Living Artificial Skin: Photosensitizer and Cell Sandwiched Bacterial Cellulose for Chronic Wound Healing

Chronic wounds pose a significant global public health challenge due to their suboptimal treatment efficacy caused by bacterial infections and microcirculatory disturbances. Inspired by the biofunctionality of natural skin, an artificial skin (HV@BC@TBG) is bioengineered with bacterial cellulose (BC) sandwiched between photosensitizers (PS) and functionalized living cells. Glucose-modified PS (TBG) and vascular endothelial growth factor (VEGF)-functionalized living cells (HV) are successively modified on each side of BC through biological metabolism and bio-orthogonal reaction. As the outermost layer, the TBG layer can generate reactive oxygen species (ROS) upon light illumination to efficiently combat bacterial infections. The HV layer is the inner layer near the diabetic wound, which servs as a living factory to continuously secrete VEGF to accelerate wound repair by promoting fibroblast proliferation and angiogenesis. The sandwiched structural artificial skin HV@BC@TBG is nontoxic, biocompatible, and demonstrated its ability to significantly accelerate the healing process of infected diabetic wounds, rendering it a promising next-generation medical therapy for chronic wound management.

A Flexible Escape Skin Bioinspired by the Defensive Behavior of Shedding Scales

Artificial skins with functions such as sensing, variable stiffness, actuation, self-healing, display, adhesion, and camouflage have been developed and widely used, but artificial skins with escape function are still a research gap. In nature, every species of animal can use its innate skills and functions to escape capture. Inspired by the behavior of fish-scale geckoes escaping predation by shedding scales when grasped or touched, we propose a flexible escape skin by attaching artificial scales to a flexible film. Experiments demonstrate that the escape skin has significant effects in reducing escape force, escaping from harmful force environments, and resisting mechanical damage. Furthermore, we enabled active control of escape force and skin hardness by changing temperature, increasing the adaptability of the escape skin to the surrounding. Our study helps lay the foundation for engineering systems that depend on escape skin to improve robustness.

Robust Gradient Hydrogel-Loaded Nanofiber Fleshy Artificial Skin Via A Coupled Microfluidic Electrospinning-Reactive Coating Strategy

Skin regeneration attracts tremendous interest due to the important role of skin for human protection and beauty. Thus, methods allowing artificial skin to be carried out in a controllable fashion are potentially important for wound healing, which involves an intersection of materials, medicine, biology, and other disciplines. Herein, aiming at a new general methodology for fleshy materials, a new hydrogel-loaded hydrophobic-hydrophilic nanofiber fleshy artificial skin is designed and fabricated. The gradient hydrogel-loaded nanofiber artificial skin integrates both advantages of nanofiber and hydrogel, exhibiting fleshy feature (comparability to real skin in terms of appearance, texture, and function), excellent air permeability, compatibility, and good mechanical and antibacterial property. Interestingly, the efficient transport channels are formed throughout the hydrogel-loaded nanofiber structure, which is beneficial for water absorption and transfer. These advantages enable the establishment of a moist and favorable microenvironment; thus, greatly accelerating wound healing process. This work couples microfluidic electrospinning with reactive coating technique, which is in favor of material design and fabrication with controllable and uniform structures. The hydrogel-loaded nanofiber fleshy artificial skin shows comparability to real skin in terms of beauty, texture, and function, which would definitely provide new opportunities for the further optimization and upgrading of artificial skin.

Biomimetic Electronic Skin through Hierarchical Polymer Structural Design

Human skin comprises multiple hierarchical layers that perform various functions such as protection, sensing, and structural support. Developing electronic skin (E-skin) with similar properties has broad implications in health monitoring, prosthetics, and soft robotics. While previous efforts have predominantly concentrated on sensory capabilities, this study introduces a hierarchical polymer system that not only structurally resembles the epidermis-dermis bilayer structure of skin but also encompasses sensing functions. The system comprises a polymeric hydrogel, representing the "dermis", and a superimposed nanoporous polymer film, forming the "epidermis". Within the film, interconnected nanoparticles mimic the arrangement of interlocked corneocytes within the epidermis. The fabrication process employs a robust in situ interfacial precipitation polymerization of specific water-soluble monomers that become insoluble during polymerization. This process yields a hybrid layer establishing a durable interface between the film and hydrogel. Beyond the structural mimicry, this hierarchical structure offers functionalities resembling human skin, which includes (1) water loss protection of hydrogel by tailoring the hydrophobicity of the upper polymer film; (2) tactile sensing capability via self-powered triboelectric nanogenerators; (3) built-in gold nanowire-based resistive sensor toward temperature and pressure sensing. This hierarchical polymeric approach represents a potent strategy to replicate both the structure and functions of human skin in synthetic designs.

Novel Chip for Applying Mechanical Forces on Human Skin Models Under Dynamic Culture Conditions

In recent years the need for in vitro skin models as a replacement for animal studies has resulted in significant progress in the development of skin-on-a-chip models. These devices allow the fine control of the microenvironment of the model and the incorporation of chemical and physical stimuli. In this study, we describe the development of an easy and low-budget open-top dynamic microfluidic device for skin-on-a-chip experiments using polydimethylsiloxane and a porous polyethylene terephthalate membrane. The chip allows the incorporation of compressive stimuli during the cultivation period by the use of syringe pumps. Proof-of-concept results show the successful differentiation of the cells and establishment of the skin structure in the chip. The microfluidic skin-on-a-chip models presented in this study can serve as a platform for future drug and feasibility studies.

Halide Perovskites-Based Diffusive Memristors for Artificial Mechano-Nociceptive System

Numerous efforts for emulating organ systems comprised of multiple functional units have driven substantial advancements in bio-realistic electronics and systems. The resistance change behavior observed in diffusive memristors shares similarities with the potential change in biological neurons. Here, the diffusive threshold switching phenomenon in Ag-incorporated organometallic halide perovskites is utilized to demonstrate the functions of afferent neurons. Halide perovskites-based diffusive memristors show a low threshold voltage of ≈0.2 V with little variation, attributed to the facile migration of Ag ions uniformly dispersed within the halide matrix. Based on the reversible and reliable volatile threshold switching, the memristors successfully demonstrate fundamental nociceptive functions including threshold firing, relaxation, and sensitization. Furthermore, to replicate the biological mechano-nociceptive phenomenon at a system level, an artificial mechano-nociceptive system is built by integrating a diffusive memristor with a force-sensing resistor. The presented system is capable of detecting and discerning the detrimental impact caused by a heavy steel ball, effectively exhibiting the corresponding sensitization response. By further extending the single nociceptive system into a 5 × 5 array, successful stereoscopic nociception of uneven impulses is achieved in the artificial skin system through array-scale sensitization. These results represent significant progress in the field of bio-inspired electronics and systems.

Microstructured Polyelectrolyte Elastomer-Based Ionotronic Sensors with High Sensitivities and Excellent Stability for Artificial Skins

High-performance flexible pressure sensors are highly demanded for artificial tactile sensing. Using ionic conductors as the dielectric layer has enabled ionotronic pressure sensors with high sensitivities owing to giant capacitance of the electric double layer (EDL) formed at the ionic conductor/electronic conductor interface. However, conventional ionotronic sensors suffer from leakage, which greatly hinders long-term stability and practical applications. Herein, a leakage-free polyelectrolyte elastomer as the dielectric layer for ionotronic sensors is synthesized. The mechanical and electrical properties of the polyelectrolyte elastomer are optimized, a micropyramid array is constructed, and it is used as the dielectric layer for an ionotronic pressure sensor with marked performances. The obtained sensor exhibits a sensitivity of 69.6 kPa-1 , a high upper detecting limit on the order of 1 MPa, a fast response/recovery speed of ≈6 ms, and excellent stability under both static and dynamic loads. Notably, the sensor retains a high sensitivity of 4.96 kPa-1 at 500 kPa, and its broad sensing range within high-pressure realm enables a brand-new coding strategy. The applications of the sensor as a wearable keyboard and a quasicontinuous controller for a robotic arm are demonstrated. Durable and highly sensitive ionotronic sensors potentialize high-performance artificial skins for soft robots, human-machine interfaces, and beyond.

