The Use of Acellular Fish Skin Grafts in Burn Wound Management-A Systematic Review

Abstract

Background and Objectives: Burn wound healing and management continues to be a major challenge for patients and health care providers resulting in a considerable socio-economic burden. Recent advances in the development of applicable xenografts as an alternative to split-thickness skin grafts have allowed for the development of acellular fish skin. Acellular fish skin acts as a skin substitute, reducing inflammatory responses and advancing proinflammatory cytokines that promote wound healing. Due to these beneficial wound healing properties, acellular fish skin might represent an effective treatment approach in burn wound management. Materials and Methods: A systematic review of the literature, up to March 2022, was conducted using the electronic databases PubMed and Web of Science. Titles and abstracts were screened for the following key terms (variably combined): "fish skin", "fish skin grafts", "acellular fish skin", "Omega3 Wound matrix", "xenograft", "burn injury", "burns". Results: In total, 14 trials investigating the effects of acellular fish skin in burn wounds or split-thickness donor sites were determined eligible and included in the present review. Existing evidence on the use of acellular fish skin indicates an acceleration of wound healing, reduction in pain and necessary dressing changes as well as treatment-related costs and improved aesthetic and functional outcomes compared to conventional treatment options. Conclusions: Acellular fish skin xenografts may represent an effective, low-cost alternative in treatment of superficial- and partial-thickness burns. However, results mainly originate from preclinical and small cohort studies. Future larger cohort studies are warranted to elucidate the full potential of this promising approach.

Keywords: acellular fish skin; burn injury; burn wound management; fish skin grafts.

Figure 1

Study inclusion. In total, 79 publications evaluating the use of acellular fish skin grafts in burn injuries were identified. After elimination of duplicates (n = 7), full-text evaluation of the remaining publications was performed (n = 72). Only articles published in English or German language were included (exclusion of n = 3). 14 publications were determined eligible and included in the present review. Study types were defined as follows: preclinical study (n = 3), case report/series (n = 4), clinical pilot study (n = 2), clinical cohort study (n = 4), retrospective data analysis (n = 1).