Skin substitutes : current concepts and a new classification system

Complex wounds are characterized by complete loss of cutaneous cover. The most common plastic surgery technique is the autogenous skin graft; however, the amount of material available from donor areas is often limited. The development of synthetic or biological products as skin substitutes is therefore an area of interest. The present study aimed to clas sify the different types of skin substitutes available based on three criteria: the skin la yer to be replaced, which can be categorized into epidermal (E), dermal (D), and dermalepi dermal composites (C); the durability in the wound bed, which can be temporary (T) or permanent (P); and the origin of the material, subdivided into biological (b), biosynthetic (bs), and synthetic (s).