High-Performance Dual-Responsive Sensing Skin Enabled by Bioinspired Transduction of Coplanar Square-Loop Electrodes

Advancements in intelligent robots and human-machine interaction necessitate a shift in artificial skins toward multimodal perception. Dual-responsive skins that can detect proximity and pressure information are significant to establishing continuous sensing of interaction processes and extending interactive application scenarios. To address the current limitations of inadequate dual-mode performance, such as limited proximal response change and low tactile sensitivity, this paper presents a bioinspired complementary gradient architecture-enabled (CGA) transduction design and a high-performance dual-responsive skin based on coplanar square-loop electrodes. Through systematic investigation into the transduction of various electrode configurations, comparative results reveal the remarkable potential of coplanar electrodes to deliver superior dual-mode performance without compromise. Simulations and experiments prove that the proposed CGA response mechanism can capture local interface deformation and overall compression signals, further enhancing response sensitivity. The final developed artificial skin is sensitive to external pressure and the approach of objects simultaneously, exhibiting a long detection distance (∼40 mm), a high proximity response (>0.4), and outstanding touch sensitivity (0.131 kPa-1). Furthermore, we demonstrate proof-of-concept applications for the proposed sensing skin in a dual-mode teleoperation interface and adaptive grasping interactions.

Histological assessment of nanostructured fibrin-agarose skin substitutes grafted in burnt patients. A time-course study

A previously developed fibrin-agarose skin model-UGRSKIN-showed promising clinical results in severely burnt patients. To determine the histological parameters associated to the biocompatibility and therapeutic effects of this model, we carried out a comprehensive structural and ultrastructural study of UGRSKIN grafted in severely burnt patients after 3 months of follow-up. The grafted epidermis was analogue to native human skin from day 30th onward, revealing well-structured strata with well-differentiated keratinocytes expressing CK5, CK8, CK10, claudin, plakoglobin, filaggrin, and involucrin in a similar way to controls, suggesting that the epidermis was able to mature and differentiate very early. Melanocytes and Langerhans cells were found from day 30th onward, together with a basement membrane, abundant hemidesmosomes and lack of rete ridges. At the dermal layer, we found an interface between the grafted skin and the host tissue at day 30th, which tended to disappear with time. The grafted superficial dermis showed a progressive increase in properly-oriented collagen fibers, elastic fibers and proteoglycans, including decorin, similarly to control dermis at day 60-90th of in vivo follow-up. Blood vessels determined by CD31 and SMA expression were more abundant in grafted skin than controls, whereas lymphatic vessels were more abundant at day 90th. These results contribute to shed light on the histological parameters associated to biocompatibility and therapeutic effect of the UGRSKIN model grafted in patients and demonstrate that the bioengineered skin grafted in patients is able to mature and differentiate very early at the epithelial level and after 60-90 days at the dermal level.

Artificial Skin Therapies; Strategy for Product Development

Significance: Tissue-engineered artificial skin for clinical reconstruction can be regarded as an established practice. Bi-layered skin equivalents are available as established allogenic or autologous therapy, and various acellular skin replacements can support tissue repair. Moreover, there is considerable commonality between the skin and other soft tissue reconstruction products. This article presents an attempt to create a comprehensive global landscape review of advanced replacement materials and associated strategies for skin and soft tissue reconstruction. Recent Advances: There has been rapid growth in the number of commercial and pre-commercial products over the past decade. In this survey, 263 base products for advanced skin therapy have been identified, across 8 therapeutic categories, giving over 350 products in total. The largest market is in the United States, followed by the E.U. zone. However, despite these advances, and the investment of resources in each product development, there are key issues concerning the clinical efficacy, cost-benefit of products, and clinical impact. Each therapeutic strategy has relative merits and limitations. Critical Issues: A critical consideration in developing and evaluating products is the therapeutic modality, associated regulatory processes, and the potential for clinical adoption geographically, determined by regulatory territory, intellectual property, and commercial distribution factors. The survey identifies an opportunity for developments that improve basic efficacy or cost-benefit. Future Directions: The economic pressures on health care systems, compounded by the demands of our increasingly ageing population, and the imperative to distribute effective health care, create an urgent global need for effective and affordable products.

Short- and Long-term Outcomes of an Acellular Dermal Substitute versus Standard of Care in Burns and Reconstructions: A Phase I/II Intrapatient Randomized Controlled Trial

OBJECTIVE

Dermal substitutes promote dermal regeneration and improve scar quality, but knowledge gaps remain regarding their efficacy and indications for use. The authors investigated the safety and short- and long-term efficacy of an acellular dermal substitute in patients with full-thickness wounds.

METHODS

This intrapatient randomized controlled, open-label, phase I (safety) and phase II (efficacy) study compared treatment with Novomaix (Matricel GmbH), a dermal collagen/elastin-based scaffold, with split-thickness skin graft (STSG) only. The primary safety outcome was graft take at 5 to 7 days postsurgery. Postsurgical scar quality was assessed by measuring elasticity, color, and scores on the Patient and Observer Scar Assessment Scale at 3 months, 12 months, and 6 years.

RESULTS

Twenty-five patients were included, of which 24 received treatment allocation. Graft take and wound healing were statistically significantly lower/delayed in the dermal matrix group compared with STSG alone (P < .004). Serious adverse events were delayed epithelialization in four dermal matrix and three STSG study areas. At 12 months postsurgery, skin extension (P = .034) and elasticity (P = .036) were better for the dermal matrix group compared with the group receiving STSG alone. Other scar quality parameters at 12 months and 6 years did not differ between treatment arms.

CONCLUSIONS

The dermal substitute was a safe treatment modality for full-thickness wounds. Compared with STSG alone, time to wound healing was slightly increased. Nevertheless, scar quality at 12 months seemed somewhat improved in the wounds treated with the dermal substitute, indicative of enhanced scar maturation. In the long term, final scar quality was similar for both treatment modalities.

A Tactile Skin System for Touch Sensing with Ultrasound Tomography

The tomographic imaging method is promising in large-area touch-sensing applications. This paper presents a new type of such touch sensor using ultrasonic tomography (UST) via sound attenuation imaging. UST is gaining popularity as a portable, fast, and inexpensive imaging system for medical and industrial applications. UST can be developed in different operation modes. A transmission mode UST is being investigated as a force- and touch-sensitive skin. A prototype skin sensor was developed in a 200 mm diameter circular UST array containing two sets of 16 transducers, with one operating at a central frequency of 40 kHz and the other at 300 kHz. The extension of the sensor in terms of dimension, up to 400 mm diameter, and number of sensors, up to 32 transducers, is possible where eight points of contact were reconstructed successfully. The medium contains a 20 mm high water region, and a soft silicone membrane covers the liquid region. When touchpoints or forces are applied to the soft skin of the membrane, the sound pathway is disrupted, resulting in an image of the touch position and touch force intensity using a tomographic UST algorithm. Several static and dynamic experiments are conducted to demonstrate this novel application of UST. In addition, a correlation analysis is carried out to establish the force quantification potential for the UST-based tactile skin.

