From secondary intent to accelerated regenerative healing: emergence of the biointelligent scaffold therapeutic strategy for chronic wounds

This chapter introduces the concept of the bio-intelligent scaffold and discusses the development of a pro-angiogenic porous fibrin-alginate synthetic skin replacement biomaterial called Smart Matrix (SM) as an example. The rapid integration of SM 1-1.5 mm thick used with a 0.15 mm split-thickness overgraft can achieve nascent full-thickness skin reconstruction of an acute wound within 7 days, with benign, non-contractile long-term outcome. A new pre-clinical delayed wound model was used to investigate whether acellular dermal scaffolds could accelerate a healing response. Both Matriderm and SM activated healing but only SM produced a normal histological neodermis. Although many new biomaterial-based advanced wound treatments are now available for clinical use, almost all function by promoting the process of ‘healing by secondary intention’. For typical critical-sized defects healing will take many weeks to achieve. Therefore the possibility that a bio-intelligent biomaterial scaffold could activate regenerative type healing of chronic wounds would offer important clinical benefit and enhance the quality of patient’s lives