The effectiveness of skin allografts in survival rate of patients with major burns.

Background: Burns are still one of the most prevalent injuries in the world. Allograft is in high demand as a biological dressing for any superficial open wounds, not just burn victims. Skin allograft is the gold standard for treating burns in people who do not have enough skin to cover all of the injured areas of their bodies. Studies have shown that skin allografts are superior to topical antimicrobial dressings in partial thickness burns and can reduce complications and length of hospital stay in burn patients. However, to the best of our knowledge very few studies have investigated these results in our country. The aim of the current study is to evaluate and report the outcomes of skin allograft on burn patient survival in Iran.

Method: This prospective clinical trial study was performed on patients admitted to the burn center of Imam Khomeini Hospital in Tehran between July 15, 2017 and April 27, 2021. The control group consisted of patients admitted to the burn ward who were not undergoing skin allografts. This group was matched with the case group in terms of sex, age, and percentage of burns. We compared the outcome of the study was the duration of hospitalization, and status of patients at discharge. The study protocol was approved by Iranian Registry of Clinical Trials (IRCT) under the code of IRCT2016112431074N1 (https://fa.irct.ir/trial/24517).

Result: Overall, 112 patients in the case group and 224 patients in the control group were studied. The length of hospital stay in the case group (41.13±11.7) was considerably longer than the control group (24.6±12.1) (P<0.001), but the mortality rate in the two groups was not statistically different (P=0.633). The average survival time of case group (53 days, 95% CI=45-56) was higher than the control group (49 days, 95% CI=39-58) (P=0.012). Number of allograft usage (OR=0.038, 95% CI=0.142-0.945) and also Age (OR=1.03, 95% CI=1.005-1.070) were predictors of death.

Conclusion: Although the use of skin allografts in large burns (more than 50%) reduced mortality in burn patients, their use in burns less than 50% has not been effective in reducing patient mortality. Due to the limited access to this valuable product, its use in burns less than 50% should be done with caution and, due to the limited access to skin allografts in most burn centers in Iran, patients with extensive burns (more than 50%) should be used as a priority.