Comparison of the Effectiveness of Three Different Skin Substitutes for the Treatment of Pediatric Burns

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Methods : A retrospective study was conducted on burn patients under 18-years admitted to our Burn Unit between 2015-2021, who were divided into 3 groups according to the type of skin substitute used (EZ-derm®, Biobrane® and Suprathel®). Demographic, clinical data and short- and long-term outcomes were analyzed. Effectiveness was analyzed by escharectomy and grafting rate during acute management and long-term follow-up reintervention rate. Results : A total of 378 patients were included (179 Ez-derm®group, 107 Biobrane® group and 92 Suprathel® group). No differences in demographics or burn characteristics were observed between them. Patients treated with Suprathel®had a significantly shorter hospital stay [median 4 days (IQR 2-9)], a lower rate of escharectomy and grafting during acute management (21.1%), and a lower long-term follow-up reintervention rate (18.5%) when compared to the Ez-derm® group [median stay 9 days (IQR 6-13); escharectomy and graft 24.6% and reintervention 26.8%] and to the Biobrane® group [median stay 9 days (IQR 7-14); escharectomy and graft 32.1% and reintervention 26.2%]. Conclusion : Treatment of partial-thickness burns with Suprathel® is associated with a shorter hospital stay, lower need for escharectomy and grafting, and lower need for long-term reintervention. Therefore, it should be considered the treatment of choice for pediatric partial-thickness burns. Introduction Partial-thickness burns are the most common burn injury among children, and represent a serious public health problem, particularly for pediatric patients, due to their high short-term morbidity and multiple and severe long-term sequelae ( 1 , 2 ). Optimal management of partial-thickness burns is focused on promoting uninterrupted wound healing by providing a moist environment, removal of exudate, prevention of infection and minimization of pain, scar formation and functional impairment ( 3 ). Currently, the standard of care to reduce the risk of short-term complications and long-term sequelae is early debridement of partial-thickness burns and coverage with skin substitutes ( 4 ). There are currently many different types of skin substitutes available, which differ mainly in their component materials, such as porcine collagen (EZ-derm®) ( 5 , 6 ), synthetic collagen (Biobrane®) ( 7 – 9 ) or synthetic copolymer (Suprathel®) ( 10 – 12 ). However, there is presently no "gold standard" skin substitute for the optimal treatment of this type of burn injury ( 13 , 14 ). The aim of this study is to compare the results with three different skin substitutes used in the acute treatment of partial-thickness burns in children (EZ-derm®, Biobrane® and Suprathel®), analyzing both the short- and long-term outcomes. Methods A retrospective study was conducted on patients under 18 years of age with partial-thickness burns admitted to our Burn Unit, between January 2015 and December 2021, who underwent surgical debridement of the burns and subsequent coverage with a skin substitute. During the time interval included in our study, three types of skin substitutes were available at different time periods at our institution. Initially Ez-derm® (2015–2017), then Biobrane® (2018–2019 and finally Suprathel® (2020–2021) were used. Patients were divided into three study groups based on the type of skin substitute used in each case (Ez-derm®, Biobrane®, or Suprathel®). Patients in whom the type of skin substitute employed was not recorded, as well as those for whom esthetic and functional outcomes were not documented during the subsequent follow-up evaluations, were excluded. Patients admitted to our Burn Unit for the treatment of chronic burn sequelae were also excluded from the study. Demographic variables (gender, age, weight, ethnicity), burn characteristics (etiology, burned total body surface area [TBSA], burn depth), length of hospital stay (LOS), incidence of both acute complications (need for escharotomy and graft) and long-term sequelae (hypertrophy, scar contracture, alopecia), and the need for surgical treatment of the sequelae were analyzed. Effectiveness of each skin substitute was evaluated by escharectomy and grafting rate during acute management and long-term follow-up reintervention rate. The protocol of the study obtained the approval of La Paz Hospital Institutional Review Board (IRB number PI-5041) and complied with the guidelines of the Declaration of Helsinki (as revised in 2013). Informed consent was not deemed necessary due to the retrospective nature of this study, the absence of human samples, and the anonymous collection of analytical data. Data collection was performed using Excel 2010, and statistical analysis was conducted using the IBM SPSS Statistics 22.0 software package. The distribution of numerical variables was assessed using the Shapiro-Wilk and Kolmogorov-Smirnoff tests. Variables that did not follow a normal distribution were described using medians and interquartile range (IQR), while those with a normal distribution were presented as means and standard deviation. For variables with a normal distribution, Analysis of Variance (ANOVA) was applied, while the Kruskal-Wallis test was used for variables that did not follow a normal distribution. Discrete variables were presented as frequency and percentage, and their analysis was conducted using the Chi-squared test or the Fisher's test when the former was not applicable. All statistical calculations were performed using a two-tailed approach, and statistical significance was determined with a p-value of less than 0.05. Results A total of 378 patients were included (211 males and 167 females), with a mean age of 4.7±1.4 years. Ez-derm® group had the highest volume with 179 patients, followed by Biobrane® (107 patients) and Suprathel® (92 patients), with no demographic differences between them ( Table 1 ). Concerning burn features ( Table 2 ), thermal burns were the most frequent in the three groups, involving more than 95% of the cases, followed by chemical and electrical burns, with no differences in the distribution between the groups. Most of the thermal burns were caused by scalding (78.4% in Ez-derm®; 81.3% in Biobrane® and 80.4% in Suprathel®). Regarding burn depth, deep partial-thickness burns were more frequently observed than superficial partial-thickness burns, affecting more than 60% of the patients in all three groups, with no significant differences between the groups (p=0.310). There were also no differences when comparing the median burned TBSA, which was 8% in Ez-derm® and Suprathel® groups, and 9% in Biobrane® patients (p=0.112). Concerning postoperative outcomes, patients treated with Suprathel® had a significantly shorter hospital stay (median 4 days) when compared to those treated with Ez-derm® or Biobrane® (median 9 days in both groups; p=<0.001). The need for escharectomy and grafting was also significantly lower in the Suprathel® group (21.1%) compared to the Ez-derm® and Biobrane® groups (24.6% and 32.1% respectively; p=0.018). Long-term complications were observed in about one third of the patients in each group, with no differences between them. Hypertrophy was the most frequent sequelae in all groups, followed by alopecia and scar contracture. Finally, a significantly lower need for surgical treatment of the sequelea was observed in the Suprathel® group (18.5%) compared to the Ez-derm® group (26.8%) and the Biobrane® group (26.2%), again this difference being statistically significant (p=0.031). However, there was no difference in the type of surgery performed, being intralesional Triamcinolone injection the most frequent in all three groups, followed by scar contracture release with graft or Z-plasty. Short and long-term postoperative outcomes are shown in Table 