Mechanochromic and Conductive Chiral Nematic Nanostructured Film for Bioinspired Ionic Skins

Chameleon skin is naturally adaptive and can sense environmental changes and transform sensing into bioelectrical and optical signals by manipulating ion transduction and photonic nanostructures. The increasing interest in mimicking biological skins has considerably promoted the development of advanced photonic materials with an increasing ionic conductivity. Herein, we report the judicious design and fabrication of a bioinspired mechanochromic chiral nematic nanostructured film with good ionic conductivity by infiltrating fluorine-rich ionic liquids (FILs) into a swollen self-assembled cellulose nanocrystal (CNC) film with helical nanoarchitectures. Notably, the introduction of 2-hydroxyethyl acrylate considerably enhances the compatibility of hydrophobic FILs and hydrophilic CNCs. The resulting FIL-CNC nanostructured films exhibited excellent mechanochromism, good ionic conductivity, and outstanding optical/electrical dual-signal sensing performance when used as a bioinspired ionic skin for real-time monitoring of human motions. Owing to the integration of FILs, the underwater stability of the chiral liquid crystal nanostructures of CNCs was significantly enhanced. Notably, underwater contact/contactless sensing modes and encrypted information transmission have been achieved with the FIL-CNC nanostructured film. This study can offer great insights for the advancement of biomimetic multifunctional artificial skins and emerging interactive devices, which can find important applications in wearable iontronics, human-machine interactions, and intelligent robots.

Electrospun Nanofiber-Based Bioinspired Artificial Skins for Healthcare Monitoring and Human-Machine Interaction

Artificial skin, also known as bioinspired electronic skin (e-skin), refers to intelligent wearable electronics that imitate the tactile sensory function of human skin and identify the detected changes in external information through different electrical signals. Flexible e-skin can achieve a wide range of functions such as accurate detection and identification of pressure, strain, and temperature, which has greatly extended their application potential in the field of healthcare monitoring and human-machine interaction (HMI). During recent years, the exploration and development of the design, construction, and performance of artificial skin has received extensive attention from researchers. With the advantages of high permeability, great ratio surface of area, and easy functional modification, electrospun nanofibers are suitable for the construction of electronic skin and further demonstrate broad application prospects in the fields of medical monitoring and HMI. Therefore, the critical review is provided to comprehensively summarize the recent advances in substrate materials, optimized fabrication techniques, response mechanisms, and related applications of the flexible electrospun nanofiber-based bio-inspired artificial skin. Finally, some current challenges and future prospects are outlined and discussed, and we hope that this review will help researchers to better understand the whole field and take it to the next level.

Multiparametric Quantitative Analysis of Photodamage to Skin Using Optical Coherence Tomography

Ultraviolet (UV) irradiation causes 90% of photodamage to skin and long-term exposure to UV irradiation is the largest threat to skin health. To study the mechanism of UV-induced photodamage and the repair of sunburnt skin, the key problem to solve is how to non-destructively and continuously evaluate UV-induced photodamage to skin. In this study, a method to quantitatively analyze the structural and tissue optical parameters of artificial skin (AS) using optical coherence tomography (OCT) was proposed as a way to non-destructively and continuously evaluate the effect of photodamage. AS surface roughness was achieved based on the characteristic peaks of the intensity signal of the OCT images, and this was the basis for quantifying AS cuticle thickness using Dijkstra's algorithm. Local texture features within the AS were obtained through the gray-level co-occurrence matrix method. A modified depth-resolved algorithm was used to quantify the 3D scattering coefficient distribution within AS based on a single-scattering model. A multiparameter assessment of AS photodamage was carried out, and the results were compared with the MTT experiment results and H&E staining. The results of the UV photodamage experiments showed that the cuticle of the photodamaged model was thicker (56.5%) and had greater surface roughness (14.4%) compared with the normal cultured AS. The angular second moment was greater and the correlation was smaller, which was in agreement with the results of the H&E staining microscopy. The angular second moment and correlation showed a good linear relationship with the UV irradiation dose, illustrating the potential of OCT in measuring internal structural damage. The tissue scattering coefficient of AS correlated well with the MTT results, which can be used to quantify the damage to the bioactivity. The experimental results also demonstrate the anti-photodamage efficacy of the vitamin C factor. Quantitative analysis of structural and tissue optical parameters of AS by OCT enables the non-destructive and continuous detection of AS photodamage in multiple dimensions.

Bioconversion of retinol and its cell barrier function in human immortalized keratinocytes cells and artificial epidermis-dermis skin

The current study aimed to characterize cellular uptake and bioconversion of retinol in fully differentiated human immortalized keratinocytes cells (HaCaT) and artificial skin by measuring the cell integrity of skin barriers, time-dependent transport of retinol, and bioconversion to its metabolites. The expression of epidermal differentiation related genes including Keratin 1 (KRT1), Keratin 10 (KRT10), and Involucrin (IVL) significantly increased in differentiated HaCaT. TEER of HaCaT did not decrease after incubating retinol compared to control (p > 0.05), indicating that retinol tends to maintain strength and integrity of epidermal barrier. TEER of artificial skin decreased treatment of retinol for 2 h, but it was recovered after 4 h. During retinol transport, metabolite was eluted at 13.37 and 13.82 min of basal medium of both keratinocytes and artificial skin, which was identified as retinoic acid by product ion of m/z 283.47. Retinol appeared to be accumulated in keratinocytes, but its uptake tends to be reduced in a time-dependent manner. Retinoic acid converted from retinol in keratinocytes was time dependently transported. In case of artificial skin, retinol was mostly found in apical at initial incubation time, but it was reduced during incubation for 24 h. Retinoic acid was time-dependently found in a basal, which was converted via epidermis-dermis. Results from the current study suggest that topical application of retinol to human skin optimal concentration and time exposure could maintain epidermal barrier function and promote skin function due to its remarkable bioconversion to retinoic acid in the epidermis-dermis.

Advances in Spinal Cord Stimulation

Neuromodulation, specifically spinal cord stimulation (SCS), has become a staple of chronic pain management for various conditions including failed back syndrome, chronic regional pain syndrome, refractory radiculopathy, and chronic post operative pain. Since its conceptualization, it has undergone several advances to increase safety and convenience for patients and implanting physicians. Current research and efforts are aimed towards novel programming modalities and modifications of existing hardware. Here we review the recent advances and future directions in spinal cord stimulation including a brief review of the history of SCS, SCS waveforms, new materials for SCS electrodes (including artificial skins, new materials, and injectable electrodes), closed loop systems, and neurorestorative devices.

Soft, Super-Elastic, All-Polymer Piezoelectric Elastomer for Artificial Electronic Skin

Piezoelectric sensors are widely used in wearable devices to mimic the functions of human skin. However, it is considerably challenging to develop soft piezoelectric materials that can exhibit high sensitivity, stretchability, super elasticity, and suitable modulus. In this study, a soft skin-like piezoelectric polymer elastomer composed of poly(vinylidene fluoride) (PVDF) and a novel elastic substrate polyacrylonitrile is prepared by combining the radical polymerization and freeze-drying processes. Dipole-dipole interaction results in the phase transition of PVDF (α phase to β phase), which enhances the electrical and mechanical performances. Thus, we achieve a high piezoelectric coefficient (d_33max = 63 pC/N), good stretchability (211.3-259.3%), super compressibility (subjected to 99% compression strain without cracking), and super elasticity (100% recovery after extreme compression) simultaneously for the elastomer. The soft composite elastomer produces excellent electrical signal output (V_ocmax = 253 mV) and responds rapidly (15 ms) to stress-induced polarization effects. In addition, the elastomer-based sensor accurately detects various physiological signals such as gestures, throat vibrations, and pulse waves. The developed elastomers exhibit excellent mechanical properties and high sensitivity, which helps facilitate their application as artificial electronic skin to sense subtle external pressure in real time.

