Efficacy Of Skin Substitutes For Management Of Acute Burn Cases: A Systematic Review

The early management of burn cases has always been a challenging medical problem. Skin substitutes have been consistently studied and employed as the prospective treatment modality for burn cases worldwide. However, this treatment method remains uncommon in many developing countries. This systematic review is designed to weigh the efficacy of skin substitutes compared to standard treatment for managing acute burn cases. A literature search was conducted using PubMed, Scopus and Cochrane database up to February 2020 combined with additional reference searching. Studies were restricted to randomized controlled trials (RCTs), with no date and language restrictions. We evaluated the risk of bias with a revised risk of bias tool for randomized trials (RoB2). Data were categorized based on skin substitutes with further subgroup analysis for each skin substitute. We included 13 studies with six types of skin substitutes, Biobrane®, TransCyte ®, Integra®, Glyaderm®, Suprathel® and Apligraft®. Outcomes measured included wound healing time, pain, length of hospitalization and scar formation. The findings for all skin substitutes demonstrated less severe pain compared to the control group. Faster wound healing time, scar formation and length of hospitalization were identified as heterogeneous depending on the type of skin substitutes used. All of the skin substitutes studied exhibited at least non-inferior to superior performance compared to standard treatment in terms of efficacy in treating acute burn wounds, not limited to burn depth, size, location or patient age.