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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 1

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 MEBO vs silver sulphadiazine (SSD), Outcome 1 Proportion completely healed in 10 days.
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Analysis 1.1

Comparison 1 MEBO vs silver sulphadiazine (SSD), Outcome 1 Proportion completely healed in 10 days.

Comparison 2 Gentamicin iontophoresis vs routine care, Outcome 1 Chondritis.
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Analysis 2.1

Comparison 2 Gentamicin iontophoresis vs routine care, Outcome 1 Chondritis.

Comparison 2 Gentamicin iontophoresis vs routine care, Outcome 2 Gentamicin‐resistant micro‐organisms.
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Analysis 2.2

Comparison 2 Gentamicin iontophoresis vs routine care, Outcome 2 Gentamicin‐resistant micro‐organisms.

Comparison 2 Gentamicin iontophoresis vs routine care, Outcome 3 Length of hospital stay in days.
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Analysis 2.3

Comparison 2 Gentamicin iontophoresis vs routine care, Outcome 3 Length of hospital stay in days.

Comparison 3 Bioengineered skin substitute vs topical antibiotic, Outcome 1 Pain in minor burns during facial care.
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Analysis 3.1

Comparison 3 Bioengineered skin substitute vs topical antibiotic, Outcome 1 Pain in minor burns during facial care.

Comparison 3 Bioengineered skin substitute vs topical antibiotic, Outcome 2 Pain in minor burns between facial care.
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Analysis 3.2

Comparison 3 Bioengineered skin substitute vs topical antibiotic, Outcome 2 Pain in minor burns between facial care.

Comparison 3 Bioengineered skin substitute vs topical antibiotic, Outcome 3 Pain in major burns during facial care.
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Analysis 3.3

Comparison 3 Bioengineered skin substitute vs topical antibiotic, Outcome 3 Pain in major burns during facial care.

Comparison 3 Bioengineered skin substitute vs topical antibiotic, Outcome 4 Pain in major burns between facial care.
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Analysis 3.4

Comparison 3 Bioengineered skin substitute vs topical antibiotic, Outcome 4 Pain in major burns between facial care.

Comparison 3 Bioengineered skin substitute vs topical antibiotic, Outcome 5 Pain during facial care.
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Analysis 3.5

Comparison 3 Bioengineered skin substitute vs topical antibiotic, Outcome 5 Pain during facial care.

Comparison 3 Bioengineered skin substitute vs topical antibiotic, Outcome 6 Pain between facial care.
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Analysis 3.6

Comparison 3 Bioengineered skin substitute vs topical antibiotic, Outcome 6 Pain between facial care.

Comparison 3 Bioengineered skin substitute vs topical antibiotic, Outcome 7 Length of hospital stay in days.
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Analysis 3.7

Comparison 3 Bioengineered skin substitute vs topical antibiotic, Outcome 7 Length of hospital stay in days.

Comparison 4 Biological skin substitute vs SSD, Outcome 1 Hypertrophic scar formation.
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Analysis 4.1

Comparison 4 Biological skin substitute vs SSD, Outcome 1 Hypertrophic scar formation.

Table 1. Results from included trials

Study ID

Main baseline characteristics

Number of participants and drop‐out rate

Primary outcomes

Secondary outcomes

Ang 2000

Number of participants:

I: 17; C: 22.

% TBSA burned (Mean; SE; Range):

I: 2.16; 0.38; 0.13‐6.0:
C: 1.56; 0.18; 0.5‐3.5.

Initial number of participants: 115.

After randomisation: I: 57; C: 58.

Drop‐outs:I: 3; C: 0.

Participants with facial burns: I: 17; C:22.

Particpants in short term analysis:

I: 17; C: 22.

Participants in long term analysis:

I:17; C: 20.

Number of days taken for face‐wound to heal:

I: 2‐35 days (range); C: not reported.

Proportion completely healed in 10 days:

I: 14/17; C: 17/22.

Need for reconstructive surgery 6 months PB:

I: 0/17; C: 0/20.

Demling 1999

Number of participants:

Minor burns: I: 5; C: 5.
Major burns: I: 5; C: 6.

Mean age (SD years):

Minor burns: I: 31(8); C: 29(7).
Major burns: I: 44(10); C: 40(8).

