Table 1 Summary of the characteristic findings of the included studies

Bovine xenografts

Tuleubayev et al. [25], Kazakhstan 2022

RCT

68 patients (47 male and 21 female patients)

13.13 ± 5.03% in DBP and 12.11 ± 6.54% in control group

2A Grade burns in both groups

Decellularized bovine peritoneum (DBP)

DBP (31 patients)

Dressings impregnated with 10% Povidone–Iodine (37 patients)

Hospitalization: 10.45 ± 6.15 (DBP) vs. 9.92 ± 6.08 (control) (Not significant)

Dressing change: 1.35 ± 0.66 (DBP) vs. 5.22 ± 3 (control)

Level of pain: Significantly lower in DBP group

Re-epithelialization: 23 of 31 and 24 of 37 patients (not significant)

Porcine xenografts

Feng et al. [22], China 2006

RCT

40 patients (20 patients in porcine ADM group and 20 in control group)

6 months–88 years

30–94%

Xenogenic ADM (porcine)

Porcine ADM overlapped 2–3 cm at the junctions of separate pieces

Topical antimicrobial agents (povidone–iodine ointment) three times daily and the wound was exposed

Healing time: 9–14 days (porcine) vs. 14–35 days (control)

Scar index (3 months): 3.29 ± 1.63 (porcine) vs. 7.75 ± 1.78 (control)

Scar index (2 years): 2.77 ± 1.05 (porcine) vs. 7.03 ± 1.24 (control)

Dressing changes: No dressing change (porcine)

Zuo et al. [26], China 2016

RCT

6 adult burn patients (4 male and 3 female patients)

24.8 (18–35) years

88.3% ± 5.7% (total burn areas) and 81.6% ± 7.8% (full thickness burn areas)

Porcine xenograft

Fresh pigskins in 2 patients (7/15 operations)

Partial-thickness viable cryopreserved alloskins in 4 patients (8/15 operations)

Autoskin grafted time: 27.3 ± 3.8 days (1^st operation), 22.0 ± 5.7 days (2nd operation), and 15.3 ± 1.5 days (3^rd operation)

Survival percentage:

POW 1: 80.0% ± 10.0% (alloskin) vs. 75.7% ± 5.3% (pigskin) (P = 0.16)

POW 2: 71.2% ± 10.6% (alloskin) vs. 66.4% ± 6.2% (pigskin) (P = 0.30)

POW 3: 48.7% ± 2.5% (alloskin) vs. 35.0% ± 7.0% (pigskin) (P = 0.03)

TBSA that survived: 21.8% ± 10.9% (alloskin) vs. 22.4% ± 8.5% (pigskin)

Chen et al. [27], China 2013

RCT

30 patients (20 males and 10 females)

18–60 years

25–60%

Porcine acellular dermal xenograft (ADX)

ADX and split-thickness skin autograft

Split-autologous epidermal skin

Vancouver Scar Scale: Not significant after 1 month but significant after 3, 6, and 12 months

Adverse reaction: No ulcer or scar hyperplasia

Zajicek et al. [24], Czech Republic 2011

RCT

86 pediatric patients with superficial scald burns in 2 groups

5 months–7 years

1–35% in total; 10 (6–13) % in Xe-Derma and 7 (4–10) % in Askina THINSite (P = 0.028)

Acellular pig dermis Xe-Derma (porcine)

Xe-Derma (43 patients)

Synthetic hydrogel wound dressing Askina THINSite (43 patients)

Re-epithelialization: 8 (5–10) days (Xe-Derma) vs. 7 (3–10) days (Askina THINSite) (P = 0.147)

Infection: 6 (Xe-Derma) vs. 10 (Askina THINSite) (p = 0.2)

Dressing changes: One on day 2 or 3 and outer dressing change every 2 or 3 days

Karlsson et al. [23], Sweden 2022

RCT

24 patients (22 male and 2 female patients)

39 (19–73) years

11 (4–37) % in total;

7 (2–14) % treated with dressings

Porcine xenograft (EZ derm)

EZ derm (11 patients)

Biosynthetic cellulose dressing (BsC) (13 patients)

Healing time: 19 (12–35) in porcine vs. 18 (10–35) in BsC (P = 0.7)

Hospital stay: 14 (2–28) days in porcine vs. 4 (0–40) days in BsC (P = 0.331)

Patients’ POSAS total score (12-month follow-up): 45 (31–61) (porcine) vs. 33 (11–55) (BsC) (P = 0.39)

Observer POSAS total score (12-month follow-up):

20 (13–40) (porcine) vs. 19 (11–25) (BsC) (p = 0.45)

Infection:

11 of 11 (porcine) vs. 12 of 13 (BsC) (p = 1.0)

Hosseini et al. [28], Iran 2008

non-randomized clinical trial

86 burned pediatrics

4 (0.1–15) years

28.8 (10–50) % in conventional and 28.2 (10–54) % in Xenoderm group

Xenoderm: lyophilized pig skin

Xenoderm (51 patients)

Conventional treatments (SSD) (35 patients)

Hospital stay in all patients: 10 (10.8) in Xenoderm vs. 17 (14.4) days (conventional) (p = 0.10)

Hospital stay in TBSA of 20–39%: 7.5 (3–36) days (Xenoderm) vs. 20 (4–55) days (conventional) (p = 0.001)

