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INTRODUCTION made of either type I (native) or denatured collagen and they can
come in a variety of pore sizes and surface areas. Many collagen
Oral mucosa is predisposed to a variety of pathologies such dressings contain an antimicrobial agent to control pathogens
as leukoplakia, oral submucous fibrosis, oral squamous cell within the wound. [24]
carcinoma; the treatment of which may lead to significant
[7]
soft tissue loss that may not be amenable to primary closure. According to Lazovic et al. the physical properties of collagen
According to Ashley’s principles of plastic surgery, covering the sheet can be divided into two categories, i.e. biological,
raw wound is necessary to prevent infection, tissue contracture physiological. The biological properties include its non-
[1]
and scarring. A variety of approaches have been used in the inflammatory nature, low antigenicity, no toxicity and minimal
past, including split and full-thickness skin grafts, oral mucosa biodegradation. It facilitates migration of fibroblasts and
free grafts, oral connective tissue grafts, the latest being tissue microvascular cells and helps in the synthesis of neodermal
engineered grafts. For larger defects, pedicled local and distant collagen matrices. Collagen sheet also helps in minimizing
[2]
flaps or free microvascular grafts have been tried with variable scarring. The physiological properties of collagen are its non-
success rates. [2] permeability to bacterial migration, modulation of fluid flux
from the wound, elasticity, softness and suppleness, good tear
Non-vascularized free graft materials like split thickness skin strength, good suturing characteristics and enough strength to
graft, human amniotic membrane, palatal mucosa, buccal be peeled off the wound. Collagen sheet has been found to be
[7]
mucosa and collagen are easy to obtain, but each material has well tolerated in clinical trials. There have been no reports of
its own limitations. [1,3-5] One of these materials is collagen, which clinically significant immunological or histological responses
is in extensive use as temporary dressing material in a lot of to the implementation of collagen sheet that could cause its
surgical fields. This paper aims to highlight the various types of rejection. [7]
collagen, its manipulation and applications in the field of oral
cancer and precancer. Research shows that some collagen-based dressings can produce
a significant increase in the fibroblast production; can promote
COLLAGEN AS A BIOMATERIAL IN fibroblast permeation by the virtue of their hydrophilic nature; can
PLASTIC AND RECONSTRUCTIVE cause increased deposition of oriented and organized collagen
fibers by attracting fibroblasts and causing a directed migration
SURGERY of cells; can help in the uptake and bioavailability of fibronectin;
can cause preservation of leukocytes, macrophages, fibroblasts,
Collagen is the major insoluble protein (fibrous protein) in and epithelial cells; and assist in the maintenance of the chemical
the extra-cellular matrix and in connective tissues. More than and thermostatic microenvironment of the wound. [24]
80% of the skin is composed of collagen. It is also the main
component of the ligaments and tendons. In the early 1970’s, Collagen makes large areas of ulcerated skin pain free. The
John F. Burke and Ioannas Yannas developed a bio-compatible use of collagen dressing has been found to inhibit the action
collagen matrix to improve wound healing. It is commonly of metalloproteinases, hence it is useful in treating chronic
used in the management of burns, diabetic foot ulcer, toxic wounds. Collagen is a biomaterial that encourages wound
[6]
[7,8]
[25]
epidermal necrolysis, chronic wounds, etc. [10-12] This versatile healing through deposition and organisation of freshly formed
[9]
material also finds its application in the field of plastic surgery, fibres and granulation tissue in the wound bed, thus creating a
oral and maxillofacial surgery and dentistry for various purposes good environment for wound healing. Cutaneous lesions can
[26]
[13]
e.g. as an interpositional graft material during palatoplasty; bleed due to shearing of the gauze dressings. Application of
for guided bone regeneration during maxillary sinus lift; [14] collagen sheet to such wounds, not only promote angiogenesis,
for inducing bone formation along with/without certain but also aid in body's repair mechanisms. [7,27] Collagen sheets act
medicaments like gusuibu; [15,16] bone augmentation of posterior as a mechanical support, reduce oedema and loss of fluids from
atrophic mandibular ridge for placement of dental implants; the wound site, facilitate the of migration of fibroblasts into the
[17]
as a reconstructive material for orbital floor fractures; in wound, thus enhancing the metabolic activity of the granulation
[18]
treatment of localized gingival recession; as a scaffold in tissue tissue. [27-29] This fact is of particular importance in treating painful
[19]
[20]
engineering to generate dental pulp; for coverage of small and bleeding ulcers of the mucosal surfaces of the body such as
[21]
intraoral soft tissue defects of the oral cavity and much more. buccal cavity, nasal cavity, conjunctiva, urethra, vagina, and anal
Collagen also has use as a medium for culturing cells such as canal.
osteoblasts. [22]
COLLAGEN FOR COVERAGE OF SOFT
Biological dressings are the logical best candidate for the
management of wounds since they create the most physiological TISSUE DEFECTS OF ORAL MUCOSA
interface between the wound surface and the environment. SECONDARY TO RESECTION OF
[23]
Collagen is a biological skin substitute, i.e. natural, easily PRECANCEROUS AND CANCEROUS
available, ready to use, non-immunogenic, and non-pyrogenic. LESIONS
Today, a variety of collagen sheets are available with or without
carriers, e.g. gels, pastes, polymers, oxidized regenerated Cancer is one of the main causes of death in all societies, its
[30]
cellulose, and ethylene diamine tetraacetic acid. This collagen relative position varying with age and sex. Globally, oral
may be derived from bovine, porcine, equine, or avian sources, cancer is the sixth most common cause of cancer related-
[30]
which is purified to make it nonantigenic. Collagen dressings are death, although many people are unaware of its existence.
Plast Aesthet Res || Vol 3 || Mar 23, 2016 101