Date of Award

2026

Document Type

Project

Degree Name

Master of Science (MS)

Department

Physician Assistant Studies

Committee Chair

LaDonna Clark

Abstract

INTRODUCTION: Severe burns are associated with high morbidity, mortality, and treatment costs, often requiring surgical intervention to restore the skin barrier and prevent complications like infection and hypothermia. Autologous skin grafting is the current gold standard for burn wound closure but may not be feasible in cases of large TBSA injuries with limited donor sites. Bioengineered skin equivalents, including acellular dermal substitutes and cell-based therapies, offer potential benefits in wound healing and scar quality while reducing donor site morbidity. This review evaluates the effectiveness of autografts compared to bioengineered skin equivalents in severe burn management, with a focus on healing time, graft adherence, infection rates, and treatment success.

METHODS: A PubMed search was conducted using key terms like “burns”, “autografting”, “bioengineered skin”. MeSH terms and Boolean operators were added to the search strategy as well as filters for publications from 2020-2025, RCTs, systematic reviews, meta-analyses, available in full-text, and published in the English language. Four studies met inclusion criteria based on study design, patient population, burn characteristics, graft type, and clinical outcomes.

RESULTS: Across the included studies, graft adherence and infection rates were comparable between bioengineered skin equivalents and autografts. In one meta-analysis, full-thickness burn wounds treated with Matriderm plus STSG had delayed re-epithelialization by 4-7 days compared to STSG (mean difference -7.30%, p=0.02). However, acellular dermal matrices significantly improved scar quality at six months (mean difference -1.95 on Vancouver Scar Scale, p< 0.01). Cell-based therapies using cultured keratinocytes and fibroblasts accelerated epithelialization and demonstrated < 95% wound closure rates comparable to STSG, while requiring smaller donor sites and reducing pain (p< 0.0001). In other studies, autologous-engineered substitutes showed reduced donor skin requirements and lower mortality (6.25%) compared to standard autografts (96.5% integration but higher morbidity).

DISCUSSION: Evidence included in this review suggests that bioengineered skin equivalents can achieve comparable graft adherence and infection rates compared to autografts, with possible advantages in scar quality, preserved donor sites, and functional and cosmetic outcomes. They may be most beneficial in cases of large TBSA injuries, limited donor site availability, or when prioritizing aesthetic results. However, limitations in study design, risk of bias among studies, and lack of consistent methodology weaken the evidence needed to definitively conclude that bioengineered skin substitutes are an equal or superior alternative to autografting.

Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

Download

Share

COinS