Pediatric Burns: Biological and Tissue Engineered Skin Substitutes-A Systematic Review

Background/Objectives: Surgical debridement and early excision of burned areas followed by skin autograft is the gold standard of treatment for partial and full-thickness pediatric burns. However, skin autografting might be unfeasible or unlikely to succeed due limited availability of skin donor areas or inadequate conditions. In these circumstances, alternative treatment is required, and Skin Substitutes (SS) cold play a role. Recently, Biological Skin Substitutes (BSS) and Tissue Engineered Skin Substitutes (TESS) are emerging as alternative treatment options, but strong evidence is missing. This review investigates the current literature focusing on BSS and TESS, aiming to improve the medical and surgical management of pediatric patients. Methods: A systematic review was performed in accordance with the PRISMA 2020 guidelines and registered in the PROSPERO database (CRD42024627569). A comprehensive search was conducted in PubMed (MEDLINE) from 2000 to 2024 using Boolean logic and PICO-based inclusion criteria. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists according to study design. Results: Twenty-nine articles and 2676 pediatric patients undergoing surgical reconstruction by BSS or TESS for burns were included. The methodological quality was generally moderate, with most studies being observational or case series. Several strategies were critically analyzed and possibly discussed. Conclusions: While BSS and TESS are safe and effective reconstructive options, the overall level of evidence remains low to moderate. A schematic classification of SS for pediatric burns is presented. Further prospective trials are needed to define standardized algorithms for pediatric burn reconstruction.