Efficacy of dermal substitute on deep dermal to full thickness burn injury: a systematic review

Background: The study aims to systematically examine the efficacy of dermal regeneration templates (DRTs) in comparison to split thickness skin grafting (STSG) in the management of acute burn injuries post-excision and debridement. Methods: Systematic literature search was conducted by two independent reviewers from the following databases: MEDLINE, EMBASE and Cochrane Library with selection criteria set a priori. Only randomized controlled trials (RCTs) were included. Main outcomes extracted were percent of STSG take, infection rate and scar quality. Results: Seven studies were included. Three of the seven studies reported no significant difference in STSG take between burn wounds treated with dermal substitute and or STSG only. Three of the seven studies reported either low rates of infection or no significant difference in infection rates between dermal substitute and control. Four of the seven studies reported no significant difference in scar quality. Statistical pooling of data was not performed due to heterogeneity of the studies. Conclusion: Current RCTs available are generally of small sample size with poor methodological reporting. Given the results of more recent RCTs, the risk associated with DRTs is low and it can be a useful alternative for immediate wound coverage post-burn excision. However, there is still no strong evidence to support that DRTs have significant impact on scaring.