Design, Fabrication and Characterisation of Multi-Parameter Optical Sensors Dedicated to E-Skin Applications

For many years there has been a strong research interest in soft electronics for artificial skin applications. However, one challenge with stretchable devices is the limited availability of high performance, stretchable, electrical conductors and semiconductors that remain stable under strain. Examples of such electronic skin require excessive amounts of wires to address each sensing element-compression force and strain-in a conventional matrix structure. Here, we present a new process for fabricating artificial skin consisting of an optical waveguide architecture, enabling wide ranging sensitivity to external mechanical compression and strain. The manufacturing process allows design of a fully stretchable polydimethylsiloxane elastomer waveguide with embedded gratings, replicated from low cost DVD-Rs. This optical artificial skin allows the detection of compression forces from 0 to 3.8 N with controllable sensitivity. It also permits monitoring of elongation deformations up to 135%. This type of stretchable optical sensor is highly robust, transparent, and presents a large sensing area while limiting the amount of wires connecting to the sensor. Thus, this optical artificial skin presents far superior mechanical properties compared to current electronic skin.

Self-Powered Gradient Hydrogel Sensor with the Temperature-Triggered Reversible Adhension

The skin, as the largest organ of human body, can use ions as information carriers to convert multiple external stimuli into biological potential signals. So far, artificial skin that can imitate the functionality of human skin has been extensively investigated. However, the demand for additional power, non-reusability and serious damage to the skin greatly limits applications. Here, we have developed a self-powered gradient hydrogel which has high temperature-triggered adhesion and room temperature-triggered easy separation characteristics. The self-powered gradient hydrogels are polymerized using 2-(dimethylamino) ethyl metharcylate (DMAEMA) and N-isopropylacrylamide (NIPAM) under unilateral UV irradiation. The prepared hydrogels achieve good adhesion at high temperature and detachment at a low temperature. In addition, according to the thickness-dependent potential of the gradient hydrogel, the hydrogels can also sense pressure changes. This strategy can inspire the design and manufacture of self-powered gradient hydrogel sensors, contributing to the development of complex intelligent artificial skin sensing systems in the future.

Using Novel Multi-Frequency Analysis Methods to Retrieve Material and Temperature Information in Tactile Sensing Areas

This article presents a novel artificial skin technology based on the Electric Impedance Tomography (EIT) that employs multi-frequency currents for detecting the material and the temperature of objects in contact with piezoresistive sheets. To date, few artificial skins in the literature are capable of detecting an object's material, e.g., wood, skin, leather, or plastic. EIT-based artificial skins have been employed mostly to detect the position of the contact but not its characteristics. Thanks to multi-frequency currents, our EIT-based artificial skin is capable of characterising the spectral profile of objects in contact and identifying an object's material at ambient temperature. Moreover, our model is capable of detecting several levels of temperature (from -10 up to 60 °C) and can also maintain a certain accuracy for material identification. In addition to the known capabilities of EIT-based artificial skins concerning detecting pressure and location of objects, as well as being low cost, these two novel modalities demonstrate the potential of EIT-based artificial skins to achieve global tactile sensing.

An Integrated 3D Hydrophilicity/Hydrophobicity Design for Artificial Sweating Skin (i-TRANS) Mimicking Human Body Perspiration

Artificial skins reproducing properties of human skin are emerging and significant for study in various areas, such as robotics, medicine, and textiles. Perspiration, as one of the most imperative thermoregulation functions of human skin, is gaining increasing attention, but how to realize ideal artificial skin for perspiration simulation remains challenging. Here, an integrated 3D hydrophilicity/hydrophobicity design is proposed for artificial sweating skin (i-TRANS). Based on normal fibrous wicking materials, the selective surface modification with gradient of poly(dimethylsiloxane) (PDMS) creates hydrophilicity/hydrophobicity contrast in both lateral and vertical directions. With the additional help of bottom hydrophilic Nylon 6 nanofibers, the constructed i-TRANS is able to transport "sweat" directionally without trapping undesired excess water and attain uniform "secretion" of sweat droplets on the top surface, decently mimicking human skin perspiration situation. This fairly comparable simulation not only presents new insights for replicating skin properties, but also provides proper in vitro testing platforms for perspiration-relevant research, greatly avoiding unwanted interference from the "skin" layer. In addition, the facile, fast, and cost-effective fabrication approach and versatile usage of i-TRANS can further facilitate its application.

Effect of artificial skin membrane on the expression of miR-155 and miR-506-3p in patients with second-degree burns

OBJECTIVE

To investigate the effect of artificial skin on the expression of miR-155 and miR-506-3p in patients with second-degree burns.

METHODS

The study subjects included 50 patients with second-degree burns treated from July 2019 to July 2021. The control group received routine nursing, while the research group received both routine and artificial skin intervention simultaneously. The changes in wound tissue fibrosis and prognosis were observed. The expression levels of miR-155 and miR-506-3p and their downstream regulatory factors were detected and correlated with the rehabilitation of patients after artificial skin treatment.

RESULTS

After treating second-degree burns with artificial skin membranes, the patient's wound tissue fibrosis and inflammation level improved. At the same time, the expression levels of miR-155 and miR-506-3p in related tests were higher than those in patients with available treatment.

CONCLUSION

The effect of artificial skin membrane on the wound healing of second-degree burn patients may be realized by influencing the expression levels of miR-155 and miR-506-3p and their related signaling pathways.

Proteinic Artificial Skin with Molecularly Encoded Coloration

An ability to integrate adaptive coloration and tissue-like compositions, structures, as well as mechanical properties, and so forth into a material remains elusive. To address this problem, this work presents a solution whereby these features were integrated into a proteinic artificial skin through biomimetic design. In this artificial skin, silk fibroin was used to mimic the structural framework of the cytoskeleton due to its unique molecular network structure and outstanding and tunable mechanical properties. Meanwhile, a thermochromic filamentous network consisting of C₂₅-GAGAGAGY amphiphilic peptides was designed to mimic the functional tracks in the cytoskeleton, enabling its temperature-adaptive coloration ability. The interconnected linkage between the structural frame and functional units makes this artificial skin have stable structures, mechanical properties, and functions. The whole protein composition also makes this artificial skin essentially different from other existing color-tunable artificial skins, which are a combination of organic and inorganic compounds. Furthermore, because the protein composition is compatible with a range of dyes, the chromatic gamut of adaptive coloration of the developed artificial skin can be further expanded by color fusion. With the further inclusion of other functional units, such as photothermal and magnetothermal nanoparticles, the thermochromism of the artificial skin could be realized through sun exposure and alternating magnetic field modulation. With this diversity in color change pathways and stimulation mode, as well as the environmental friendliness of the material used, these artificial proteinic skins have promising applications as sensors in physiological monitoring, food preservation, and anti-counterfeiting.

Tactile Sensing Using Magnetic Foam

For biomedical applications, smart materials that are used as sensors or actuators have to match some criteria, especially bio-compatibility and softness. Smart polymers are candidates that fulfill these two criteria. A sensitivity to compression is created by adding magnetic particles to a compressible foam polymer. A foam-based composite is fabricated for its small Poisson’s ratio, which enables significant compression, up to 50%. This large compression induces a change in its magnetic properties, which can be detected using coils. By setting the sensing coils as a compact array of 3 × 3, the sensor successfully detected and localized an applied deformation.