Dressing changes: 6.02 (8.3) (Xenoderm) vs. 12.9 (9.3) times (conventional) (p = 0.0005)

Mortality: 0 (Xenoderm) vs. 5 (conventional)

Hosseini et al. [29], Iran 2009

non-randomized clinical trial

118 burn patients

26.54 (2–80) in conventional and 26.52 (1–81) years in Xenoderm group

30–75%; 44.7 (31–70) % in conventional and 42.8 (30–72) % in Xenoderm group

Xenoderm: lyophilized pig skin

Xenoderm (65 patients)

Conventional treatment (saline-soaked dressing) (53 patients)

Hospital stay: 18.7 (15.2) (Xenoderm) vs. 24.2 (18.2) days (conventional) (p = 0.11)

Dressing changes: 10.4 (10.9) (Xenoderm) vs. 18.04 (13.6) (conventional) (P = 0.005)

Mortality: 7 (10.8%) (Xenoderm) vs. 19 (35.8%) (conventional) (P = 0.001)

Fish xenografts

Li et al. [30], 2021

animal study

30 Sprague–Dawley rats and 5 Bama mini-pigs

6–8-week-old rats

NA (3 round full-thickness skin defects with a diameter of 1.8 cm on each rat and six 5 × 5 cm² square full-thickness skin defect on each pig)

Fish skin-derived ADM (TS-ADM) and porcine ADM (DC-ADM)

TS (alkaline decellularization and γ-irradiation sterilization without freeze-drying)

DC (porcine ADM as active control) and Vaseline gauze (VLGZ as negative control)

Re-epithelialization (2w) in pigs: 23.4% ± 6.3% in TS vs. 10.7% ± 2.6% in VLGZ vs. 12.4% ± 4.6% in DC (significant) Wound dressing: after 2 weeks, TS was significantly easier to remove

Wound closure rate (day 35): TS inhibited scar hyperplasia;

collagen deposition in group TS was notably higher than other two groups

Lima et al. [31], Brazil 2020

Phase II Pilot RCT

30 pediatrics

2–12 years

 < 20%

Tilapia skin (TS)

Tilapia skin (TS)

SSD cream 1%

Re-epithelialization: 10.07 ± 0.46 (TS) vs. 10.47 ± 0.74 days (SSD)

Dressing changes: 3.00 ± 0.76 (TS) vs. 9.27 ± 1.39 (SSD)

Anesthetic use: lower in TS group

Lima et al. [15], Brazil 2020

Phase II RCT

62 patients

(Arm A: SPTB involving < 10% of

TBSA; Arm B: SPTB involving 10–20%

of TBSA; Arm C: DPTB involving 5–15%

of TBSA)

18–50 years

SPTB affecting up to 20% TBSA, or DPTB affecting 5–15% TBSA

Nile Tilapia Fish Skin (NTFS)

NTFS (A: 13, B: 9, and C: 10)

SSD cream 1%

group (A: 10, B: 10,

and C: 10)

Re-epithelialization: NTFS (A: 9.77 ± 0.83; B: 10.56 ± 1.13; C: 18.10 ± 0.99) and SSD (A: 11.20 ± 0.063; B: 11.70 ± 0.067; C: 21.30 ± 1.42) [significant]

Dressing changes: NTFS (A: 2.08 ± 0.28; B: 2.33 ± 0.71; C: 6.10 ± 2.02) and SSD (A: 5.80 ± 0.42; B: 11.00 ± 0.47; C: 20.20 ± 1.69) [significant]

Lima et al. [32], Brazil 2021

Phase III RCT

115 outpatients with SPTB

18–70 years

 < 15%

Nile Tilapia Fish Skin (NTFS)

Glycerolized fish skin (NTFS) (57 patients)

SSD cream 1% (58 patients)

Re-epithelialization: 9.7 ± 0.6 in NTFS vs. 10.2 ± 0.9 in SSD (P = 0.001)

Dressing changes: 1.6 ± 0.7 in NTFS vs. 4.9 ± 0.5 in SSD (P < 0.001)

Stone et al. [33], USA 2018

animal study

36 full thickness burn wounds on pigs

NR

NA

omega-3 rich fish skin graft (FSG)

A) FSG (day 0) + 1.5:1 mSTSG (day 7);

B) FSG (day 0) + 3:1 mSTSG and FSG applied over the graft (day 7)

C) cadaver porcine skin (day 0) + 1.5:1 mSTSG (day 7);

Infection: No infection in FSG

Outcome measures, including contraction rates, TEWL measurements, hydration levels, and blood perfusion levels: FSG was similar to cadaver skin

Wound healing:

The 3:1 mSTSG treated with FSG resulted in similar healing as the wounds treated with the 1.5:1 mSTSG

Stone et al. [34], USA 2021

animal study

6 female Yorkshire pigs (24 deep partial-thickness and 36 full-thickness burns)

NR

NA

Fish skin graft (FSG) or fetal bovine dermis (FBD)

FSG

FBD

Re-epithelialization (day 14): 50.2% in FSG vs. 23.5% in FBD (P < 0.005)

Reduction in original wound size (day 14): 93.1% in FSG vs. 106.7% in FBD (P = 0.005)