From grafts to skin substitutes in the treatment of lower limb wounds: the latest advances in tissue technology

Since the end of the 19th century, skin grafting has long been the standard treatment for dermo-epidermal tissue loss. Flap techniques developed gradually, with rotation flaps in the 1960s and 1970s, until the advent of microsurgery in the 1980s and 2000s. The surgical achievements of a few pioneers boosted anatomical research on skin vascularization, leading to a proliferation of surgical coverage techniques that made it possible to fill large skin defects while respecting the thickness, color, and suppleness of the area to be covered, with aesthetic requirements accompanying those of closure.
At the same time, the development of technologies enabling wound granulation using negative pressure techniques has launched research into dermal and epidermal substitutes, focusing on a wide variety of biomaterials as well as fibroblast and keratinocyte cell cultures. It is currently necessary to distinguish between medical devices that promote skin regeneration and true skin substitutes that can replace it immediately.
The spectacular evolution of these covering techniques now makes it possible to limit visible scarring in a world where even the slightest physical deformity remains a cause of social exclusion in many countries.