3 . Discussion This article compares the effectiveness of three skin substitutes in the treatment of partial-thickness pediatric burns in a national referral center. Although in recent years many different skin substitutes have been used in the treatment of burns, studies comparing these skin substitutes are scarce in the literature. Our study represents a novelty that can broaden our knowledge on the optimal management of burns in children. Burns are one of the most common injuries in children and, unlike other accidental injuries, they have a high morbidity and cause severe long-term sequelae, which pose a great burden on both patients and their families (‎3).The main objective when treating partial-thickness burns treatment is to promote prompt healing while preventing infection ( 15 ). In this context, skin substitutes provide temporary coverage of the affected skin, which reduces the growth of pathogens and promotes wound healing. Different types of skin substitutes differ mainly in their component materials. However, the optimal type of skin substitute that can provide all these characteristics has not yet been determined, due to the scarcity of high-quality evidence in the studies carried out ( 4 , 16 ). This work is the first retrospective study comparing Ez-derm®, Biobrane® and Suprathel® for the treatment of acute burns in pediatric patients, analyzing parameters such as hospital stay, need for escharectomy and grafting, long-term sequelae and need for surgery of the sequelae. There was no bias in patient selection, for all three skin substitutes were never simultaneously available at our institution, and the criteria to use one or another was determined by the availability of the skin substitute at the time. Therefore, there was no bias in patient selection, as proven, on the other hand, by the fact that our three groups could be considered equivalent, for there were no statistical differences regarding the demographic or clinical features of the patients. Ez-derm® consist of a porcine xenograft widely used in the USA for adult burns ( 17 , 18 ). However, the evidence in pediatric patients is really scarce. The only retrospective study that analyzed the use of porcine xenografts in burns in children showed a decrease in pain and in the need for sedoanalgesia ( 6 ). The main disadvantage of this type of skin substitute is the need for periodic dressings changes (every 24–48 hours), which leads to increased manipulation of the burned area and a prolonged hospital stay. In our study, the median hospital stay in this group of patients was 9 days, similar to data reported by other authors ( 18 ). The median time to healing has been reported to be 15 days, with a complication rate of 16%. ( 17 , 19 ), although to date these results have not been compared with that of other skin substitutes in pediatric burns. Biobrane® is a bilaminated biosynthetic material composed of a semi-permeable silicone membrane adhered to a nylon fabric mesh that is coated with a layer of type I collagen of porcine origin ( 7 ). A systematic review found that membranous dressings such as Biobrane® proved to work better in terms of healing than antiseptics or gauze treatments, with reduced hospital stay, shorter healing time and reduced pain, although its application can be challenging in some anatomical regions, such as hands, face, neck or genitalia this being one of its main disadvantages ( 13 ). The use of Biobrane® in pediatric patients with partial-thickness burns has been widely studied, with good long-term results ( 5 , 7 ). However, it requires frequent dressing changes (every 24–48 hours), similar to Ez-derm®, with the subsequent risk of infection secondary to manipulation ( 5 ). In fact, clinical trials have reported an increased risk of developing clinically significant infections in children treated with Biobrane® when compared to silver dressings, which require less handling ( 19 ). Ou et al. used Biobrane® in a case series of 106 pediatric scald burns, with an average burned total body surface area of 11%, and an infection rate of 7–8% in superficial partial-thickness burns and 62.1% in deep partial-thickness burns ( 20 ). Suprathel® is a resorbable biosynthetic skin substitute composed of a blend of polylactic acid, trimethylene carbonate and 𝜀-caprolactone that resembles the protective properties of human epithelium ( 21 ). It is a microporous membrane that prevents the accumulation of exudate in wounds ( 22 ). Its effectiveness in pediatric burns has been demonstrated in terms of reduction of pain and scar formation when compared with other semi-synthetic dressings. ( 10 , 11 ). However, there is no documented evidence of its role in enhanced re-epithelialization, reduced need for grafting or lower infection rate. Another advantage of Suprathel® is its ease of use and adaptability. After burn debridement, Suprathel® is applied directly to the debrided area, it adheres and adapts to it, and is subsequently covered with paraffin or non-adherent gauzes, which are changed every 7–10 days. Another of its advantages is that, whereas both Ez-derm® and Biobrane® require the placement of s staples, stitches or biological glue to fix the skin substitute to the adjacent healthy skin, Suprathel® is self-adherent. The three study groups can be considered equivalent, since no differences in demographic or clinical data (such as burned total body surface area, type of burn and burn depth) were observed. It can therefore be assumed that the differences we found can be attributed to the type of skin substitute employed. Our study showed that patients treated with Suprathel® had a significant shorter hospital stay when compared to those treated with Ez-derm® or Biobrane® (p < 0.001). This may be due to the different intraoperative and postoperative management of each skin substitute. Suprathel® is applied in the operating room and is removed after 10–14 days without the need for any outer dressing changes in between, and this can be done on an outpatient basis without the need for hospitalization. However, in the groups of patients treated with Ez-derm® and Biobrane®, outer dressing changes are required every 24-48h. These dressings changes might be painful and often require sedoanalgesia, which also justifies why these patients require longer hospitalization. The need for escahectomy and grafting was also significantly lower in the Suprathel® group when compared to the Ez-derm® and Biobrane® patients. Hypertrophy was the most frequent long-term sequelae in all groups, with the Suprathel® group showing the lowest incidence of long-term sequelae, although these differences were not statistically significant. When analyzing the need for surgery for long-term sequelae, we observed that it was also significantly lower in the Suprathel® group compared to the other two groups. Burn depth is the main factor determining the need for grafting, and the risk of developing long-term sequelae and their severity. However, no significant differences in burn characteristics were observed in the three groups. Patients treated with Suprathel® required fewer dressing changes and did not require the use of sutures, staples or glue, compared to the Ez-derm® treatment group and the Biobrane® group. Less need for dressing changes and for foreign materials decreases the risk of burn contamination and/ or infection and, therefore burn deepening, which might explain the lower rate of escharectomy and grafting and severe long-term sequelae observed in the group of patients treated with Suprathel®. Therefore, patients treated with Suprathel® are at a lower risk of short-term complications but also have fewer long-term sequelae, and these sequelae are less severe, as they require surgical correction less frequently. This suggests that Suprathel® should be considered as the standard of care regarding skin substitutes in the treatment of partial-thickness