Skin substitutes as alternatives to autografting in a wartime trauma setting

Wartime injuries present extreme problems in wound management, with extensive skin degloving, deep tissue necrosis, and severe wound contamination. Several wound stabilization technologies, commonly used in burn and chronic wound treatment centers, have significantly advanced the treatment of wartime extremity trauma. Early skin coverage of these wounds is an ongoing challenge. Engineered skin substitutes offer advantages of expedited wound coverage and decreased donor site morbidity in the treatment of burns and chronic wounds. These substitutes, however, possess significant limitations when used in the presence of infection or full-thickness defects. Therefore, extrapolating the use of engineered skin substitutes to the coverage of acute war wounds is not clinically indicated. The timing and level of care in which skin substitutes could be applied for war wounds requires further clinical research.