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Pignet et al. Plast Aesthet Res 2024;11:40 https://dx.doi.org/10.20517/2347-9264.2024.54 Page 7 of 14

[19]
threshold . No statistically significant difference was demonstrated between the pain levels before dressing
changes in the intervention group treated with NTG and the control group treated with Aquacel® Ag. Pain
[19]
levels after dressing changes, on the other hand, were significantly lower when NTG was used .

In their second study phase, Lima Júnior et al. analyzed pain intensity throughout the treatment using the
VAS . In study arm A (SPTB covering less than 10% of TBSA), no notable difference in pain intensity
[14]
between the NTG and silver sulfadiazine cream groups was observed. In study arm B (SPTB covering 10%
to 20% of TBSA), patients treated with NTG reported significantly lower pain intensity during the second,
third, fourth, and fifth evaluation visits. Concerning study arm C (deep partial-thickness burns), the results
are discussed separately in the next chapter .
[14]

In the third phase of their study, Lima Júnior et al. measured pain intensity after the first application of the
dressing and at the beginning of each visit using the VAS and Electronic von Frey . A significant reduction
[18]
in pain intensity (measured with VAS) was observed in the intervention group treated with NTG compared
to the control group treated with silver sulfadiazine cream. It was found that VAS and Burns Specific Pain
Anxiety Scale were significantly lower in the NTG group .
[18]
Fish skin may serve as an alternative to autologous grafting in deep partial-thickness burns
The normal healing period for deep partial-thickness burns (DPTB) lasts at least three weeks . Optimal
[29]
therapy is based on the early tangential excision of necrotic tissue followed by wound coverage to avoid
excessive inflammation and improve aesthetic and functional outcomes . According to the standard of
[30]
[30]
care, wound coverage is usually achieved by STSGs . However, various skin substitutes have been
proposed as an alternative to autografting in deep partial-thickness burns [31,32] . In a different approach, skin
substitutes have been used prior to autografting to prevent infections and water loss, enhance wound bed
conditions, and improve graft take rates [33,34] . There is evidence that the early use of dermal substitutes prior
to autografting might improve skin graft quality, functional and cosmetic outcomes and contribute to the
[33]
prevention of contractures . Currently, there are three studies (one case report, one RCT, and one
retrospective controlled cohort study) that reported the use of Kerecis® Omega3 Wound Matrix as an
alternative to autografting in deep partial-thickness burns [14-16] With our search strategy, we did not find any
published data on the use of FSG in deep partial-thickness burns before autografting.

Wallner et al. performed a retrospective cohort study involving twelve patients with multiple burn wounds
[16]
exhibiting mixed burn depth patterns . All burn wounds in this study were treated with enzymatic
debridement (NexoBrid™, MediWound Germany GmbH, Germany) instead of surgical excision on the
second day after the patient’s admission. Subsequent wound coverage in deep dermal burns was performed
either with Kerecis® Omega3 Wound Matrix (intervention group; twelve wounds) or a STSG (0.2 mm,
meshed 1:1.5; control group; seven wounds). SPTB were covered with an alloplastic epidermal substitute
(Suprathel®, PolyMedics Innovations GmbH, Germany; eight wounds) after the enzymatic debridement.
[16]
Due to the lack of comparability, the latter are not further discussed here . Wound healing, scar quality-
associated parameters (skin elasticity, skin thickness, hydration, pigmentation, vascularity and sebum
[16]
production), pain and itch levels were investigated 12 months after the burn injury . Compared to burns
managed with STSG, those treated with Kerecis® Omega3 Wound Matrix demonstrated faster wound
healing properties, a significantly higher water-storage capacity (similar to healthy skin), reduced pain
[16]
levels, as well as ameliorated functional and cosmetic outcomes, such as improved scar quality . Sebum
production and skin elasticity, however, showed no statistically significant superiority compared to STSG-
[16]
treated wounds .