Histologic Study of Artificial Skin Used in the Treatment of Full-Thickness Thermal Injury

TLDR

Integra artificial skin is an effective treatment for full‑thickness burns and may become the preferred option for extensive burn injuries. The study aimed to identify the sequential histologic phases of repair following Integra application. Serial biopsy specimens were obtained from 131 patients 7 days to 2 years after application to examine the dermal and epidermal layers. Histology revealed six sequential repair phases, occasional eosinophilic infiltration or giant cell formation that did not correlate with adverse outcomes, and overall good repair with intact dermis, complete epidermal closure, and minimal scarring.

Abstract

Integra artificial skin is an effective means of treatment for full-thickness burns. In extensive burn injury the use of such skin substitutes may become the treatment of choice. The artificial skin consists of a dermal substitute of bovine collagen and chondroitin-6-sulfate and an epidermal layer of synthetic polysiloxane polymer (Silastic). Serial biopsy specimens were obtained from 131 patients during a period of 7 days to 2 years after application. In this histologic study, six sequential phases of repair were discerned. In addition, there were occasional unusual histologic features, eosinophilic infiltration, and/or macrophage-derived giant cell formation in the wound area; however, such findings did not clinically correlate with a negative response to Integra artificial skin. Good repair was obtained, with rare exceptions. An intact dermis was achieved as well as definitive closure of a complete epidermal layer with a minimum of scarring.