Skin bioprinting: the future of burn wound reconstruction?

Abstract

Burns are a significant cause of trauma, and over the years, the focus of patient care has shifted from just survival to facilitation of improved functional outcomes. Typically, burn treatment, especially in the case of extensive burn injuries, involves surgical excision of injured skin and reconstruction of the burn injury with the aid of skin substitutes. Conventional skin substitutes do not contain all skin cell types and do not facilitate recapitulation of native skin physiology. Three-dimensional (3D) bioprinting for reconstruction of burn injuries involves layer-by-layer deposition of cells along with scaffolding materials over the injured areas. Skin bioprinting can be done either in situ or in vitro. Both these approaches are similar except for the site of printing and tissue maturation. There are technological and regulatory challenges that need to be overcome for clinical translation of bioprinted skin for burn reconstruction. However, the use of bioprinting for skin reconstruction following burns is promising; bioprinting will enable accurate placement of cell types and precise and reproducible fabrication of constructs to replace the injured or damaged sites. Overall, 3D bioprinting is a very transformative technology, and its use for wound reconstruction will lead to a paradigm shift in patient outcomes. In this review, we aim to introduce bioprinting, the different stages involved, in vitro and in vivo skin bioprinting, and the various clinical and regulatory challenges in adoption of this technology.

Application of 3D Bioprinting Technologies to the Management and Treatment of Diabetic Foot Ulcers

“…Examples of personalized tissues that have been manufactured by 3D bioprinting include cartilage [ 17 ], bone [ 18 ], as well as cardiac patches [ 19 ]. In comparison to commercially available skin substitutes, 3D bioprinting of skin grafts enables customization of the size and shape of constructs to fit the patient’s unique wound topology, thereby ensuring complete wound coverage and better aesthetics post-healing [ 136 ]. This feature is elegantly illustrated through in situ bioprinting, where the material is directly deposited onto the wound site to achieve complete coverage [ 119 , 120 ].…”

A Critical Update of the Assessment and Acute Management of Patients with Severe Burns

“…Using this technique, full-thickness wounds in mice and pigs achieved complete reepithelialization in 8 weeks. 205 In another technique, amniotic fluid-derived stem cells and bone marrow-derived mesenchymal stem cells are suspended in a gel containing collagen, fibrin, and thrombin and are printed directly onto the wound. Then a second layer of the same gel is applied.…”

“…Then a second layer of the same gel is applied. 205 Other groups have developed similar techniques mimicking the two-layer structure of skin, and have been able to print functional sweat glands in mice by using a composite hydrogel based on gelatin and sodium alginate. 206…”

Preliminary investigation on a new natural based poly(gamma‐glutamic acid)/Chitosan bioink

“…These points are relevant specifically for bioprinting process, and have not been explored in other investigations, but they are investigated in this article. A bioink composition does not fit every cell type: fibroblast has been here selected as cell model because an application of the bioink could be skin regeneration, that is, after burns (Hoffman, 2002; Varkey, Visscher, van Zuijlen, Atala, & Yoo, 2019).…”