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https://www.mdpi.com/2075-4426/11/12/1259/htm3.7. Dermal Regeneration Templates (DRT)
Dermal templates are used when split-thickness skin grafts are not sufficient for the reconstruction of tissue defects. They provide a scaffold, which promotes tissue regeneration, immediate wound closure and depicts a physical barrier to prevent wound infections [28]. Advantages include the restoration of the skin’s pliability and mobility whilst providing sufficient sturdiness [28,29]. Types of DRTs include products derived from animal and human sources as well as scaffolds that have been artificially constructed of highly purified biomaterial or entirely synthetic polymers. For scars developing following large burn injuries, synthetic polyurethane dermal templates such as Integra (Life Sciences Corp., Princeton, NJ, USA) or NovoSorb Biodegradable Temporising Matrix (Polymedics, Denkendorf, Germany) have been established to address the lack of autologous skin to graft and to restore the dermal skin layer [30]. Integra presents a decellularized dermal template derived from animal sources and consists of purified collagen from bovine tendons crosslinked with glycosaminoglycan obtained from shark cartilage and may be supplied with a removable silicone layer that functions as a temporary epidermis [30]. In contrast, BTM is a fully synthetic dermal template which consists of biodegradable polyurethane foam with a temporary non-biodegradable polyurethane seal [31]. Compared to Integra, BTM evades the risk of cross-species immune rejection or disease transmission, as well as circumvents ethical and cultural objections to using animal-derived products [28].BTM application has shown to be successful in improving scar quality upon application and limiting wound contraction significantly [32,33]. Its reconstructive possibilities can be used for a variable range of tissue defects that are not responsive to instant skin grafting. Key advantages are the vascularization and integration of the template even in the presence of infection, thereby allowing an application in patients with an array of comorbidities [34].
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