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Langenbeck's Archives of Surgery
Published in: Langenbeck's Archives of Surgery 1/2024

01-12-2024 | Skin Graft | Research

Efficacy of acellular fish skin graft in the management of chronic ulcer: a systematic review and meta-analysis

Authors: Jing Gao, Li-xiu Ge, Qiao-ying Gao, Ai-min Zhang, Li-juan Hu

Published in: Langenbeck's Archives of Surgery | Issue 1/2024

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Abstract

Background

The wounds failing to heal through a timely and orderly standard of care (SOC) treatment are considered as chronic wounds, which add significant burden to healthcare systems around the world. SOC treatment has been commonly applied for management of chronic wounds, but SOC alone may not be adequate to heal all ulcers effectively. Fish skin graft (FSG) is a xenogenic skin substitute which could be used for accelerating skin healing. The current study was performed with the view of evaluating the effectiveness of FSG as an adjuvant treatment of SOC for chronic ulcer treatment.

Methods

Two authors independently searched the following electronic databases: PubMed, Embase, and CENTRAL, using keywords including “diabetic foot ulcer,” “fish skin graft,” and “wound healing.” Clinical studies that evaluated the clinical outcomes of FSG in treatment of chronic ulcers were included in this meta-analysis. Random- or fixed-effect modeled meta-analyses were performed according to the heterogeneity test result (i.e., I2), to analyze the clinical outcome of FSG.

Results

A total of 8 studies were included in qualitative synthesis and meta-analysis, with 145 patients treated by SOC and 245 patients treated by SOC plus FSG. There was no significant difference between two groups for time to healing (MD = 1.99, 95% CI: −3.70~7.67, p = 0.493). The complete healing rate was significantly higher in FSG group compared with SOC alone (OR = 3.44, 95% CI: 2.03~5.82, p < 0.001***). Mean percentage area reduction (PAR) was reported in six studies, with a range of 71.6~97.3%. However, many of these studies did not report the value of standard deviation (SD), so we could not pool the data. No significantly different ulcer recurrence rate (RR = 0.60, 95% CI: 0.07~5.27, p = 0.645) and severe adverse events (SAEs) risk (RR = 1.67, 95% CI: 0.42~6.61, p = 0.467) were found between two groups.

Conclusions

The application of FSG treatment for patients with chronic ulcers that do not respond well to SOC management could significantly increase the complete healing rate compared with SOC alone, without increased recurrence rate and SAEs risk.
Appendix
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Metadata
Title
Efficacy of acellular fish skin graft in the management of chronic ulcer: a systematic review and meta-analysis
Authors
Jing Gao
Li-xiu Ge
Qiao-ying Gao
Ai-min Zhang
Li-juan Hu
Publication date
01-12-2024
Publisher
Springer Berlin Heidelberg
Published in
Langenbeck's Archives of Surgery / Issue 1/2024
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-024-03230-1

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