Current Advancements and Strategies in Tissue Engineering for Wound Healing: A Comprehensive Review

Abstract

Significance: With an aging population leading to an increase in diabetes and associated cutaneous wounds, there is a pressing clinical need to improve wound-healing therapies. Recent Advances: Tissue engineering approaches for wound healing and skin regeneration have been developed over the past few decades. A review of current literature has identified common themes and strategies that are proving successful within the field: The delivery of cells, mainly mesenchymal stem cells, within scaffolds of the native matrix is one such strategy. We overview these approaches and give insights into mechanisms that aid wound healing in different clinical scenarios. Critical Issues: We discuss the importance of the biomimetic niche, and how recapitulating elements of the native microenvironment of cells can help direct cell behavior and fate. Future Directions: It is crucial that during the continued development of tissue engineering in wound repair, there is close collaboration between tissue engineers and clinicians to maintain the translational efficacy of this approach.

Keywords: biomimetic; tissue engineering; wound healing.

Umber Cheema, BSc (Hon), PhD

Figure 1.

Adult skin consists of epidermis, dermis, and appendages. Skin stem cells have been described in the hair follicles, sebaceous glands, and the interfollicular epidermis. Adapted from Servier Medical Art.

Figure 2.

A basic diagrammatic representation of different wound types, the treatment challenges, and possible tissue engineering solutions in relation to the varying wound severities. The hatched shading over diagrammatic skin layers represents tissue loss.

Figure 3.

(A) Pie chart showing the number of studies performed in the various animal models. (B) The percentage of studies employing splints and either diabetic strains or inducing diabetes in the animal before wounding. (C) The number of days over which animal wound healing is measured, modal value found to be 14 days. (D) Top panel shows the diameter of the circular wound for various animal models; bottom panel shows the area in the case of rectangular wounds.

Figure 4.

Mesenchymal stem cells possess the right characteristics for use in tissue regeneration of skin.

Figure 5.

Representation of the number of studies that adopt various approaches to wound healing. Percentage of studies applying either of the following: cells directly to the wound, growth factors directly, or a scaffold, as well as those that combine these approaches, that is, scaffold with encapsulated cells, scaffolds with encapsulated growth factors, and all three combined or cells with additional growth factors.

Figure 6.

Overview of a number of cell-scaffold interactions to re-create elements of the biomimetic niche. Re-capitulating elements of the biomimetic niche helps to direct cell behavior, response, and fate.