burns in children. Our study has several strengths. On one hand, it is a novel study comparing the effectiveness of three different skin substitutes in pediatric partial-thickness burns. In addition, it has a considerable sample size, with patients being followed up for at least two years after the burn injury, and reviewed over a 7-year period (2015–2021), which reduces the risk of a possible historical bias. However, there are also some limitations, mainly related to its retrospective, single-center design. Due to the retrospective nature of the database, certain data that were not recorded during follow-up might not be retrievable for the statistical analysis. The retrospective design of our study make our conclusions liable to bias from unmeasured confounders. In addition, given that this study was conducted at a single center, it is important to acknowledge that treatment protocols for acute-phase burn care may vary across different burn centers. Thus, these findings should be corroborated through further research involving larger samples collected from multiple centers. Conclusion Treatment of partial-thickness burns with Suprathel® in pediatric patients is associated with lower need for escharectomy and grafting, shorter hospital stays and lower long-term reoperation rate when compared to burns treated with other skin substitutes, such as BiobraneⓇ and Ez-dermⓇ. It should therefore be considered the treatment of choice for burn injuries in these patients. However, further multicenter studies are still required to confirm these results. Declarations Conflicts of interest : The authors of this manuscript do not refer to any conflict of interest. Funding : This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Ethics approval : The protocol of the study obtained the approval of La Paz Hospital Institutional Review Board (IRB number PI-5041) and complied with the guidelines of the Declaration of Helsinki (as revised in 2013). Authors' contributions statement : All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Carlos Delgado-Miguel, Ada García Morán, Lara Fuentes Gómez, Miriam Miguel-Ferrero, Mercedes Díaz and Juan Carlos López-Gutiérrez. The first draft of the manuscript was written by Carlos Delgado-Miguel and all authors commented on previous versions of the manuscript. 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Ez-derm group ® (n=179) Biobrane group ® (n=107) Suprathel group ® (n=92) p-value Gender; n (%) • Male • Female 105 (58.7) 74 (41.3) 53 (49.5) 54 (50.5) 53 (57.6) 39 (42.4) 0.298 Age (years); mean (SD) 5.3 (3.7) 4.1 (2.4) 4.8 (1.8) 0.147 Weight (kg); mean (SD) 22.4 (15.1) 18.9 (10.4) 20.2 (14.7) 0.065 Ethnicity; n (%) • Caucasian • Arab • Latin • African 74 (41.3) 47 (26.3) 35 (19.6) 23 (12.8) 46 (43.0) 29 (27.1) 22 (20.6) 10 (9.3) 42 (45.7) 21 (22.8) 20 (21.7) 9 (9.8) 0.512 SD, standard deviation. Table 2. Burn clinical features distributed by groups. Ez-derm group ® (n=179) Biobrane group ® (n=107) Suprathel group ® (n=92) p-value Type of burn; n (%) • Thermal • Chemical • Electrical 171 (95.5) 4 (2.2) 4 (2.2) 107 (100) 0 (0) 0 (0) 91 (98.9) 1 (1.1) 0 (0) 0.126 Scald; n (%) 134 (78.4) 87 (81.3) 71 (80.4) 0.310 Burndepth; n (%) • Superficial partial-thickness • Deep partial-thickness 50 (27.9) 129 (72.1) 35 (32.7) 72 (67.3) 33 (35.9) 59 (64.1) 0.071 Burned TBSA (%); median ( IQR ) 8 (5-10) 9 (6-15) 8 (5-10) 0.112 TBSA, total body surface area; IQR, interquartile range. Table 3. Postoperative outcomes and long-term complications. Ez-derm group ® (n=179) Biobrane group ® (n=107) Suprathel group ® (n=92) p-value Length of hospital stay (days); median ( IQR ) 9 (6-13) 9 (7-14) 4 (2-9) <0.001 Need for escharectomy and grafting; n (%) 44 (24.6) 34 (32.1) 19,1 (21,1) 0.018 Long-term sequelae; n (%) Hypertrophy Scar contracture Alopecia 54 (30.2) 52 (29.1) 4 (2.2) 11 (6.1) 35 (32.7) 32 (29.9) 3 (2.8) 4 (3.7) 27 (29.3) 26 (28.3) 3 (3.2) 4 (4.3) 0.860 Need for reintervention; n (%) 48 (26.8) 28 (26.2) 17 (18.5) 0.031 Type of reintervention; n (%) • Intralesional Triamcinolone injection • Scar contracture release + graft • Scar contracture release + Z-plasty 29 (60.4) 11 (22.9) 8 (16.7) 18 (64.3) 7 (25) 3 (10.7) 11 (64.7) 4 (23.5) 2 (11.7) 0.314 IQR, interquartile range. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 13 Dec, 2024 Read the published version in European Journal of Pediatrics → Version 1 posted Editorial decision: Revision requested 01 Nov, 2024 Reviews received at journal 02 Sep, 2024 Reviewers agreed at journal 02 Sep, 2024 Reviewers invited by journal 03 Jul, 2024 Editor assigned by journal 03 Jul, 2024 Submission checks completed at journal 03 Jul, 2024 First submitted to journal 02 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4676446","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":330583126,"identity":"6fa775d8-7aee-42a7-850a-6ed06c02cb2a","order_by":0,"name":"Carlos Delgado-Miguel","email":"data:image/png;base64,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","orcid":"","institution":"Fundación Jiménez Díaz University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Carlos","middleName":"","lastName":"Delgado-Miguel","suffix":""},{"id":330583130,"identity":"fcd069ae-4b6e-4d7e-9660-b80f0e4eb51c","order_by":1,"name":"Ada García Morán","email":"","orcid":"","institution":"La Paz Children´s University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ada","middleName":"García","lastName":"Morán","suffix":""},{"id":330583133,"identity":"22cd0067-1dee-47d1-a93f-fd667393648b","order_by":2,"name":"Lara Fuentes Gómez","email":"","orcid":"","institution":"La Paz Children´s University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Lara","middleName":"Fuentes","lastName":"Gómez","suffix":""},{"id":330583135,"identity":"e75e29ca-eb59-4195-ba02-062356f1907e","order_by":3,"name":"Mercedes Díaz","email":"","orcid":"","institution":"La Paz Children´s University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mercedes","middleName":"","lastName":"Díaz","suffix":""},{"id":330583138,"identity":"092d0ccf-3bba-4bd8-b208-c756078d3d4c","order_by":4,"name":"Miriam Miguel-Ferrero","email":"","orcid":"","institution":"La Paz Children´s University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Miriam","middleName":"","lastName":"Miguel-Ferrero","suffix":""},{"id":330583139,"identity":"cb3096f3-a6ba-4da5-b076-82c86cdc6230","order_by":5,"name":"Juan Carlos López-Gutiérrez","email":"","orcid":"","institution":"La Paz University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"Carlos","lastName":"López-Gutiérrez","suffix":""}],"badges":[],"createdAt":"2024-07-02 21:25:59","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4676446/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4676446/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00431-024-05916-6","type":"published","date":"2024-12-13T15:57:06+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":71552357,"identity":"846b84c7-cc54-4cc6-b41e-2c47b6219704","added_by":"auto","created_at":"2024-12-16 16:05:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":544326,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4676446/v1/f9e633e0-3b51-4fe4-833f-f3f0beb9b564.