Review of acellular and cellular artificial skins

Following the development of a bilayer acellular artificial skin by Yannas et al. which seemed unique with respect to spontaneous conversion of the inner collagen sponge into a dermis-like connective tissue layer, we started to develop an alternative acellular artificial skin and extended the indications for the material. Since reporting our early results of experimental and clinical use of the original version of the acellular artificial skin, several improvements have been made in stages to eliminate some drawbacks related to disinfection and preservation and to reduce the primary cost of manufacture. We used this material on 51 skin defects in 39 patients with success. The latest version of the material was also evaluated in multicenter clinical trials involving 80 cases. Separately, a material capable of sustained release of an antibiotic was developed and used in 6 wounds prone to infection with success. To solve the problem of two-stage surgery, a cellular artificial skin composed of an outer keratinocytic layer and an inner collagen sponge containing fibroblasts was produced using cell culture method by modifying the technique proposed by Boyce et al. This report reviews our acellular and cellular artificial skins.