Biological dressings as a substitutes of the skin in the treatment of burn wounds.

The skin is a tissue which is the most exposed to external factors. It is formed by numerous specialized cells and performs mainly protective functions. Due to its special properties such as: resistance, elasticity and semipermeability, it protects our body from mechanical injuries, infections, loss of physiological fluids as well as harmful radiation (1, 2). The human skin is formed of multi-layer squamous epithelium; epidermis and dermis. It is the largest organ in our body in terms of the occupied space. Patients who lose a large percentage of their skin’s surface as a result of thermal traumas face life threatening complications particularly connected with infections and loss of body fluids (3). Extensive and frequently very deep wounds resulting from burning require specialist treatment. The primary method of choice in the management of full-thickness burn traumas (third degree burns) is skin grafting with the use of the patient’s own skin (autologous split-thickness skin graft) (4, 5, 32). The first attempts to close wounds using the skin as a biological dressing date back to the beginning of the 19th century. At first, these were experiments which were not successful, but which gave rise to the search for effective treatment methods of burns and chronic wounds. In 1803, Baronio was one of the first who claimed that the skin might be grafted from one site of the body to another (tested on sheep). Reverdin, in 1869, performed the first autograft of the epidermis in people. In 1871, Pollock performed the first allograft of his own skin mixed with the skin of the patient. Finally, in 1881, Girdner dressed a large wound with the skin obtained from a cadaver and described graft rejection (6). Autologous split-thickness skin graft constitutes a treatment method which presents certain constraints. The main limitation of this technique is insufficient amount of healthy, uninjured skin – donor site deficit, in patients with severe burns (4, 7). Donor sites are areas from which the split-thickness skin is removed and used to cover burn wounds. Unfortunately, in the case of massive and extensive burns encompassing numerous body areas, the lack of donor sites frequently renders the removal of the skin and, consequently, the autograft impossible. On other occasions, it may happen that the extent of burn wounds is so large that the amount of the skin removed from the donor sites is insufficient to cover the whole area of burning. The situations mentioned above prompt the search for other methods to treat burn wounds with the use of other available biological dressings.