Collagen-Based Biomaterials for Cutaneous Repair and Scar Management: From Chronic Wounds to Hypertrophic Scars
Collagen in Skin
DOI:
https://doi.org/10.22034/LSSJ.2025.178Keywords:
collagen, wound healing, skin regeneration, biomaterials, chronic wounds, tissue engineering, dressings.Abstract
Background: As the primary structural protein of the cutaneous extracellular matrix, collagen plays a foundational role in orchestrating every phase of the wound healing cascade, making it a critical substrate for advanced biomaterial development.
Objective: This narrative review synthesizes clinical evidence and physiological mechanisms of collagen-based biomaterials—including dressings, bioengineered skin substitutes, and scar therapies—in cutaneous repair.
Methods: High-level evidence was evaluated, focusing on systematic reviews, meta-analyses, and randomized controlled trials (RCTs).
Results: Clinical data strongly support the efficacy of topical collagen dressings, demonstrating accelerated healing trajectories for diabetic foot ulcers (RR 1.69), venous leg ulcers (RR 1.36), and chronic wounds overall (RR 1.44), with collagen-oxidized regenerated cellulose (ORC) matrices showing the highest performance. In deep or severe tissue injuries, acellular dermal regeneration templates (Integra®, Matriderm®) and living bilayered skin equivalents (Apligraf®) markedly enhance anatomical restoration in full-thickness defects and burns. Regarding scar modification, intradermal injectable collagen therapies yield a 50% to 70% volume improvement in atrophic acne scars, while prophylactic application of collagen-GAG matrices mitigates pathological postoperative scar formation. Key translational limitations include high procurement costs, susceptibility to bacterial biofilm degradation, and potential immunogenicity (1% to 3% for bovine derivatives), which are increasingly being bypassed by emerging recombinant human collagen technologies.
Conclusion: Level 1 clinical evidence validates collagen-based biomaterials for chronic wound management, scar prevention, and the structural correction of atrophic deformities. Future breakthroughs are directed toward matrix-metalloproteinase (MMP)-responsive smart hydrogels and genetically personalized scar therapies.
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