Cultured skin as a 'smart material' for healing wounds: experience in venous ulcers.

The healing of chronic wounds is a difficult and varied problem. The engineering of a cultured skin tissue offers an adaptive therapy for chronic wounds. Our hypothesis has been that living tissue can act as a 'smart material' to heal wounds. We have examined the healing characteristics of a bilayered cultured skin equivalent (Graftskin) in a controlled study and present clinical data from interim analyses for 233 patients over 6 months of treatment. All venous ulcer patients will be followed for up to 1 year. We report on three basic scenarios of healing: (i) promotion of healing by secondary intention, (ii) persistent biological wound closure with stimulation of underlying healing, and (iii) healing by frank graft take of the cultured material with remodelling of the tissue over time. Our results indicate that the cultured skin equivalent is responsive to individual wound conditions and thus acts as a 'smart material' in the chronic wound.