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eComparison of the Effectiveness of Three Different Skin Substitutes for the Treatment of Pediatric Burns\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePartial-thickness burns are the most common burn injury among children, and represent a serious public health problem, particularly for pediatric patients, due to their high short-term morbidity and multiple and severe long-term sequelae (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Optimal management of partial-thickness burns is focused on promoting uninterrupted wound healing by providing a moist environment, removal of exudate, prevention of infection and minimization of pain, scar formation and functional impairment (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Currently, the standard of care to reduce the risk of short-term complications and long-term sequelae is early debridement of partial-thickness burns and coverage with skin substitutes (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere are currently many different types of skin substitutes available, which differ mainly in their component materials, such as porcine collagen (EZ-derm\u0026reg;) (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), synthetic collagen (Biobrane\u0026reg;) (\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) or synthetic copolymer (Suprathel\u0026reg;) (\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). However, there is presently no \"gold standard\" skin substitute for the optimal treatment of this type of burn injury (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The aim of this study is to compare the results with three different skin substitutes used in the acute treatment of partial-thickness burns in children (EZ-derm\u0026reg;, Biobrane\u0026reg; and Suprathel\u0026reg;), analyzing both the short- and long-term outcomes.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA retrospective study was conducted on patients under 18 years of age with partial-thickness burns admitted to our Burn Unit, between January 2015 and December 2021, who underwent surgical debridement of the burns and subsequent coverage with a skin substitute. During the time interval included in our study, three types of skin substitutes were available at different time periods at our institution. Initially Ez-derm\u0026reg; (2015\u0026ndash;2017), then Biobrane\u0026reg; (2018\u0026ndash;2019 and finally Suprathel\u0026reg; (2020\u0026ndash;2021) were used. Patients were divided into three study groups based on the type of skin substitute used in each case (Ez-derm\u0026reg;, Biobrane\u0026reg;, or Suprathel\u0026reg;).\u003c/p\u003e \u003cp\u003ePatients in whom the type of skin substitute employed was not recorded, as well as those for whom esthetic and functional outcomes were not documented during the subsequent follow-up evaluations, were excluded. Patients admitted to our Burn Unit for the treatment of chronic burn sequelae were also excluded from the study.\u003c/p\u003e \u003cp\u003eDemographic variables (gender, age, weight, ethnicity), burn characteristics (etiology, burned total body surface area [TBSA], burn depth), length of hospital stay (LOS), incidence of both acute complications (need for escharotomy and graft) and long-term sequelae (hypertrophy, scar contracture, alopecia), and the need for surgical treatment of the sequelae were analyzed. Effectiveness of each skin substitute was evaluated by escharectomy and grafting rate during acute management and long-term follow-up reintervention rate.\u003c/p\u003e \u003cp\u003eThe protocol of the study obtained the approval of La Paz Hospital Institutional Review Board (IRB number PI-5041) and complied with the guidelines of the Declaration of Helsinki (as revised in 2013). Informed consent was not deemed necessary due to the retrospective nature of this study, the absence of human samples, and the anonymous collection of analytical data.\u003c/p\u003e \u003cp\u003eData collection was performed using Excel 2010, and statistical analysis was conducted using the IBM SPSS Statistics 22.0 software package. The distribution of numerical variables was assessed using the Shapiro-Wilk and Kolmogorov-Smirnoff tests. Variables that did not follow a normal distribution were described using medians and interquartile range (IQR), while those with a normal distribution were presented as means and standard deviation. For variables with a normal distribution, Analysis of Variance (ANOVA) was applied, while the Kruskal-Wallis test was used for variables that did not follow a normal distribution. Discrete variables were presented as frequency and percentage, and their analysis was conducted using the Chi-squared test or the Fisher's test when the former was not applicable. All statistical calculations were performed using a two-tailed approach, and statistical significance was determined with a p-value of less than 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 378 patients were included (211 males and 167 females), with a mean age of 4.7\u0026plusmn;1.4 years. Ez-derm\u0026reg; group had the highest volume with 179 patients, followed by Biobrane\u0026reg; (107 patients) and Suprathel\u0026reg; (92 patients), with no demographic differences between them (\u003cem\u003eTable 1\u003c/em\u003e).\u003c/p\u003e\n\u003cp\u003eConcerning burn features (\u003cem\u003eTable 2\u003c/em\u003e), thermal burns were the most frequent in the three groups, involving more than 95% of the cases, followed by chemical and electrical burns, with no differences in the distribution between the groups. Most of the thermal burns were caused by scalding (78.4% in Ez-derm\u0026reg;; 81.3% in Biobrane\u0026reg; and 80.4% in Suprathel\u0026reg;). Regarding burn depth, deep partial-thickness burns were more frequently observed than superficial partial-thickness burns, affecting more than 60% of the patients in all three groups, \u0026nbsp;with no significant differences between the groups (p=0.310). There were also no differences when comparing the median burned TBSA, which was 8% in Ez-derm\u0026reg; and Suprathel\u0026reg; groups, and 9% in Biobrane\u0026reg; patients (p=0.112).\u003c/p\u003e\n\u003cp\u003eConcerning postoperative outcomes, patients treated with Suprathel\u0026reg; had a significantly shorter hospital stay (median 4 days) when compared to those treated with Ez-derm\u0026reg; or Biobrane\u0026reg; (median 9 days in both groups; p=\u0026lt;0.001). The need for escharectomy and grafting was also significantly lower in the Suprathel\u0026reg; group (21.1%) compared to the Ez-derm\u0026reg; and Biobrane\u0026reg; groups (24.6% and 32.1% respectively; p=0.018).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLong-term complications were observed in about one third of the patients in each group, with no differences between them. Hypertrophy was the most frequent sequelae in all groups, followed by alopecia and scar contracture. Finally, a significantly lower need for surgical treatment of the sequelea was observed in the Suprathel\u0026reg; group (18.5%) compared to the Ez-derm\u0026reg; group (26.8%) and the Biobrane\u0026reg; group (26.2%), again this difference being statistically significant (p=0.031). However, there was no difference in the type of surgery performed, being intralesional Triamcinolone injection the most frequent in all three groups, followed by scar contracture release with graft or Z-plasty. Short and long-term postoperative outcomes are shown in \u003cem\u003eTable 3\u003c/em\u003e.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis article compares the effectiveness of three skin substitutes in the treatment of partial-thickness pediatric burns in a national referral center. Although in recent years many different skin substitutes have been used in the treatment of burns, studies comparing these skin substitutes are scarce in the literature. Our study represents a novelty that can broaden our knowledge on the optimal management of burns in children.