The importance of skin to survival, and the devastating physical and psychological consequences of scarring following reparative healing of extensive or difficult to heal human wounds, cannot be disputed. We discuss the significant challenges faced by patients and healthcare providers alike in treating these wounds. New state of the art technologies have provided remarkable insights into the role of skin stem and progenitor cells and their niches in maintaining skin homeostasis and in reparative wound healing. Based on this knowledge, we examine different approaches to repair extensive burn injury and chronic wounds, including full and split thickness skin grafts, temporising matrices and scaffolds, and composite cultured skin products. Notable developments include next generation skin substitutes to replace split thickness skin autografts and next generation gene editing coupled with cell therapies to treat genodermatoses. Further refinements are predicted with the advent of bioprinting technologies, and newly defined biomaterials and autologous cell sources that can be engineered to more accurately replicate human skin architecture, function and cosmesis. These advances will undoubtedly improve quality of life for patients with extensive burns and difficult to heal wounds.

皮肤对生存的重要性，以及在广泛或难以治愈的人类伤口修复性愈合后疤痕形成的破坏性生理和心理后果，是无可争议的。我们讨论了患者和医疗保健提供者在治疗这些伤口方面面临的重大挑战。最先进的新技术为皮肤干细胞和祖细胞及其在维持皮肤稳态和修复性伤口愈合中的作用及其生态位提供了显着的见解。基于这些知识，我们研究了修复大面积烧伤和慢性伤口的不同方法，包括全层和分层皮肤移植物、临时基质和支架，以及复合培养皮肤产品。显着的发展包括下一代皮肤替代品以替代分裂厚度皮肤自体移植物和下一代基因编辑与细胞疗法相结合以治疗遗传性皮肤病。随着生物打印技术以及新定义的生物材料和自体细胞源的出现，预计会进一步改进，这些材料可以被设计成更准确地复制人类皮肤结构、功能和外观。这些进步无疑将改善大面积烧伤和难以愈合伤口的患者的生活质量。功能和化妆品。这些进步无疑将改善大面积烧伤和难以愈合伤口的患者的生活质量。功能和化妆品。这些进步无疑将改善大面积烧伤和难以愈合伤口的患者的生活质量。