Allograft skin, the gold-standard for burn skin substitute? A systematic literature review and meta-analysis

Abstract BACKGROUND Allograft skin transplantation has been considered to be the gold standard for replacing tissue damage, following burns. However, increasingly new biosynthetic skin substitutes are being developed as alternatives. The objective of this systematic review is to compare allograft skin with other skin substitutes, which have been used in the treatment of burns. METHODS Randomized and non-randomized clinical trial studies, that compared allograft skin to any other skin substitute in the treatment of burns, were extracted from the Pubmed/Medline, Scopus, EMBASE and Web of Science. For the risk of bias analysis, the Cochrane bias risk handbook was used for randomized studies, and ROBINS-1 was used for non-randomized studies. Outcomes such as healing, self-grafting, scar appearance, and mortality were evaluated. RESULTS Twelve randomized and six non-randomized trials were selected, with most of the methodologies presenting a high risk of bias. Based on the outcomes of the studies it was not possible to detect any advantages for using allograft skin, as opposed to other skin substitutes. In the meta-analysis, only two outcomes could be evaluated: healing and graft take percentage, however, no significant differences were observed between the groups. CONCLUSION Due to the poor quality of the primary studies, it was not possible to identify differences in the results that compared the use of allograft skin with other substitutes in the treatment of patients with burns. These results support the fact that surgeons primarily base the choice of skin substitute on clinical experience and cost, at least when treating burns.