Negative pressure wound therapy, artificial skin and autogenous skin implantation in diabetic foot ulcers

OBJECTIVE

Diabetic foot ulcers (DFUs) are one of the most serious diabetic consequences, leading to amputations. Various therapies have been used to treat DFUs; however, a combination of negative pressure suction, artificial skin and autogenous skin implantation have never been investigated. This study aimed to evaluate the effectiveness of a novel three-step therapy protocol using negative pressure wound therapy (NPWT), artificial skin and autogenous skin implantation in patients with DFUs.

METHOD

At a single tertiary university hospital between 2015 and 2018, the three-step therapy protocol was applied to patients with DFUs and its safety and efficacy was investigated.

RESULTS

A total of 21 patients took part in the study. The majority of the patients were female (62%), with a mean age of 65 years and a mean body mass index of 21kg/m². A third (n=7) of operative sites experienced minor complications, with two requiring re-operation. At a median follow up of 24 months, the average time of complete wound healing was 46 days, and the wound healing rate was 71%. The first-stage wound healing rate was 90%. All patients had achieved remission without any further recurrence of disease.

CONCLUSION

This comprehensive surgical technique for managing DFUs achieved a high local cure rate, minimal functional morbidity, and acceptable wound complication rates. The three-step therapy protocol has the potential to promote the healing process of DFUs, which is expected to serve as a new method for the treatment and cure of DFUs.

Tough and Degradable Self-Healing Elastomer from Synergistic Soft-Hard Segments Design for Biomechano-Robust Artificial Skin

Increasing biomechanical applications of skin-inspired devices raise higher requirements for the skin-bionic robustness and environmental compatibility of elastomers. Here, a tough and degradable self-healing elastomer (TDSE) is developed by a synergistic soft-hard segments design. The polyester/polyether copolymer is introduced in soft segments to endow TDSE with flexibility and degradability. The two isomeric diamines are regulated in hard segments for elevating the toughness and fracture energy to 82.38 MJ/m³ and 43299 J/m² and autonomous self-healing ability with 93% efficiency in 7 h for the TDSE. Employing TDSE and ionic liquid, a biomechano-robust artificial skin (BA-skin) is constructed with a stretch-insensitive mechanosensation capability during 50% cyclic stretching. The BA-skin has high biomechano-robustness to bear tear damage and good environmental compatibility with total decomposability in a lipase solution. This work provides a molecular design guideline for high-performance skin-bionic elastomers for applications in skin-inspired devices.

A Phase Inversion-Based Microfluidic Fabrication of Helical Microfibers towards Versatile Artificial Abdominal Skin

Microfluidic spinning technology (MST), incorporating microfluidics with chemical reactions, has gained considerable interest for constructing anisotropic advanced microfibers, especially helical microfibers. However, these efforts suffer from the limited material choices, restricting their applications. Here, a new phase inversion-based microfluidic spinning (PIMS) method is proposed for producing helical microfibers. This method undergoes a physicochemical phase inversion process, which is capable of efficiently manufacturing strong (tensile stress of more than 25 MPa), stretchable, flexible and biocompatible helical microfibers. The helical microfibers can be used to fabricate bi-oriented stretchable artificial abdominal skin, preventing incisional hernia formation and promoting the wound healing without conglutination. This research not only offers a universal approach to design helical microfibers but also provides a new insight into artificial skin.

Percutaneous fetoscopic spina bifida repair: effect on ambulation and need for postnatal cerebrospinal fluid diversion and bladder catheterization

OBJECTIVE

A trial comparing prenatal with postnatal open spina bifida (OSB) repair established that prenatal surgery was associated with better postnatal outcome. However, in the trial, fetal surgery was carried out through hysterotomy. Minimally invasive approaches are being developed to mitigate the risks of open maternal-fetal surgery. The objective of this study was to investigate the impact of a novel neurosurgical technique for percutaneous fetoscopic repair of fetal OSB, the skin-over-biocellulose for antenatal fetoscopic repair (SAFER) technique, on long-term postnatal outcome.

METHODS

This study examined descriptive data for all patients undergoing fetoscopic OSB repair who had available 12- and 30-month follow-up data for assessment of need for cerebrospinal fluid (CSF) diversion and need for bladder catheterization and ambulation, respectively, from eight centers that perform prenatal OSB repair via percutaneous fetoscopy using a biocellulose patch between the neural placode and skin/myofascial flap, without suture of the dura mater (SAFER technique). Univariate and multivariate logistic regression analyses were used to examine the effect of different factors on need for CSF diversion at 12 months and ambulation and need for bladder catheterization at 30 months. Potential cofactors included gestational age at fetal surgery and delivery, preoperative ultrasound findings of anatomical level of the lesion, cerebral lateral ventricular diameter, lesion type and presence of bilateral talipes, as well as postnatal findings of CSF leakage at birth, motor level, presence of bilateral talipes and reversal of hindbrain herniation.

RESULTS

A total of 170 consecutive patients with fetal OSB were treated prenatally using the SAFER technique. Among these, 103 babies had follow-up at 12 months of age and 59 had follow-up at 30 months of age. At 12 months of age, 53.4% (55/103) of babies did not require ventriculoperitoneal shunt or third ventriculostomy. At 30 months of age, 54.2% (32/59) of children were ambulating independently and 61.0% (36/59) did not require chronic intermittent catheterization of the bladder. Multivariate logistic regression analysis demonstrated that significant prediction of need for CSF diversion was provided by lateral ventricular size and type of lesion (myeloschisis). Significant predictors of ambulatory status were prenatal bilateral talipes and anatomical and functional motor levels of the lesion. There were no significant predictors of need for bladder catheterization.

CONCLUSION

Children who underwent prenatal OSB repair via the percutaneous fetoscopic SAFER technique achieved long-term neurological outcomes similar to those reported in the literature after hysterotomy-assisted OSB repair. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Therapeutic Efficacy of Artificial Skin Produced by 3D Bioprinting

The skin protects the body from external barriers. Certain limitations exist in the development of technologies to rapidly prepare skin substitutes that are therapeutically effective in surgeries involving extensive burns and skin transplantation. Herein, we fabricated a structure similar to the skin layer by using skin-derived decellularized extracellular matrix (dECM) with bioink, keratinocytes, and fibroblasts using 3D-printing technology. The therapeutic effects of the produced skin were analyzed using a chimney model that mimicked the human wound-healing process. The 3D-printed skin substitutes exhibited rapid re-epithelialization and superior tissue regeneration effects compared to the control group. These results are expected to aid the development of technologies that can provide customized skin-replacement tissues produced easily and quickly via 3D-printing technology to patients.

Automatic quantitative analysis of structure parameters in the growth cycle of artificial skin using optical coherence tomography

SIGNIFICANCE

Artificial skin (AS) is widely used in dermatology, pharmacology, and toxicology, and has great potential in transplant medicine, burn wound care, and chronic wound treatment. There is a great demand for high-quality AS product and a non-invasive detection method is highly desirable.

AIM

To quantify the constructure parameters (i.e., thickness and surface roughness) of AS samples in the culture cycle and explore the growth regularities using optical coherent tomography (OCT).

APPROACH

An adaptive interface detection algorithm is developed to recognize surface points in each A-scan, offering a rapid method to calculate parameters without constructing OCT B-scan pictures and further achieving realizing real-time quantification of AS thickness and surface roughness. Experiments on standard roughness plates and H&E-staining microscopy were performed as a verification.

RESULTS

As applied on the whole cycle of AS culture, our method's results show that during the air-liquid culture, the surface roughness of the skin first decreases and then exhibits an increase, which implies coincidence with the degree of keratinization under a microscope. And normal and typical abnormal samples can be differentiated by thickness and roughness parameters during the culture cycle.

CONCLUSIONS

The adaptive interface detection algorithm is suitable for high-sensitivity, fast detection, and quantification of the interface with layered characteristic tissues, and can be used for non-destructive detection of the growth regularity of AS sample thickness and roughness during the culture cycle.

