Comparison of a combination of skin substitutes and skin graft versus skin grafts alone for wound treatment

The skin is the largest organ in the body and has many important functions, such as protecting organs and tissues in the body from environmental, chemical and biological hazards; taking in and excreting more water; creates keratin, vitamin D, and color; receiving signals from the nervous system; and regulates body temperature. Malformations or injuries that damage the integrity of the skin can cause serious problems or even death. Wound healing is an important physiological process in human skin that facilitates the repair of damage and the maintenance of homeostasis. Complications or diseases can be fatal if the patient does not recover within the specified time. Therefore, it is important to develop biomaterials that facilitate tissue regeneration and exhibit strong biological properties. We performed a meta-analysis of randomized controlled trials to compare a combination of skin resurfacing and skin grafting with skin grafting alone for the treatment of wounds, assessed using the Vancouver Scar Scale.

This study followed specific guidelines for the collection and analysis of evidence. These guidelines are outlined in a document called PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).

This meta-analysis used several databases, including PubMed, ProQuest, Web of Science, Science Direct, Scopus, EBSCOhost, and ClinicalTrials.gov, to comprehensively review randomized controlled trials of the compared the effectiveness of combined skin substitutes and skin graft with graft. skin only in wound care. The results mainly include scar characteristics evaluated using the Vancouver Scar Scale.

This meta-analysis included a total of 216 participants from 7 randomized controlled trials. The trials were conducted between 2002 and 2015. Skin materials used in the trials included integra, glyaderm, matriderm, and cellonex viscose cellulose sponge. According to the International Statistical Institute, all included studies were conducted in a developed country. Mean age and duration of follow-up varied from 10.6 to 70 years and from 1 week to 12 months after surgery. The Vancouver Scar Scale is used to assess traumatic injuries and burns. This study showed that the use of skin grafts resulted in statistically significant improvements in Vancouver Scar Scale scores compared to skin grafts alone. The percent change was 1.38 (95% CI: 0.13–2.63; p = 0.03).

A meta-analysis shows that there are significant benefits in using skin substitutes and helping to close wounds effectively. In addition, the Vancouver Scar Scale shows better results in the healing process compared to relying on a skin graft alone. Skin substitutes do not have inherent superiority over each other; rather, its suitability to the individual patient’s injury condition is an important factor in this regard. There is a need for skin substitutes that are useful on a large scale, not just grafts.

Author: Dr. Indri Lakhsmi Putri, dr., Sp.BPRE, Subsp.KM(K)

Additional data for this article can be found online at: https://journals.sagepub.com/doi/10.1177/20503121241266342

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