Table 2.

Clinical evidence for ADMs in burn wounds.

Authors	Product name(s), Material	Usage, Population	Summary findings
Retrospective studies
Guo et al. (2016)	Unspecified PADM	Deep dermal burn wound treatment 60 adult burned patients Excluded: older than 65 years, those with naturally occurring musculoskeletal or visceral injuries, and those already admitted into hospital 3 + days after injury	Early dermabrasion + PADM mean healing time was 22.50 ± 4.72days, whereas early dermabrasion and nano-silver dressings only needed up to 6.0 days longer Early dermabrasion and PADM mean time in hospital was 28.3 ± 7.2 days, whereas only early dermabrasion and nano-silver dressing treatment needed 36.5 ± 8.3 days 3 months after injury: the mVSS-TBSA shows significant improvement of vascularity, pliability, pigmentation and height in the patients treated by early dermabrasion and PADM
Prospective studies
Heimbach et al. (2003)	Integra™, BADM	216 burn injury patients who were treated at 13 burn care facilities in the USA. The mean TBSA burned was 36.5% (range = 1%–95%). Integra™ was applied to fresh, clean, surgically excised burn wounds	The incidence of invasive infection at Integra™-treated sites was 3.1% (95% CI = 2.0%–4.5%) and that of superficial infection 13.2% (95% CI = 11.0%–15.7%). Mean take rate of Integra™ was 76.2%; the median take rate was 95%. The mean take rate of epidermal autograft was 87.7%; the median take rate was 98%
Nguyen et al. (2010)	Integra™, BADM	6 adult patients who had been successfully treated with Integra™ ± STSG	Integra™ sites correlated well with normal skin as measured by Cutometer Statistically significant correlation between Integra™ sites and normal skin for the elastic function and gross elasticity No correlations found between STSG and normal skin
Moiemen et al. (2010)	Integra™, BADM	8 patients (9 reconstruction sites) had unmeshed Integra™ with TNP therapy between the 1st and the 2nd stages. Patients underwent serial biopsies on days 7, 14, 21 and 28 after application	Application of TNP dressings reduced shearing forces and seroma and hematoma formation
Angspatt et al. (2017)	PoreSkin®, HADM	Burn scar treatment 8 patients, 11 hypertrophic burn scars	Graft take of PoreSkin was 97.7% at day 21. Autologous skin graft placed over PoreSkin was 91.8% VSS shows statistically significant improvement in scar quality with PoreSkin No major complications or rejection
Demircan et al. (2015)	Matriderm®, BADM	15 paediatric patients with full-thickness facial burns. In all patients, TBSA burnt was >50%	Average TBSA of patients was 72% (range = 50–90%) VSS of the first 10 of 15 patients at 6 months: average 2.55 ± 1.42 (range = 1–6) Mean vascularity, pigmentation, pliability and height: 0.1, 0.3, 0.7 and 1.2, respectively
Bloemen et al. (2010)	Matriderm®, BADM	46 patients, 69 pairs of BADM and conventionally treated (no BADM) sites	12 years follow-up Reconstructive scars: 1 surface roughness parameter better in BADM scars Subjective assessment showed several statistically significant differences in favour of BADM scars with pliability, relief and the general observer score Higher elasticity scores for BADM scars, though not statistically significant For scars treated with a largely expanded meshed skin graft, significantly higher elasticity was found with BADM
Okuno et al. (2018)	PELNAC®, HADM	Studying yeast culture properties isolated from burn wounds in vitro 36 of 273 patients fulfilled inclusion criteria to isolate burn wounds tissue for analysis	Yeast was isolated from 7 patients: Candida parapsilosis (4/7), C. albicans (2/7) and C. glabrata (1/7) C. parapsilosis penetrated ADM in 3 days and more efficiently in 7 days C. parapsilosis grew, crossed the ADM and formed a biofilm in 7 days

ADM, acellular dermal matrix; BADM, bovine acellular dermal matrix; CI, confidence interval; HADM, human acellular dermal matrix; mVSS, modified Vancouver Scar Scale; PADM, porcine acellular dermal matrix; STSG, split-thickness skin graft; TBSA, total body surface area; TNP, topical negative pressure; VSS, Vancouver Scar Scale.