Design and Fabrication of Sodium Alginate/Carboxymethyl Cellulose Sodium Blend Hydrogel for Artificial Skin

Tissue-engineered skin grafts have long been considered to be the most effective treatment for large skin defects. Especially with the advent of 3D printing technology, the manufacture of artificial skin scaffold with complex shape and structure is becoming more convenient. However, the matrix material used as the bio-ink for 3D printing artificial skin is still a challenge. To address this issue, sodium alginate (SA)/carboxymethyl cellulose (CMC-Na) blend hydrogel was proposed to be the bio-ink for artificial skin fabrication, and SA/CMC-Na (SC) composite hydrogels at different compositions were investigated in terms of morphology, thermal properties, mechanical properties, and biological properties, so as to screen out the optimal composition ratio of SC for 3D printing artificial skin. Moreover, the designed SC composite hydrogel skin membranes were used for rabbit wound defeat repairing to evaluate the repair effect. Results show that SC4:1 blend hydrogel possesses the best mechanical properties, good moisturizing ability, proper degradation rate, and good biocompatibility, which is most suitable for 3D printing artificial skin. This research provides a process guidance for the design and fabrication of SA/CMC-Na composite artificial skin.

A Frequency Modulation-Based Taxel Array: A Bio-Inspired Architecture for Large-Scale Artificial Skin

This work introduces an array prototype based on a Frequency Modulation (FM) encoding architecture to transfer multiple sensor signals on a single wire. The use case presented adopts Hall-effect sensors as an example to represent a much larger range of sensor types (e.g., proximity and temperature). This work aims to contribute to large area artificial skin systems which are a key element to enhance robotic platforms. Artificial skin will allow robotic platforms to have spatial awareness which will make interaction with objects and users safe. The FM-based architecture has been developed to address limitations in large-scale artificial skin scalability. Scalability issues include power requirements; number of wires needed; as well as frequency, density, and sensitivity bottlenecks. In this work, eight sensor signals are simultaneously acquired, transferred on a single wire and decoded in real-time. The overall taxel array current consumption is 36 mA. The work experimentally validates and demonstrates that different input signals can be effectively transferred using this approach minimizing wiring and power consumption of the taxel array. Four different tests using single as well as multiple stimuli are presented. Observations on performances, noise, and taxel array behaviour are reported. The results show that the taxel array is reliable and effective in detecting the applied stimuli.

Carbon/Silicone Nanocomposite-Enabled Soft Pressure Sensors with a Liquid-Filled Cell Structure Design for Low Pressure Measurement

In the fields of humanoid robots, soft robotics, and wearable electronics, the development of artificial skins entails pressure sensors that are low in modulus, high in sensitivity, and minimal in hysteresis. However, few sensors in the literature can meet all the three requirements, especially in the low pressure range (<10 kPa). This article presents a design for such pressure sensors. The bioinspired liquid-filled cell-type structural design endows the sensor with appropriate softness (Young's modulus < 230 kPa) and high sensitivity (highest at 0.7 kPa-1) to compression forces below 0.65 N (6.8 kPa). The low-end detection limit is ~0.0012 N (13 Pa), only triple the mass of a bee. Minimal resistance hysteresis of the pressure sensor is 7.7%. The low hysteresis is attributed to the study on the carbon/silicone nanocomposite, which reveals the effect of heat treatment on its mechanical and electromechanical hysteresis. Pressure measurement range and sensitivity of the sensor can be tuned by changing the structure and strain gauge parameters. This concept of sensor design, when combined with microfluidics technology, is expected to enable soft, stretchable, and highly precise touch-sensitive artificial skins.

Microwave-Assisted Synthesis of Stretchable and Transparent Poly(Ethyleneglycol-Sebacate) Elastomers with Autonomous Self-Healing and Capacitive Properties

Introducing functional synthetic biomaterials to the literature became quite essential in biomedical technologies. For the growth of novel biomedical engineering approaches, progressive functional properties as well as the robustness of the manufacturing processes are essential. By using acid-induced epoxide ring-opening polymerizations through catalysts, a wide variety of biodegradable and functionalized biomaterials can be synthesized. Sebacic acid (SA) and poly(ethylene glycol) diglycidyl ether (PEGDGE) are amongst the FDA-approved biocompatible materials. In this study, we focused on the rapid synthesis of caffeine-catalyzed self-healable elastomer via a facile microwave-assisted synthesis route. The elastomer prepared can be used in various applications, including tactile sensors, wearable electronics, and soft robotics. SA and PEGDGE were catalyzed in the presence of caffeine under microwave irradiation followed by crosslinking in vacuo, yielding an elastomeric material. The chemical characterizations of the obtained elastomer were carried out. The resulting material is transparent, highly stretchable, and has capacitive and self-healing properties even at room temperature. The material developed can be easily applied for the aforementioned applications.

Artificial Skin Perception

Skin is the largest organ, with the functionalities of protection, regulation, and sensation. The emulation of human skin via flexible and stretchable electronics gives rise to electronic skin (e-skin), which has realized artificial sensation and other functions that cannot be achieved by conventional electronics. To date, tremendous progress has been made in data acquisition and transmission for e-skin systems, while the implementation of perception within systems, that is, sensory data processing, is still in its infancy. Integrating the perception functionality into a flexible and stretchable sensing system, namely artificial skin perception, is critical to endow current e-skin systems with higher intelligence. Here, recent progress in the design and fabrication of artificial skin perception devices and systems is summarized, and challenges and prospects are discussed. The strategies for implementing artificial skin perception utilize either conventional silicon-based circuits or novel flexible computing devices such as memristive devices and synaptic transistors, which enable artificial skin to surpass human skin, with a distributed, low-latency, and energy-efficient information-processing ability. In future, artificial skin perception would be a new enabling technology to construct next-generation intelligent electronic devices and systems for advanced applications, such as robotic surgery, rehabilitation, and prosthetics.

Recent Impact of Microfluidics on Skin Models for Perspiration Simulation

Skin models offer an in vitro alternative to human trials without their high costs, variability, and ethical issues. Perspiration models, in particular, have gained relevance lately due to the rise of sweat analysis and wearable technology. The predominant approach to replicate the key features of perspiration (sweat gland dimensions, sweat rates, and skin surface characteristics) is to use laser-machined membranes. Although they work effectively, they present some limitations at the time of replicating sweat gland dimensions. Alternative strategies in terms of fabrication and materials have also showed similar challenges. Additional research is necessary to implement a standardized, simple, and accurate model representing sweating for wearable sensors testing.

Microfluidic Skin-on-a-Chip Models: Toward Biomimetic Artificial Skin

The role of skin in the human body is indispensable, serving as a barrier, moderating homeostatic balance, and representing a pronounced endpoint for cosmetics and pharmaceuticals. Despite the extensive achievements of in vitro skin models, they do not recapitulate the complexity of human skin; thus, there remains a dependence on animal models during preclinical drug trials, resulting in expensive drug development with high failure rates. By imparting a fine control over the microenvironment and inducing relevant mechanical cues, skin-on-a-chip (SoC) models have circumvented the limitations of conventional cell studies. Enhanced barrier properties, vascularization, and improved phenotypic differentiation have been achieved by SoC models; however, the successful inclusion of appendages such as hair follicles and sweat glands and pigmentation relevance have yet to be realized. The present Review collates the progress of SoC platforms with a focus on their fabrication and the incorporation of mechanical cues, sensors, and blood vessels.

