In recent years, skin grafting has evolved from the initial
autograft and allograft preparations to biosynthetic and tissue-
engineered human skin equivalents (HSE). Apligraf (graftskin)
(Organogenesis, Canton, MA) is a living, cell-based, bilayered
skin construct. Like human skin, Apligraf has 2 primary layers,
including an outer, epidermal layer made of living human
keratinocytes, the most common cell type of the human epidermis,
to replicate the structure of the human epidermis. The human
keratinocytes and fibrobasts are derived from neonatal
forsekins. The dermal layer of Apligraf consists of living human
fibroblasts and bovine type 1 collagen, the most common cell
type in the human dermis, to create a dermis-like structure that
produces additional matrix proteins. Proponents state that
Apligraf stimulates the patient's own cells to regenerate tissue
and heal the wound through mechanisms that include the secretion
of growth factors, cytokines, and matrix proteins (Snyder, et
al., 2012). Apligraf does not c