\u003c/p\u003e \u003cp\u003eBurns are one of the most common injuries in children and, unlike other accidental injuries, they have a high morbidity and cause severe long-term sequelae, which pose a great burden on both patients and their families (\u0026lrm;3).The main objective when treating partial-thickness burns treatment is to promote prompt healing while preventing infection (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In this context, skin substitutes provide temporary coverage of the affected skin, which reduces the growth of pathogens and promotes wound healing. Different types of skin substitutes differ mainly in their component materials. However, the optimal type of skin substitute that can provide all these characteristics has not yet been determined, due to the scarcity of high-quality evidence in the studies carried out (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis work is the first retrospective study comparing Ez-derm\u0026reg;, Biobrane\u0026reg; and Suprathel\u0026reg; for the treatment of acute burns in pediatric patients, analyzing parameters such as hospital stay, need for escharectomy and grafting, long-term sequelae and need for surgery of the sequelae. There was no bias in patient selection, for all three skin substitutes were never simultaneously available at our institution, and the criteria to use one or another was determined by the availability of the skin substitute at the time. Therefore, there was no bias in patient selection, as proven, on the other hand, by the fact that our three groups could be considered equivalent, for there were no statistical differences regarding the demographic or clinical features of the patients.\u003c/p\u003e \u003cp\u003eEz-derm\u0026reg; consist of a porcine xenograft widely used in the USA for adult burns (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). However, the evidence in pediatric patients is really scarce. The only retrospective study that analyzed the use of porcine xenografts in burns in children showed a decrease in pain and in the need for sedoanalgesia (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The main disadvantage of this type of skin substitute is the need for periodic dressings changes (every 24\u0026ndash;48 hours), which leads to increased manipulation of the burned area and a prolonged hospital stay. In our study, the median hospital stay in this group of patients was 9 days, similar to data reported by other authors (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The median time to healing has been reported to be 15 days, with a complication rate of 16%. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), although to date these results have not been compared with that of other skin substitutes in pediatric burns.\u003c/p\u003e \u003cp\u003eBiobrane\u0026reg; is a bilaminated biosynthetic material composed of a semi-permeable silicone membrane adhered to a nylon fabric mesh that is coated with a layer of type I collagen of porcine origin (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). A systematic review found that membranous dressings such as Biobrane\u0026reg; proved to work better in terms of healing than antiseptics or gauze treatments, with reduced hospital stay, shorter healing time and reduced pain, although its application can be challenging in some anatomical regions, such as hands, face, neck or genitalia this being one of its main disadvantages (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The use of Biobrane\u0026reg; in pediatric patients with partial-thickness burns has been widely studied, with good long-term results (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). However, it requires frequent dressing changes (every 24\u0026ndash;48 hours), similar to Ez-derm\u0026reg;, with the subsequent risk of infection secondary to manipulation (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In fact, clinical trials have reported an increased risk of developing clinically significant infections in children treated with Biobrane\u0026reg; when compared to silver dressings, which require less handling (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Ou et al. used Biobrane\u0026reg; in a case series of 106 pediatric scald burns, with an average burned total body surface area of 11%, and an infection rate of 7\u0026ndash;8% in superficial partial-thickness burns and 62.1% in deep partial-thickness burns (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSuprathel\u0026reg; is a resorbable biosynthetic skin substitute composed of a blend of polylactic acid, trimethylene carbonate and \u0026#120576;-caprolactone that resembles the protective properties of human epithelium (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). It is a microporous membrane that prevents the accumulation of exudate in wounds (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Its effectiveness in pediatric burns has been demonstrated in terms of reduction of pain and scar formation when compared with other semi-synthetic dressings. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). However, there is no documented evidence of its role in enhanced re-epithelialization, reduced need for grafting or lower infection rate. Another advantage of Suprathel\u0026reg; is its ease of use and adaptability. After burn debridement, Suprathel\u0026reg; is applied directly to the debrided area, it adheres and adapts to it, and is subsequently covered with paraffin or non-adherent gauzes, which are changed every 7\u0026ndash;10 days. Another of its advantages is that, whereas both Ez-derm\u0026reg; and Biobrane\u0026reg; require the placement of s staples, stitches or biological glue to fix the skin substitute to the adjacent healthy skin, Suprathel\u0026reg; is self-adherent.\u003c/p\u003e \u003cp\u003eThe three study groups can be considered equivalent, since no differences in demographic or clinical data (such as burned total body surface area, type of burn and burn depth) were observed. It can therefore be assumed that the differences we found can be attributed to the type of skin substitute employed. Our study showed that patients treated with Suprathel\u0026reg; had a significant shorter hospital stay when compared to those treated with Ez-derm\u0026reg; or Biobrane\u0026reg; (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This may be due to the different intraoperative and postoperative management of each skin substitute. Suprathel\u0026reg; is applied in the operating room and is removed after 10\u0026ndash;14 days without the need for any outer dressing changes in between, and this can be done on an outpatient basis without the need for hospitalization. However, in the groups of patients treated with Ez-derm\u0026reg; and Biobrane\u0026reg;, outer dressing changes are required every 24-48h. These dressings changes might be painful and often require sedoanalgesia, which also justifies why these patients require longer hospitalization. The need for escahectomy and grafting was also significantly lower in the Suprathel\u0026reg; group when compared to the Ez-derm\u0026reg; and Biobrane\u0026reg; patients. Hypertrophy was the most frequent long-term sequelae in all groups, with the Suprathel\u0026reg; group showing the lowest incidence of long-term sequelae, although these differences were not statistically significant. When analyzing the need for surgery for long-term sequelae, we observed that it was also significantly lower in the Suprathel\u0026reg; group compared to the other two groups. Burn depth is the main factor determining the need for grafting, and the risk of developing long-term sequelae and their severity. However, no significant differences in burn characteristics were observed in the three groups. Patients treated with Suprathel\u0026reg; required fewer dressing changes and did not require the use of sutures, staples or glue, compared to the Ez-derm\u0026reg; treatment group and the Biobrane\u0026reg; group. Less need for dressing changes and for foreign materials decreases the risk of burn contamination and/ or infection and, therefore burn deepening, which might explain the lower rate of escharectomy and grafting and severe long-term sequelae observed in the group of patients treated with Suprathel\u0026reg;. Therefore, patients treated with Suprathel\u0026reg; are at a lower risk of short-term complications but also have fewer long-term sequelae, and these sequelae are less severe, as they require surgical correction less frequently. This suggests that Suprathel\u0026reg; should be considered as the standard of care regarding skin substitutes in the treatment of partial-thickness burns in children.