TEB.2017.0477. Epub 2018 Feb 12.
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.
皮肤真皮层的复杂性意味着该区域的损伤可能导致功能永久受损。真皮部分或全部丧失是深度烧伤和慢性伤口（如压疮或糖尿病溃疡）的特征。传统皮肤移植物存在的问题导致组织工程和生物材料科学领域进行了大量研究，以开发出大量替代皮肤替代品。鉴于人工皮肤替代品描述的不同材料、制造方法和实施技术数量众多，已经创建了许多分类系统来简化它们的分类。其中一些系统面向临床医生，而另一些系统则面向研究人员。然而，没有一个系统既能满足临床医生的需求，也能满足研究人员的需求，而且都不够直观。创建一个有效的分类系统对于人工皮肤替代品的监管、分配、组织和选择将特别有帮助。本综述的目的是检查现有的皮肤替代品分类方法，并提出一种新的系统，该系统使用受因子设计启发的算法。我们的系统允许同时研究或在这种情况下描述多个因素，因为所有的皮肤替代品都具有多个特征：（1）细胞性（无细胞或有细胞），（2）分层（单层或双层），（3）替代区域（表皮、真皮或两者），（4）使用的材料（天然、合成或两者兼有），以及（5）持久性（临时或永久）。这些因素和水平组合成一个算法，其中显示了所有可能的组合。我们系统的多因素和回文结构应该使所有用户都能够快速了解所选皮肤替代品的组成，或者根据他们的具体要求搜索皮肤替代品。我们认为，我们提出的分类可以被临床医生和生物医学研究人员使用，考虑到组织工程领域的多学科性质以及支撑皮肤替代品开发的科学，这应该是一个优势。我们还讨论了一些商业上可获得或正在开发的最先进的皮肤替代品，以展示我们的新分类方法如何运作。
