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Cuticell: A Promoting

Epithelization Dressing
Material As An
Alternative Skin
Substitute Application
Danar Widyatmoko

Pembimbing:
Dr. Amru Sungkar Sp.B,Sp.BP-RE (K)
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INTRODUCTION
 Chronic wounds, including diabetic ulcers,
pressure ulcers, venous ulcers, and arterial
insufficiency ulcers, present with a complex
issue.
 Patients with chronic wounds can be difficult
to treat.
 The challenge is to find treatments that
overcome these barriers and allow for full skin
closure.
(Nicholas and Yeung,2016)
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 The most commonly used plastic surgery


technique is the allogeneic skin graft.
However, the amount of donor area skin is
often limited.
 The development of synthetic or biological
products as skin substitutes is therefore of
interest.
(Marcus Gastro,2011)
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 One of the current options for the treatment


of major skin losses is the use of skin
substitutes, which can be of:
 Synthetic (generated by tissue engineering).
 Human origin, such as allografts (derived
from cadaver skin) and xenografts (derived
from animal skin).
(Marcus Gastro,2011)
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A SERIES CASE REPORTS


A 61-year-old woman has performed wide
excision of fibroma on the calcaneus. Wound
care using a Cuticell® every 5 days. Size of the
wound narrows, growing epithelial tissue,
granulation tissue decrease, pain complaints
are reduced.
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A SERIES CASE REPORTS


A 32-year-old male with inferior paraplegia e.c
Burst Fracture Vertebra Thoracal XII, patients with
decubitus ulcer wounds in the calcaneus
region,wound care using Cuticell® every 5 days.
Size of the wound narrows, growing epithelial
tissue, granulation tissue decrease, pain
complaints are reduced.
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A SERIES CASE REPORTS

A 44-year-old woman had a raw surface injury


on the temporal region with a history of
craniotomy, wound care using a Cuticell®
every 5 days. Size of the wound narrows,
growing epithelial tissue, granulation tissue
decrease, pain complaints are reduced.
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DISCUSSION
 The complete loss of cutaneous cover can
occur as a result of different conditions
including burns, trauma, infections,
autoimmune diseases, and complex wounds.
 The loss of the cutaneous barrier increases the
risk of infection, water loss, and hypothermia,
which increases morbidity, the cost and
length of hospitalization and in some cases,
can result in death.
(Marcus Gastro,2011)
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 Thecreation of bioengineered skin substitutes


for wound healing dates back to the 1970s
when cultured epidermal autographs (CEAs)
were created after successful culturing of
human keratinocytes.
 A few years later in the early 1980s, the first
dermal substitute was created, Integra.

(Nicholas and Yeung,2016)


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 From there, a number of advances have been


made, all with significant improvements in the
healing of chronic wounds.
 Commercially available skin substitutes for
chronic wounds can be easily classified
anatomically between dermal skin substitutes,
both cellular and acellular, and composite skin
substitutes, which consist of dermal and
epidermal layers.
(Nicholas and Yeung,2016)
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Marcus, et al. 2011


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(Nicholas and Yeung,2016)


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 Although the use of skin substitutes has


significantly decreased morbidity and mortality
of chronic wounds, there are still limitations in
current technology, including the composition
and mechanical characteristics of the ECM
(Extracellular Matrix), the cell types used, the
cell incorporation methods, and the use of
growth factors.
(Nicholas and Yeung,2016)
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 The ideal dressing should be able to maintain


high humidity at the wound-dressing interface,
remove excess exudate, permit the exchange
of gases, provide thermal insulation, be
impermeable to microorganisms, free of
particles and toxic wound contaminants, and
be removable without causing trauma to the
wound.
(Ferreira, et al. 2009)
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 Cuticell® Epigraft is epithelialisation dressing


produces spectacular results when it comes
to re-epithelialisation of split-thickness skin
grafts.
 Manufactured from cellulose film Cuticell®
Epigraft serves as a temporary replacement
for the missing epithelium, thus protecting the
wound and allowing it to heal in a shorter
time without external disturbance.
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Indications for Cuticell® Epigraft are:

 Split-thickness skin grafts


 Category 2a/2b burns
 Wounds with characteristics comparable
to split-thickness skin graft sites
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The factors that make a successful Skin Builder –


Cuticell® Epigraft

 Serves as an effective anti- microbial barrier


on the wound site.
 Works without adhesives and is fixed with a
simple retention bandage.
 Is a remarkably thin, conformable dressing. It
is easy to apply and can be cut to individual
shapes.
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The factors that make a successful Skin Builder –


Cuticell® Epigraft

 Istranslucent and allows visual assessment


of the healing process. Excess exudate
can be controlled by cutting the dressing
thus allowing built up fluids to drain.
 Keeps its integrity throughout. It will not
grow into the wound and therefore
comes off in a single piece with minimum
trauma for the patient.
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 Skin grafting is a frequently used procedure in


plastic and dermatologic surgery for the
replacement of damaged or missing skin. The
success of the procedure depends on the
complete integration of the graft with the recipient
bed and on the reepithelialization of the donor
site.
(Fanti, et al. 2013)
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 Donor sites may be treated with various dressings, An


ideal donor site dressing should have barrier
proprieties against bacterial infections, should
promote epidermal healing, should reduce wound
pain being easy to apply and remove.

 The use of the microbial cellulose dressing Cuticell® is


satisfactory, while dealing with patients needs and
device simplifies the management and healing of the
donor areas in split-thickness skin grafts.

(Fanti, et al. 2013)


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(Fanti,2013)
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CONCLUSION
 Three patients with Vulnus granulosum have been reported
to have cuticell application with varying epithelial rate.

 In these patients did wound care using Cuticell® because


this dressing is very suitable and can be cut to suze, making
it ideal dressing, in addition to lower cost per unit than
other silicon or skin substitute.

 Skin substitutes play an important role in plastic surgery, in


particular in the treatment of burns and other complex
wounds, as they are a valuable resource for the restoration
of cutaneous continuity.
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Thank you