\u003c/p\u003e \u003cp\u003eOur study has several strengths. On one hand, it is a novel study comparing the effectiveness of three different skin substitutes in pediatric partial-thickness burns. In addition, it has a considerable sample size, with patients being followed up for at least two years after the burn injury, and reviewed over a 7-year period (2015\u0026ndash;2021), which reduces the risk of a possible historical bias. However, there are also some limitations, mainly related to its retrospective, single-center design. Due to the retrospective nature of the database, certain data that were not recorded during follow-up might not be retrievable for the statistical analysis. The retrospective design of our study make our conclusions liable to bias from unmeasured confounders. In addition, given that this study was conducted at a single center, it is important to acknowledge that treatment protocols for acute-phase burn care may vary across different burn centers. Thus, these findings should be corroborated through further research involving larger samples collected from multiple centers.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eTreatment of partial-thickness burns with Suprathel\u0026reg; in pediatric patients is associated with lower need for escharectomy and grafting, shorter hospital stays and lower long-term reoperation rate when compared to burns treated with other skin substitutes, such as BiobraneⓇ and Ez-dermⓇ. It should therefore be considered the treatment of choice for burn injuries in these patients. However, further multicenter studies are still required to confirm these results.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflicts of interest\u003c/strong\u003e: The authors of this manuscript do not refer to any conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e: The protocol of the study obtained the approval of La Paz Hospital Institutional Review Board (IRB number PI-5041) and complied with the guidelines of the Declaration of Helsinki (as revised in 2013).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions statement\u003c/strong\u003e: All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Carlos Delgado-Miguel, Ada Garc\u0026iacute;a Mor\u0026aacute;n, Lara Fuentes G\u0026oacute;mez, Miriam Miguel-Ferrero, Mercedes D\u0026iacute;az and Juan Carlos L\u0026oacute;pez-Guti\u0026eacute;rrez. The first draft of the manuscript was written by Carlos Delgado-Miguel and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eGuldogan CE, Kendirci M, Tikici D, Gundogdu E, Yastı AC. Clinical infection in burn patients and its consequences. Ulus Travma Acil Cerrahi Derg. 2017;23:466‐71.\u003c/li\u003e\n \u003cli\u003eChurch D, Elsayed S, Reid O, Winston B, Lindsay R. Burn wound infections. Clin Microbiol Rev. 2006;19:403‐34.\u003c/li\u003e\n \u003cli\u003eBirchenough SA, Gampper TJ, Morgan RF. Special considerations in the management of pediatric upper extremity and hand burns. J Craniofac Surg. 2008;19:933-41.\u003c/li\u003e\n \u003cli\u003eKim LK, Martin HC, Holland AJ. Medical management of paediatric burn injuries: best practice. J Paediatr Child Health. 2012;48:290-5.\u003c/li\u003e\n \u003cli\u003eLesher AP, Curry RH, Evans J, Smith VA, Fitzgerald MT, Cina RA, Streck CJ, Hebra AV. Effectiveness of Biobrane for treatment of partial-thickness burns in children. J Pediatr Surg. 2011;46:1759-63.\u003c/li\u003e\n \u003cli\u003eBurkey B, Davis W 3rd, Glat PM. Porcine xenograft treatment of superficial partial-thickness burns in paediatric patients. J Wound Care. 2016;25:S10-5.\u003c/li\u003e\n \u003cli\u003eFan C, Pek CH, Por YC, Lim GJS. Biobrane dressing for paediatric burns in Singapore: a retrospective review. Singapore Med J. 2018;59:360-5.\u003c/li\u003e\n \u003cli\u003eMandal A. Paediatric partial-thickness scald burns--is Biobrane the best treatment available? Int Wound J. 2007;4:15-9.\u003c/li\u003e\n \u003cli\u003eHyland EJ, D\u0026apos;Cruz R, Menon S, Harvey JG, La Hei E, Lawrence T, Waddell K, Nash M, Holland AJ. Biobrane\u0026trade; versus acticoat\u0026trade; for the treatment of mid-dermal pediatric burns: a prospective randomized controlled pilot study. Int J Burns Trauma. 2018;8:63-7.\u003c/li\u003e\n \u003cli\u003eRashaan ZM, Krijnen P, Allema JH, Vloemans AF, Schipper IB, Breederveld RS. Usability and effectiveness of Suprathel\u0026reg; in partial thickness burns in children. Eur J Trauma Emerg Surg. 2017;43:549-56.\u003c/li\u003e\n \u003cli\u003eHighton L, Wallace C, Shah M. Use of Suprathel\u0026reg; for partial thickness burns in children. Burns. 2013;39:136-41.\u003c/li\u003e\n \u003cli\u003eEverett M, Massand S, Davis W, Burkey B, Glat PM. Use of a copolymer dressing on superficial and partial-thickness burns in a paediatric population. J Wound Care. 2015;24:S4-8.\u003c/li\u003e\n \u003cli\u003eVloemans AF, Hermans MH, van der Wal MB, Liebregts J, Middelkoop E. Optimal treatment of partial thickness burns in children: a systematic review. Burns. 2014;40:177-90.\u003c/li\u003e\n \u003cli\u003eVloemans AF, Dokter J, van Baar ME, Nijhuis I, Beerthuizen GI, Nieuwenhuis MK, et al. Epidemiology of children admitted to the Dutch burn centres changes in referral influence admittance rates in burn centres. Burns. 2011;37:1161-7.\u003c/li\u003e\n \u003cli\u003eCubison TC, Pape SA, Parkhouse N. Evidence for the link between healing time and the development of hypertrophic scars (HTS) in paediatric burns due to scald injury. Burns. 2006;32:992-9.\u003c/li\u003e\n \u003cli\u003eSinger AJ, Dagum AB. Current management of acute cutaneous wounds. N Engl J Med. 2008;359: 1037-46.\u003c/li\u003e\n \u003cli\u003eTroy J, Karlnoski R, Downes K, Brown KS, Cruse CW, Smith DJ, et al. The Use of EZ Derm\u0026reg; in Partial-Thickness Burns: An Institutional Review of 157 Patients. Eplasty. 2013;13:e14.\u003c/li\u003e\n \u003cli\u003eKarlsson M, Elmasry M, Steinvall I, Huss F, Olofsson P, Elawa S, et al. Biosynthetic cellulose compared to porcine xenograft in the treatment of partial-thickness burns: A randomised clinical trial. Burns. 2021:S0305-4179(21)00264-3.\u003c/li\u003e\n \u003cli\u003eHaller HL, Blome-Eberwein SE, Branski LK, Carson JS, Crombie RE, Hickerson WL, et al. Porcine Xenograft and Epidermal Fully Synthetic Skin Substitutes in the Treatment of Partial-Thickness Burns: A Literature Review. Medicina (Kaunas). 2021;57:432.\u003c/li\u003e\n \u003cli\u003eOu LF, Lee SY, Chen YC, Yang RS, Tang YW. Use of Biobrane in pediatric scald burns--experience in 106 children. Burns. 1998;24:49-53.\u003c/li\u003e\n \u003cli\u003eAfnan MAM, Saxena AK. Tissue repair in neonatal and paediatric surgery: Analysis of infection in surgical implantation of synthetic resorbable biomaterials. Biomed Mater Eng. 2018;29:799-808.\u003c/li\u003e\n \u003cli\u003eUhlig C, Rapp M, Hartmann B, Hierlemann H, Planck H, Dittel KK. Suprathel-an innovative, resorbable skin substitute for the treatment of burn victims. Burns. 2007;33:221-9.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eComparison of demographic data by group.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.642276422764226%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEz-derm group\u003c/strong\u003e\u0026reg;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=179)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBiobrane group\u003c/strong\u003e\u0026reg;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=107)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuprathel group\u003c/strong\u003e\u0026reg;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=92)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.357723577235772%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.642276422764226%\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender; n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026bull;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026bull;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e105 (58.7)\u003c/p\u003e\n \u003cp\u003e74 (41.