STAT3 signalling pathway is implicated in keloid pathogenesis by preliminary transcriptome and open chromatin analyses

Keloids are wounding-induced fibroproliferative human tumor-like skin scars of complex genetic makeup and poorly defined pathogenesis. To reveal dynamic epigenetic and transcriptome changes of keloid fibroblasts, we performed RNA-seq and ATAC-seq analysis on an early passage keloid fibroblast cell strain and its paired normal control fibroblasts. This keloid strain produced keloid-like scars in a plasma clot-based skin equivalent humanized keloid animal model. RNA-seq analysis reveals gene ontology terms including hepatic fibrosis, Wnt-β-catenin, TGF-β, regulation of epithelial-mesenchymal transition (EMT), STAT3 and adherens junction. ATAC-seq analysis suggests STAT3 signalling is the most significantly enriched gene ontology term in keloid fibroblasts, followed by Wnt signalling (Wnt5) and regulation of the EMT pathway. Immunohistochemistry confirms that STAT3 (Tyr705 phospho-STAT3) is activated and β-catenin is up-regulated in the dermis of keloid clinical specimens and keloid skin equivalent implants from the humanized mouse model. A non-linear dose-response of cucurbitacin I, a selective JAK2/STAT3 inhibitor, in collagen type I expression of keloid-derived plasma clot-based skin equivalents implicates a likely role of STAT3 signalling in keloid pathogenesis. This work also demonstrates the utility of the recently established humanized keloid mouse model in exploring the mechanism of keloid formation.

Complex approach to skin repair in an extensively burned child: a case study

The limited amount of donor sites and loss of dermis are major challenges in the therapy of extensively burned patients. Here, we present a complex treatment approach of an eight-year-old boy with full-thickness burns on 90% of the total body surface area, using simple and efficient techniques of tissue engineering. To obtain sufficient skin for grafting we repeatedly harvested the same anatomical areas. Acceleration of donor site healing was achieved by treatment with a suspension of noncultured autologous skin cells (NASC) and acellular porcine dermis (Xe-Derma (XD), Czech Republic). Moreover, such wound management allowed up to six reharvestings, compared with one-to-three procedures following routine treatment. Bilayer Integra template (Integra LifeSciences Corp., US) was used as the dermal substitute in over 60% of full-thickness burns. Following successful vascularisation of the neodermis in 3-4 weeks, the templates were covered with meshed split-thickness skin grafts (STSG), or Meek autografts, and facilitated by NASC/XD. We may conclude that such a 'sandwich' technique approach, combining four biological covers (Integra, STSG, NASC and XD), significantly contributed to the successful skin repair of the patient.

PVDF-TrFE-Based Stretchable Contact and Non-Contact Temperature Sensor for E-Skin Application

Development of stretchable electronics has been driven by key applications such as electronics skin for robotic or prosthetic. Mimicking skin functionalities imposes at a minimal level: stretchability, pressure, and temperature sensing capabilities. While the research on pressure sensors for artificial skin is extensive, stretchable temperature sensors remain less explored. In this work, a stretchable temperature and infrared sensor has been developed on a polydimethylsiloxane substrate. The sensor is based on poly(vinylidene fluoride-trifluoroethylene) (PVDF-TrFE) as a pyroelectric material. This material is sandwiched between two electrodes. The first one consists of aluminium serpentines, covered by gold in order to get electrical contact and maximum stretchability. The second one is based on poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate) (PEDOT:PSS) that has shown good electrical compatibility with PVDF-TrFE and provides the stretchability of the top electrode. Without poling the PVDF-TrFE, sensor has shown a sensitivity of around 7 pF.°C-1 up to 35% strain without any change in its behaviour. Then, taking advantage on infrared absorption of PEDOT:PSS, a poled device has shown a pyroelectric peak of 13 mV to an infrared illumination of 5 mW at 830 nm. This stretchable device valuably allows an electronic skin (e-skin) use for contact and more importantly non-contact thermal sensing.

One-component waterborne in vivo cross-linkable polysiloxane coatings for artificial skin

Polysiloxane-based artificial skins are able to emulate the mechanical and barrier performance of human skin. However, they are usually fabricated in vitro, restricting their diverse applications on human body. Herein, we presented one-component waterborne cross-linkable polysiloxane coatings prepared from emulsified vinyl dimethicone, emulsified hydrogen dimethicone, and Karstedt catalyst capsules that were first synthesized by solvent evaporation method. The coating had good storage stability and meanwhile could form an elastic film quickly through merging of silicone oil droplets and subsequent hydrosilylation reaction. It was found that the mass ratio of vinyl dimethicone emulsion/hydrogen dimethicone emulsion (V/H), and the dosage of Karstedt catalyst capsules (K/(V + H)) were critical to the curing time, morphology, and mechanical properties of the coatings. With appropriate values of V/H and K/(V + H), the polysiloxane film had the mechanical performance comparable to that from solvent-based one. The coating could be topically applied to human skin in vivo and in situ turned into an elastic, invisible thin film with good water resistance. In contrast to those reported polysiloxane materials, the one-component waterborne polysiloxane coating was nontoxic and convenient for in vivo application on human body, making it be a promising candidate as artificial skin in the fields of cosmetics, medical treatment, and E-skin.

Contribution of Palmitic Acid to Epidermal Morphogenesis and Lipid Barrier Formation in Human Skin Equivalents

The outermost barrier layer of the skin is the stratum corneum (SC), which consists of corneocytes embedded in a lipid matrix. Biosynthesis of barrier lipids occurs de novo in the epidermis or is performed with externally derived lipids. Hence, in vitro developed human skin equivalents (HSEs) are developed with culture medium that is supplemented with free fatty acids (FFAs). Nevertheless, the lipid barrier formation in HSEs remains altered compared to native human skin (NHS). The aim of this study is to decipher the role of medium supplemented saturated FFA palmitic acid (PA) on morphogenesis and lipid barrier formation in HSEs. Therefore, HSEs were developed with 100% (25 μM), 10%, or 1% PA. In HSEs supplemented with reduced PA level, the early differentiation was delayed and epidermal activation was increased. Nevertheless, a similar SC lipid composition in all HSEs was detected. Additionally, the lipid organization was comparable for lamellar and lateral organization, irrespective of PA concentration. As compared to NHS, the level of monounsaturated lipids was increased and the FFA to ceramide ratio was drastically reduced in HSEs. This study describes the crucial role of PA in epidermal morphogenesis and elucidates the role of PA in lipid barrier formation of HSEs.

A histological analysis of artificial skin in an extensively burned child, 14 years after application: a case report

INTRODUCTION

Artificial skin has become the treatment of choice in extensive, full-thickness thermal injuries. The longest follow-up of the healing process in burn sites covered with the Integra Bilayer Matrix Wound Dressing onto the wound published to date was at around five years after application. In our case report, we describe the clinical and histological analysis of an extensive, full-thickness thermal injury 14 years on from treatment with the bilayer matrix wound dressing.

CASE STUDY

A nine-year-old boy suffered a full-thickness skin loss over 85% of his body surface area following a fire accident. The bilayer matrix wound dressing was used on both legs and covered almost 30% of his body surface area. Cosmetic and functional results were satisfactory. Histological analysis performed nine years after the application of the bilayer matrix wound dressing onto the wound showed a double-layered skin composition with changes in the fibrous component of the dermis.

CONCLUSION

Despite satisfactory short- and long-term clinical results from applications of the bilayer matrix wound dressing, we found important differences in microstructure when compared with the physiological condition.

Reconstruction of Nasal Defects With Dermal Skin Substitutes-A Retrospective Study of 36 Defects

OBJECTIVES

It is uncertain whether dermal regeneration templates (DRTs) are helpful to reconstruct nasal defects. The aim of this study was to assess whether the aesthetic subunits determine the outcome.

