Page 62 - Read Online

Page 4 of 14 Pignet et al. Plast Aesthet Res 2024;11:40 https://dx.doi.org/10.20517/2347-9264.2024.54

cases of discrepancies between the two authors, respective articles were then reviewed by a third author
(L.P.K.).

RESULTS
A total of 673 studies were identified through our search from two databases, with 501 studies identified
from PubMed and 172 from Web of Science. After the exclusion of 78 duplicates, 558 studies out of 595
studies were excluded due to the non-applicability of the exact study purpose. After removing duplicates
and non-applicable studies, the remaining 37 studies were analyzed regarding the inclusion and exclusion
criteria. Articles were excluded based on the previously mentioned exclusion criteria, which included
reviews, letters or commentaries (n = 12), and preclinical studies (n = 14). After application of the inclusion
and exclusion criteria, eleven clinical studies have been identified that used fish skin for clinical applications
in burns, acute or complex trauma wounds [Figure 1]. Out of these eleven studies, four were randomized
controlled trials (RCT), three were cohort studies, and four were case reports. The effects of FSG derived
from Nile Tilapia were evaluated in four publications, whereas Kerecis® Omega3 Wound Matrix was
investigated in seven publications [Table 1].

DISCUSSION
Fish skin is beneficial for the conservative treatment of SPTB
Complete wound healing for SPTB is expected within two weeks after injury, without the need to be
[14]
surgically addressed . However, SPTB can easily progress into deep partial-thickness burns within the first
few days, necessitating surgical attention. Therefore, adequate wound therapy that prevents infection and
[26]
maintains a moist wound environment can help to prevent the burn wound from deteriorating . The most
commonly used dressings for SPTB involve silver-impregnated dressings and silver-containing creams [26-28] .
Recently, FSGs have gained increased popularity in burn care . Here, we have identified four clinical
[7]
studies focusing on the re-epithelialization duration and number of dressing changes for the treatment of
SPTB with FSGs. In all of these studies, NTGs had been used [14,17,18,20] .

Enhanced healing time
One of the most essential parameters in evaluating the effectiveness of wound dressings is the time until
complete wound healing (> 95% re-epithelialization), which is commonly assessed via clinical judgment by a
consultant. A clinical study by Lima Júnior et al. investigated the healing time of superficial and deep
[14]
partial-thickness burns treated with NTG, comparing it to silver sulfadiazine cream (10 mg/g) . Burns
treated with NTG showed a faster re-epithelialization time for both indications. However, the mean
difference in time until re-epithelialization between the treatment and the control group was found to be
more pronounced in the deep partial-thickness group (3.2 days) than in the other two groups of superficial
burns (1.4 and 1.1 days) . In a third study phase, the difference in the number of days until complete
[14]
wound healing of the burns dressed with NTG was confirmed lower (9.7 ± 0.6) than those treated with silver
sulfadiazine cream (10.2 ± 0.9). However, the difference was not relevant from a clinical standpoint, with an
[18]
average treatment duration reduction of merely a half day . In a different study conducted in a pediatric
population, no statistically significant difference emerged between the re-epithelialization time of SPTB
treated with NTG (10.1 ± 0.5) and those treated with silver sulfadiazine cream 1% (10.5 ± 0.7) . Although
[23]
differences between groups were minor, NTG performed slightly better.

Reduced number of dressing changes
In the analyzed studies, the number of dressing changes was assessed when using NTG. In the control
groups, a change of dressing was defined as replacing the primary cover (cream or dressing) and cleaning
the wound. The frequency of dressing changes was predefined depending on the extent and depth of the