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e53 (49.5)\u003c/p\u003e\n \u003cp\u003e54 (50.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e53 (57.6)\u003c/p\u003e\n \u003cp\u003e39 (42.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.357723577235772%\"\u003e\n \u003cp\u003e0.298\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.642276422764226%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years); mean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e5.3 (3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e4.1 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e4.8 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.357723577235772%\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.642276422764226%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight (kg); mean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e22.4 (15.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e18.9 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e20.2 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.357723577235772%\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.642276422764226%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnicity; n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026bull;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCaucasian\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026bull;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eArab\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026bull;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eLatin\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026bull;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAfrican\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e74 (41.3)\u003c/p\u003e\n \u003cp\u003e47 (26.3)\u003c/p\u003e\n \u003cp\u003e35 (19.6)\u003c/p\u003e\n \u003cp\u003e23 (12.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e46 (43.0)\u003c/p\u003e\n \u003cp\u003e29 (27.1)\u003c/p\u003e\n \u003cp\u003e22 (20.6)\u003c/p\u003e\n \u003cp\u003e10 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e42 (45.7)\u003c/p\u003e\n \u003cp\u003e21 (22.8)\u003c/p\u003e\n \u003cp\u003e20 (21.7)\u003c/p\u003e\n \u003cp\u003e9 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.357723577235772%\"\u003e\n \u003cp\u003e0.512\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSD, standard deviation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eBurn clinical features distributed by groups.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.781758957654723%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.403908794788272%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEz-derm group\u003c/strong\u003e\u0026reg;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=179)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.403908794788272%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBiobrane group\u003c/strong\u003e\u0026reg;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=107)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03257328990228%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuprathel group\u003c/strong\u003e\u0026reg;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=92)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.37785016286645%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.781758957654723%\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of burn; n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026bull;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eThermal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026bull;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eChemical\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026bull;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eElectrical\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.403908794788272%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e171 (95.5)\u003c/p\u003e\n \u003cp\u003e4 (2.2)\u003c/p\u003e\n \u003cp\u003e4 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.403908794788272%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e107 (100)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03257328990228%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e91 (98.9)\u003c/p\u003e\n \u003cp\u003e1 (1.1)\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.37785016286645%\"\u003e\n \u003cp\u003e0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.781758957654723%\"\u003e\n \u003cp\u003e\u003cstrong\u003eScald; n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.403908794788272%\"\u003e\n \u003cp\u003e134 (78.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.403908794788272%\"\u003e\n \u003cp\u003e87 (81.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03257328990228%\"\u003e\n \u003cp\u003e71 (80.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.37785016286645%\"\u003e\n \u003cp\u003e0.310\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.781758957654723%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBurndepth; n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026bull; Superficial partial-thickness\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026bull;\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eDeep partial-thickness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.403908794788272%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e50 (27.9)\u003c/p\u003e\n \u003cp\u003e129 (72.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.403908794788272%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e35 (32.7)\u003c/p\u003e\n \u003cp\u003e72 (67.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03257328990228%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e33 (35.9)\u003c/p\u003e\n \u003cp\u003e59 (64.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.37785016286645%\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.781758957654723%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBurned TBSA \u0026nbsp;(%); median (\u003c/strong\u003eIQR\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.403908794788272%\"\u003e\n \u003cp\u003e8 (5-10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.403908794788272%\"\u003e\n \u003cp\u003e9 (6-15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.03257328990228%\"\u003e\n \u003cp\u003e8 (5-10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.37785016286645%\"\u003e\n \u003cp\u003e0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTBSA, total body surface area; IQR, interquartile range.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003ePostoperative outcomes and long-term complications.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.807817589576544%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.938110749185668%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEz-derm group\u003c/strong\u003e\u0026reg;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=179)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.938110749185668%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBiobrane group\u003c/strong\u003e\u0026reg;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=107)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.938110749185668%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSuprathel group\u003c/strong\u003e\u0026reg;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=92)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.37785016286645%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.807817589576544%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of hospital stay (days); median (\u003c/strong\u003eIQR\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.938110749185668%\"\u003e\n \u003cp\u003e9 (6-13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.938110749185668%\"\u003e\n \u003cp\u003e9 (7-14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.938110749185668%\"\u003e\n \u003cp\u003e4 (2-9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.37785016286645%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.807817589576544%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeed for escharectomy and grafting; n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.938110749185668%\"\u003e\n \u003cp\u003e44 (24.