Pediatric Burn Treatment Using Tilapia Skin as a Xenograft for Superficial Partial-Thickness Wounds: A Pilot Study

Abstract

This study aims to evaluate the efficacy of Nile tilapia skin as a xenograft for the treatment of partial-thickness burn wounds in children. This is an open-label, monocentric, randomized phase II pilot study conducted in Fortaleza, Brazil. The study population consisted of 30 children between the ages of 2 and 12 years with superficial “partial-thickness” burns admitted less than 72 hours from the thermal injury. In the test group, the tilapia skin was applied. In the control group, a thin layer of silver sulfadiazine cream 1% was applied. Tilapia skin showed good adherence to the wound bed, reducing the number of dressing changes required, the amount of anesthetics used, and providing benefits for the patients and also for healthcare professionals, by reducing the overall work load. The number of days to complete burn wound healing, the total amount of analgesics required throughout the treatment, burn improvement on the day of dressing removal, and pain throughout the treatment were similar to the conventional treatment with silver sulfadiazine. Thus, tilapia skin can be considered an effective and low-cost extra resource in the therapeutic arsenal of pediatric superficial partial thickness burns.

Paediatric Partial-Thickness Burn Therapy: A Meta-Analysis and Systematic Review of Randomised Controlled Trials

“…SSD [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ] treatment was reported in comparison with amnion membrane (AM) [ 20 , 40 , 41 ], biosynthetic dressings (Biobrane, EzDerm, Transcyte) [ 18 , 21 , 22 , 40 , 41 , 42 , 43 , 44 ], Biobrane only [ 18 , 21 , 22 , 42 , 43 ], negative pressure wound therapy (NPWT) [ 27 , 35 , 45 ], silver foam dressings (Acticoat, Aquacel Ag, Mepilex Ag) [ 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ] and Acticoat only [ 46 , 47 , 49 ], which can be seen in the following figures. The attributes of each aforementioned intervention, as well as autografts [ 41 , 52 ], Silvasorb [ 25 ], Tilapia [ 16 ], additional treatments (viz., collagenase [ 19 ], vitamin E + C + Zinc [ 53 ], wIRA [ 36 ], heparin [ 38 ], rhGM-CSF […”

“…Only one multi-centre study [ 17 ] was identified. Six studies reported outcomes from II/A [ 16 , 20 , 22 , 35 , 36 , 39 ], five from II/B [ 20 , 27 , 34 , 39 , 41 ], three from II/A and MD [ 17 , 25 , 42 ] and one from MD injuries only [ 46 ], while in the remaining studies, the exact depth of the injury was not specified in children with PT burns [18,19,21,23,24,26,37.40,43–45,47,48,53]. The trial and patient characteristics of the 29 RCTs analysed in this study are summarised in Table 1 .…”

“…In the past, the gold standard for the topical treatment of paediatric PT burns was the soft, white and water-soluble silver sulphadiazine (SSD) 1% cream, under many product names such as Dermazin ® , Flamazine ® , Silvadene ® or Silvazin ® [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. It is still the most commonly administered treatment in many countries as it allows wounds to heal without the need for surgical intervention.…”

Utilização de pele de tilápia para o reparo e proteção do palato após remoção de enxertos

“…A pele de tilápia-do-Nilo (Oreochromis niloticus) apresenta estrutura morfológica semelhante à pele humana, sendo a derme composta por feixes de colágeno compactados, longos e organizados do tipo I, com elevada resistência à tração (ALVES et al, 2018). Até o momento, a utilização desse biomaterial em outras áreas como cirurgia plástica, ginecologia e queimadura DIAS et al, 2019;DIAS et al, 2020;LIMA JUNIOR et al, 2020a;LIMA JUNIOR et al, 2020b;RODRIGUEZ et al, 2020) tem se mostrado eficaz, sem ocorrência de efeitos colaterais significativos.…”

“…A queda da pele de proteção era esperada em um período anterior a 7 dias, devido ao meio intra-oral ser dinâmico e úmido, sofrendo constantes traumas e interações químicas com o material. Dessa forma, o material tem uma reabsorção mais rápida do que seu uso em área externa ao meio bucal, como por exemplo, o uso da pele em queimaduras da derme, as quais devem receber a troca do material a cada 12 dias(LIMA JUNIOR et al, 2020b).As principais limitações do estudo estão na impossibilidade de cegamento do participante e do operador, já que a diferença entre os materiais é visualmente e texturalmente perceptível. Portanto, nesse estudo, apenas o examinador foi cegado.Outra dificuldade foi imposta pela decorrência da pandemia COVID-19, já que não foi possível a inclusão de maior número de participantes e grupos de estudo devido à suspensão de todas as atividades de pesquisa clínica desde março de 2020.…”