A Review of Iranian Status in Using Skin Grafts and Stem Cells for Severe Burn Wound Healing: Preclinical and Clinical Studies

PurposeBurns, based on the depth of the tissue damage, are categorized into four degrees: first, second (superficial and deep), third, and fourth degrees (full thickness). Treatment of full-thickness skin defects needs skin grafts. In Iran, many efforts were made by Iranian burn care providers to overcome the obstacles in burn management. This study seeks to provide a better understanding of the accessible approaches for successful burn care, especially in countries with the same facilities as Iran.MethodsWe reviewed recent works published by Iranian burn care providers and scientists, as preclinical and clinical studies, in order to find the solutions and step-by-step developments in Iran in the field of burn management.ResultsBurn care providers in Iran have no practical knowledge about using synthetic skin substitutes due to their unavailability and high cost in the Iranian market. Consequently, they provide some solutions, including using the allograft, especially the fresh one, as the best skin substitute in Iranian burn centers. Moreover, several studies were carried out in the field of stem cell therapy and tissue engineering for burn care in Iran that need to be more extended and applied in clinics.ConclusionAccessing allografts needs to promote the tendency of skin donation. Although allografts are excellent sources, they are not enough; therefore, further studies are required for providing new skin substitutes. However, it takes time. In order to access already available skin substitutes, in countries like Iran, creating some facilities by manufacturers of these substitutes and a balance of price are required.Lay SummaryThird-degree burns, which are called full-thickness burns, involve the whole depth of the skin. These wounds will not heal spontaneously as there do not exist any dermal appendages in-depth of these wounds, and they need wound coverage for healing. Instant coverage with a skin graft can facilitate regeneration and repair. Many efforts are done by Iranian burn care providers in order to find devised solutions to overcome the challenges, including no access to synthetic substitutes, despite many requirements. In Iran, due to a shortage of tissue-engineered skin substitutes, surgeons use allograft for burn wound healing. They established skin banks in order to preserve processed allografts in order to overcome obstacles such as limited access to the skin donor and the disadvantages of using fresh allografts. However, skin substitutes are still needed. Some progress has been made in preclinical and clinical studies in the field of tissue engineering and stem cell therapy, but further studies are required. This study seeks to provide a better understanding of the accessible approaches for successful burn management, especially in countries with the same facilities as Iran.