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.938110749185668%\"\u003e\n \u003cp\u003e34 (32.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.938110749185668%\"\u003e\n \u003cp\u003e19,1 (21,1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.37785016286645%\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.807817589576544%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLong-term sequelae; n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eHypertrophy\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e\u0026nbsp;Scar contracture\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAlopecia\u003c/strong\u003e\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.938110749185668%\"\u003e\n \u003cp\u003e54 (30.2)\u003c/p\u003e\n \u003cp\u003e52 (29.1)\u003c/p\u003e\n \u003cp\u003e4 (2.2)\u003c/p\u003e\n \u003cp\u003e11 (6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.938110749185668%\"\u003e\n \u003cp\u003e35 (32.7)\u003c/p\u003e\n \u003cp\u003e32 (29.9)\u003c/p\u003e\n \u003cp\u003e3 (2.8)\u003c/p\u003e\n \u003cp\u003e4 (3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.938110749185668%\"\u003e\n \u003cp\u003e27 (29.3)\u003c/p\u003e\n \u003cp\u003e26 (28.3)\u003c/p\u003e\n \u003cp\u003e3 (3.2)\u003c/p\u003e\n \u003cp\u003e4 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.37785016286645%\"\u003e\n \u003cp\u003e0.860\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.807817589576544%\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeed for reintervention; n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.938110749185668%\"\u003e\n \u003cp\u003e48 (26.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.938110749185668%\"\u003e\n \u003cp\u003e28 (26.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.938110749185668%\"\u003e\n \u003cp\u003e17 (18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.37785016286645%\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.807817589576544%\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of reintervention; n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026bull; Intralesional Triamcinolone injection\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026bull; Scar contracture release + graft\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026bull; Scar contracture release + Z-plasty\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.938110749185668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e29 (60.4)\u003c/p\u003e\n \u003cp\u003e11 (22.9)\u003c/p\u003e\n \u003cp\u003e8 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.938110749185668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e18 (64.3)\u003c/p\u003e\n \u003cp\u003e7 (25)\u003c/p\u003e\n \u003cp\u003e3 (10.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.938110749185668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11 (64.7)\u003c/p\u003e\n \u003cp\u003e4 (23.5)\u003c/p\u003e\n \u003cp\u003e2 (11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.37785016286645%\"\u003e\n \u003cp\u003e0.314\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIQR, interquartile range.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejpe","sideBox":"Learn more about [European Journal of Pediatrics](https://www.springer.com/journal/431)","snPcode":"431","submissionUrl":"https://submission.nature.com/new-submission/431/3","title":"European Journal of Pediatrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4676446/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4676446/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: Early debridement of partial-thickness burns and coverage with skin substitutes is currently the standard of care in children, although there is currently no “gold standard” skin substitute Our aim is to compare the effectiveness of three different skin substitutes, analyzing the medium and long-term outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A retrospective study was conducted on burn patients under 18-years admitted to our Burn Unit between 2015-2021, who were divided into 3 groups according to the type of skin substitute used (EZ-derm®, Biobrane® and Suprathel®). Demographic, clinical data and short- and long-term outcomes were analyzed. Effectiveness was analyzed by escharectomy and grafting rate during acute management and long-term follow-up reintervention rate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: A total of 378 patients were included (179 Ez-derm®group, 107 Biobrane® group and 92 Suprathel® group). No differences in demographics or burn characteristics were observed between them. Patients treated with Suprathel®had a significantly shorter hospital stay [median 4 days (IQR 2-9)], a lower rate of escharectomy and grafting during acute management (21.1%), and a lower long-term follow-up reintervention rate (18.5%) when compared to the Ez-derm® group [median stay 9 days (IQR 6-13); escharectomy and graft 24.6% and reintervention 26.8%] and to the Biobrane® group [median stay 9 days (IQR 7-14); escharectomy and graft 32.1% and reintervention 26.2%].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Treatment of partial-thickness burns with Suprathel® is associated with a shorter hospital stay, lower need for escharectomy and grafting, and lower need for long-term reintervention. Therefore, it should be considered the treatment of choice for pediatric partial-thickness burns.\u003c/p\u003e","manuscriptTitle":"Comparison of the Effectiveness of Three Different Skin Substitutes for the Treatment of Pediatric Burns","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-26 03:31:00","doi":"10.21203/rs.3.rs-4676446/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-01T10:19:27+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-02T07:35:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"166818991525631516258456462566176807690","date":"2024-09-02T06:33:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-03T14:12:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-03T14:11:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-03T11:06:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Pediatrics","date":"2024-07-02T21:24:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejpe","sideBox":"Learn more about [European Journal of Pediatrics](https://www.springer.com/journal/431)","snPcode":"431","submissionUrl":"https://submission.nature.com/new-submission/431/3","title":"European Journal of Pediatrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"e99dedee-7c4c-4160-b187-2dc7bef9f303","owner":[],"postedDate":"July 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-16T15:59:29+00:00","versionOfRecord":{"articleIdentity":"rs-4676446","link":"https://doi.org/10.1007/s00431-024-05916-6","journal":{"identity":"european-journal-of-pediatrics","isVorOnly":false,"title":"European Journal of Pediatrics"},"publishedOn":"2024-12-13 15:57:06","publishedOnDateReadable":"December 13th, 2024"},"versionCreatedAt":"2024-07-26 03:31:00","video":"","vorDoi":"10.1007/s00431-024-05916-6","vorDoiUrl":"https://doi.org/10.1007/s00431-024-05916-6","workflowStages":[]},"version":"v1","identity":"rs-4676446","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4676446","identity":"rs-4676446","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}