烧伤,一个重大的全球健康问题,估计每年有180,000人死亡。尽管多年来治疗方法取得了巨大进展,与烧伤相关的发病率和死亡率仍然很高。自体皮肤移植,特别是分裂厚度皮肤移植(STSG),一直是烧伤重建的基石,显着促进了总体表面积(TBSA)的生存和功能恢复。然而,由于全厚度供体收获的限制,在供体部位进行初次封闭的要求继续构成挑战。1970年代后期皮肤再生模板(DRT)的引入标志着组织工程向前迈出了重要的一步,解决STSG皮肤替代的不足。这篇系统综述旨在比较不同移植物类型的结果-生物工程,自体移植物,同种异体移植,和异种移植-在过去24年的烧伤重建。审查的重点是每种嫁接类型的利弊,提供基于经验和证据的临床见解。该方法涉及对2000年1月至2024年1月以英文发表的研究进行系统回顾,涵盖随机对照试验(RCTs)。队列研究,病例对照研究,案例系列。参与者包括所有年龄段的人,他们接受了皮肤移植的烧伤重建,特别是分裂厚度的移植物,全厚度移植物,复合移植物,和表皮移植物(自体移植物,同种异体移植,和异种移植物)和生物工程移植物。主要结果是功能和美容结果,患者满意度,移植物存活,和并发症。使用Cochrane用于随机试验版本2(RoB2)的偏倚风险工具评估偏倚风险,纽卡斯尔-渥太华量表(NOS)用于非随机研究,和加拿大卫生经济研究所(IHE)病例系列质量评估工具。我们最初的搜索总共产生了1,995篇文章,其中10项研究被选择用于最终分析。在评估的四项临床试验中,75%的人表现出高风险的偏倚。审查的研究涉及各种移植物类型,六项研究(60%)集中在同种异体移植物上,三个(30%)在自体移植物上,和一个(10%)的生物工程皮肤移植物。结果各不相同,强调烧伤伤口管理的复杂性。我们的评估揭示了自体工程皮肤替代品和同种异体移植物的有希望的结果,但也强调了包括在内的研究之间的方法学差异。观察性研究的主导地位和结果指标的多样性为直接比较提供了障碍。未来的研究应该解决这些限制,采用结构良好的RCT,标准化结果测量,并探索长期结果和患者特异性因素。再生医学领域的快速发展为新型移植方法提供了巨大的潜力。本系统综述为使用不同移植物类型的烧伤重建的各种结果提供了有价值的见解。自体工程皮肤替代品和同种异体移植似乎具有重要的前景,表明嫁接技术可能发生转变。然而,方法上的不一致和缺乏高质量的证据强调了进一步研究以微调烧伤护理方法的必要性.
Burn injuries, a major global health concern, result in an estimated 180,000 fatalities annually. Despite tremendous progress in treatment methods over the years, the morbidity and mortality associated with burns remain significant. Autologous skin grafting, particularly split-thickness skin grafting (STSG), has been a cornerstone in burn reconstruction, and it has facilitated survival and functional recovery for total body surface area (TBSA) significantly. However, the requirement for primary closure at the donor site due to the constraints of full-thickness donor harvesting continues to pose challenges. The introduction of dermal regenerative templates (DRT) in the late 1970s marked a substantial step forward in tissue engineering, addressing the inadequacy of dermal replacement with STSGs. This systematic review aimed to compare the outcomes of different graft types - bioengineered, autografts, allografts, and xenografts - in burn reconstruction over the last 24 years. The review focused on the pros and cons of each graft type, offering clinical insights grounded in experience and evidence. The approach involved a systematic review of studies published in English from January 2000 to January 2024, covering randomized controlled trials (RCTs), cohort studies, case-control studies, and case series. The participants comprised individuals of all ages who underwent burn reconstruction with skin grafts, specifically split-thickness grafts, full-thickness grafts, composite grafts, and epidermal grafts (autografts, allografts, and xenografts) and bioengineered grafts. The primary outcomes were functional and cosmetic results, patient satisfaction, graft survival, and complications. The risk of bias was evaluated using the Cochrane risk-of-bias tool for randomized trials version 2 (RoB 2), the Newcastle-Ottawa Scale (NOS) for non-randomized studies, and the Canada Institute for Health Economics (IHE) quality appraisal tool for case series. Our initial search yielded a total of 1,995 articles, out of which 10 studies were selected for final analysis. Among the four clinical trials assessed, 75% showed a high risk of bias. The studies reviewed involved various graft types, with six studies (60%) concentrating on allografts, three (30%) on autografts, and one (10%) on bioengineered skin grafts. The outcomes were varied, underlining the intricate nature of burn wound management. Our evaluation revealed promising results for autologous-engineered skin substitutes and allografts but also highlighted methodological disparities among the studies included. The dominance of observational studies and the diversity of outcome measures present obstacles to direct comparisons. Future research should address these limitations, employing well-structured RCTs, standardized outcome measures, and exploring long-term outcomes and patient-specific factors. The rapidly evolving field of regenerative medicine offers great potential for novel grafting methods. This systematic review provides valuable insights into the diverse outcomes of burn reconstruction using different graft types. Autologous-engineered skin substitutes and allografts seem to hold significant promise, suggesting a possible shift in grafting techniques. However, methodological inconsistencies and the lack of high-quality evidence underscore the necessity for further research to fine-tune burn care approaches.