Conclusion & Future Perspective
Despite recent advances in the development of biomaterials and fabrication strategies for skin repair and regeneration, their clinical use still requires several drawbacks to be addressed. Numerous wound-care products were developed, such as lotions, dressings and tissue-engineered skin substitutes, and are currently commercialized. Until now, the gold standard for skin regeneration still relies on the use of autografts and allografts, which present significant limitations as previously discussed. Advanced strategies, combining additive biomanufacturing processes, biomaterials, cells and growth factors, have emerged as a group of techniques with high potential for skin regeneration applications. These techniques allow printing of skin substitutes in a precise and automated manner, enabling the production of skin replacements with properties that resemble both the structure and the function of native skin. These techniques enable the development of bottom-up approaches to fabricate 3D constructs that mimic the organization of healthy skin and can be used for the regeneration of full-thickness wounds, for which an efficient dermoepidermal substitute is not available.
In order to achieve effective and clinically relevant skin regeneration, relevant challenges to be addressed in the future include:
The insufficient vascularization of the regenerated skin. This requires the development of sophisticated printing systems to produce multihydrogel constructs with multiple cell types (e.g., stem cells and endothelial cells) and the controlled release of angiogenic growth factors;
Development of advanced in situ crosslinking multifunctional hydrogels, mimicking the bio-signaling and mechanical properties of the skin, and allowing the incorporation of multiple cell types;
The inability of currently available skin grafts to reproduce all skin structures, such as hair and glands. This requires a deeper understanding of skin biology and the use of more complex cellular approaches, including the use of genetically engineered cells;
Applying nano-, micro- and macro-fabrication technologies for enhancing efficacy and precision and to reproduce the natural hierarchy that characterizes the skin;
Increasing the level of automation and industrialization, as traditional laboratory processes are often characterized by a high degree of manual handling operations;
Enhancing multidisciplinarity, linking clinicians, biologists and engineers to facilitate further developments and the clinical translation of the products being investigated;
Nanomedicine. 2013;8(4):603-621. © 2013 Future Medicine Ltd.