METHODS

In this unicentric, retrospective study, the surgical procedures and outcomes of patients who received DRTs to reconstruct nasal defects were assessed and compared with the involved aesthetic subunits.

RESULTS

DRTs were used for reconstruction of 36 nasal defects in 35 patients with involvement of 76 aesthetic subunits: nasal sidewall (n = 21), nasal ala (n = 13), nasal tip/columella (n = 12, n = 1, respectively), nasal dorsum (n = 12), and extranasal aesthetic areas (n = 17). Fifty-eight nasal and 8 extranasal aesthetic subunits were reconstructed with DRTs, 10 subunits with a flap. Twenty-nine of 36 defects healed without any complications (80.5%). All reconstructed nasal tips/columella and the nasal dorsa healed without any complications. Region-specific complications were retraction of the ala rim (4/12; 33.3% of the patients with involvement of the nasal ala) and the formation of a fistula in the nasal sidewall (1/21; 4.8%). Region-specific complications of extranasal subunits were the development of an ectropium (2/3; 66.7% of the patients with involvement of the lower lid).

CONCLUSIONS

DRTs can be helpful to reconstruct nasal defects. However, if the defect involves the aesthetic subunits nasal ala or the infraorbital region, different techniques should be preferred.

Characterization of human skin equivalents developed at body's core and surface temperatures

Human skin equivalents (HSEs) are in vitro developed three‐dimensional models resembling native human skin (NHS) to a high extent. However, the epidermal lipid biosynthesis, barrier lipid composition, and organization are altered, leading to an elevated diffusion rate of therapeutic molecules. The altered lipid barrier formation in HSEs may be induced by standardized culture conditions, including a culture temperature of 37°C, which is dissimilar to skin surface temperature. Therefore, we aim to determine the influence of culture temperature during the generation of full thickness models (FTMs) on epidermal morphogenesis and lipid barrier formation. For this purpose, FTMs were developed at conventional core temperature (37°C) or lower temperatures (35°C and 33°C) and evaluated over a time period of 4 weeks. The stratum corneum (SC) lipid composition was analysed using advanced liquid chromatography coupled to mass spectrometry analysis. Our results show that SC layers accumulated at a similar rate irrespective of culture temperature. At reduced culture temperature, an increased epidermal thickness, a disorganization of the lower epidermal cell layers, a delayed early differentiation, and an enlargement of granular cells were detected. Interestingly, melanogenesis was reduced at lower temperature. The ceramide subclass profile, chain length distribution, and level of unsaturated ceramides were similar in FTMs generated at 37°C and 35°C but changed when generated at 33°C, reducing the resemblance to NHS. Herein, we report that culture temperature affects epidermal morphogenesis substantially and to a lesser extent the lipid barrier formation, highlighting the importance of optimized external parameters during reconstruction of skin.

Brain-Inspired Coding of Robot Body Schema Through Visuo-Motor Integration of Touched Events

Representing objects in space is difficult because sensorimotor events are anchored in different reference frames, which can be either eye-, arm-, or target-centered. In the brain, Gain-Field (GF) neurons in the parietal cortex are involved in computing the necessary spatial transformations for aligning the tactile, visual and proprioceptive signals. In reaching tasks, these GF neurons exploit a mechanism based on multiplicative interaction for binding simultaneously touched events from the hand with visual and proprioception information.By doing so, they can infer new reference frames to represent dynamically the location of the body parts in the visual space (i.e., the body schema) and nearby targets (i.e., its peripersonal space). In this line, we propose a neural model based on GF neurons for integrating tactile events with arm postures and visual locations for constructing hand- and target-centered receptive fields in the visual space. In robotic experiments using an artificial skin, we show how our neural architecture reproduces the behaviors of parietal neurons (1) for encoding dynamically the body schema of our robotic arm without any visual tags on it and (2) for estimating the relative orientation and distance of targets to it. We demonstrate how tactile information facilitates the integration of visual and proprioceptive signals in order to construct the body space.

Novel Adhesion Technique Using Metallic or Non-Metallic Hydrous Oxide of Metal Complexes Involving Magnetic Compound Fluid Rubber under Electrolytic Polymerization and Magnetic Field for Producing Sensors

As per sequential studies on new types of soft rubber for the artificial skin of robots, smart sensors, etc., we have proposed and investigated hybrid skin (H-Skin) and haptic sensors by using magnetic compound fluid (MCF), compounding natural rubber latex (NR-latex), and applying electric and magnetic fields. Through electrolytic polymerization, the MCF rubber is solidified. The MCF rubber has hybrid sensing functions and photovoltaic effects, and electric charge as battery. In case of the production of soft rubber sensors, however, the problem of adhesion between metal electrodes and rubber is very important. In the present study, we propose a novel adhesive technique for bonding the metal electrodes and MCF rubber by using metallic or non-metallic hydrous oxide, which is a metal complex, via electrolytic polymerization. The anionic radical hydrate reacts with the isoprene molecules of NR-latex or chloroprene rubber latex (CR-latex) such that they are cross-linked and the MCF rubber with the hydrate is solidified, which can be represented via a chemical reaction equation. By means of this adhesive technique, we presented five cases of sensors fabricated using metal electrodes and rubbers. This technique is applicable for novel cohesion between rubber and metal.

Recombinant Spider Silk Functionalized Silkworm Silk Matrices as Potential Bioactive Wound Dressings and Skin Grafts

Silk is considered to be a potential biomaterial for a wide number of biomedical applications. Silk fibroin (SF) can be retrieved in sufficient quantities from the cocoons produced by silkworms. While it is easy to formulate into scaffolds with favorable mechanical properties, the natural SF does not contain bioactive functions. Spider silk proteins, on the contrary, can be produced in fusion with bioactive protein domains, but the recombinant procedures are expensive, and large-scale production is challenging. We combine the two types of silk to fabricate affordable, functional tissue-engineered constructs for wound-healing applications. Nanofibrous mats and microporous scaffolds made of natural silkworm SF are used as a bulk material that are top-coated with the recombinant spider silk protein (4RepCT) in fusion with a cell-binding motif, antimicrobial peptides, and a growth factor. For this, the inherent silk properties are utilized to form interactions between the two silk types by self-assembly. The intended function, that is, improved cell adhesion, antimicrobial activity, and growth factor stimulation, could be demonstrated for the obtained functionalized silk mats. As a skin prototype, SF scaffolds coated with functionalized silk are cocultured with multiple cell types to demonstrate formation of a bilayered tissue construct with a keratinized epidermal layer under in vitro conditions. The encouraging results support this strategy of fabrication of an affordable bioactive SF-spider silk-based biomaterial for wound dressings and skin substitutes.

Recent Advances in Tactile Sensing Technology

Research on tactile sensing technology has been actively conducted in recent years to pave the way for the next generation of highly intelligent devices. Sophisticated tactile sensing technology has a broad range of potential applications in various fields including: (1) robotic systems with tactile sensors that are capable of situation recognition for high-risk tasks in hazardous environments; (2) tactile quality evaluation of consumer products in the cosmetic, automobile, and fabric industries that are used in everyday life; (3) robot-assisted surgery (RAS) to facilitate tactile interaction with the surgeon; and (4) artificial skin that features a sense of touch to help people with disabilities who suffer from loss of tactile sense. This review provides an overview of recent advances in tactile sensing technology, which is divided into three aspects: basic physiology associated with human tactile sensing, the requirements for the realization of viable tactile sensors, and new materials for tactile devices. In addition, the potential, hurdles, and major challenges of tactile sensing technology applications including artificial skin, medical devices, and analysis tools for human tactile perception are presented in detail. Finally, the review highlights possible routes, rapid trends, and new opportunities related to tactile devices in the foreseeable future.