Skin Tissue Engineering in Burns & Reconstructive Surgery: From Cells to Surgery and the Clinical Impact of Soft Tissue Engineering

Abstract

Skin tissue engineering has advanced to address clinical challenges where tissue is lost, donor sites are limited, or healing is impaired. Although many engineered skin substitutes exist, their clinical use varies. This thesis, “Skin Tissue Engineering in Burns and Reconstructive Surgery: From Cells to Surgery and the Clinical Impact of Soft Tissue Engineering,” provides a translational examination of engineered skin, integrating clinical practice with biomaterials science and cell–matrix interactions. The thesis comprises seven chapters that move from foundational concepts to clinical innovation and emerging technologies. It begins by outlining skin structure, wound healing, and the historical development of engineered skin, followed by a detailed review of current biological, synthetic, and composite devices. Original clinical research includes a new application technique for MatriDerm developed at Concord Hospital and the first documented invasive procedures performed through integrated synthetic dermal templates. It explores fibroblast and macrophage interactions with biological and synthetic matrices offering insight into mechanisms that influence integration and regeneration and it investigates the interplay between engineered devices and skin microbiota, including the potential for therapeutic microorganisms and antimicrobial biomaterials to address biofilm formation and infection. The final chapter evaluates emerging biomaterials, including thermo-responsive hydrogels and biologically derived polymers, highlighting their promise for next-generation soft-tissue solutions. Collectively this thesis advances a bio-physiological framework for selecting, applying, and evolving skin tissue-engineered solutions. By bridging bench-top discoveries with bedside practice, it underscores the need for continuous innovation and provides new insights that support the development of more effective, biologically grounded, and clinical strategies in skin tissue engineering.