Etiology: Flame.

% TBSA burned (Mean (SD)):

Minor burns: I: 10(3); C: 7(2).
Major burns: I: 32(9); C: 30(8).

% TBSA burned Full‐thickness (Mean (SD)):

Minor burns: I: 0; C:0.
Major burns: I: 10(3); C: 8(2).

Initial number of participants: 21.

Number of participants with minor burns: 10.

Number of participants with major burns: 11.

After randomisation:

Minor burns: I: 5; C: 5.
Major burns: I: 5; C: 6.

Participants in short term analysis:

Minor burns: I: 5; C: 5.
Major burns: I: 5; C: 6.

Mean number of days to > 90% re‐epithelialisation (SD):

Minor burns:
I: 8(1); C: 12(3); significantly different P < 0.05.

Major burns:
I: 8(2); C: 14(4); significantly different P < 0.05.

Signs of local wound infection:

Minor burns: I: 0; C: 0.
Major burns: I: 0; C: 0.

Pain during facial care (Mean (SD)):

Minor burns: I: 2(1); C: 5(1).
Major burns: I: 2(1); C: 5(1).

Pain between facial care (Mean (SD)):

Minor burns: I: 1(0.5); C: 3(2).
Major burns: I: 2(1); C: 4(2).

Mean length of stay (SD):

Minor burns: I: 1(0.5); C: 3(1).
Major burns: Not reported.

Demling 2002

Number of participants:I: 16; C: 18.

Mean age (SD):I: 39(9); C: 40(8).

Etiology:

Flame: I: 11; C: 12.
Scald: I: 5; C: 6.

% TBSA burned (Mean (SD)): I: 24(8); C: 21(9).

% TBSA burned Full‐thickness (Mean (SD)):
I: 12(7); C: 10(6).

Initial number of participants: 34.

After randomisation:

I: 16; C: 18.

Participants in short term analysis:

I: 16; C: 18.

Mean number of days to > 95% re‐epithelialisation (SD):

I: 9(4); C: 15(4); significantly different P < 0.05.

Signs of infection diagnosed with swab cultures exceeding 105 organisms/gram:

I: 0; C: 0.

Pain during facial care (Mean (SD)): I: 3(1); C: 7(2).

Pain between facial care (Mean (SD)): I: 2(1); C: 4(2).

Desai 1991

Number of participants: I: 7; C: 8.

Mean age (SE):I: 11.4 (1.2); C: 9.5(1.6).

% TBSA burned (Mean (SE)): I: 35(7); C: 50(6).

% TBSA burned Full‐thickness (Mean (SE)):I: 20(9); C: 32(7).

Initial number of participants: 15.

After randomisation: I: 7; C: 8.

Participants in short term analysis: I: 7; C: 8.

Cases of wound infection diagnosed with the occurrence of chondritis: I: 3; C: 4.

Mean number (SE) of surgical procedures required: I: 1.2(0.1) C: 1.0(0); significantly different P < 0.05.

Adverse effect of treatment: occurrence of gentamicin‐resistant micro‐organisms I: 29%; C: 0%.

Mean length of stay (SE): I: 26(1); C: 38(3).

Horch 2005

Number of participants: I: 5; C: 5.

Median age (range): I + C: 34.3(24‐67).

Initial number of participants: 10.

After randomisation: I: 5; C: 5.

Participants in short term analysis:

I: 5; C: 5.

Median number of days to complete re‐epithelialisation:
I:10.5; C: 12.4; significantly different P < 0.05.

Signs of underlying infection: I: 0; C: not reported

Hypertrophic scar formation: I: 0; C: 2.

Adverse effect of treatment: localized partial integration of the biological dressing I: 1; C: 0.

Abbreviations: I = intervention group; C = control group; TBSA = Total Body Surface Area; SE = Standard Error; PB = post‐burn; SD = Standard Deviation; P = P value.

Figuras y tablas -
Table 1. Results from included trials
Comparison 1. MEBO vs silver sulphadiazine (SSD)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Proportion completely healed in 10 days Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 1. MEBO vs silver sulphadiazine (SSD)
Comparison 2. Gentamicin iontophoresis vs routine care

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Chondritis Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2 Gentamicin‐resistant micro‐organisms Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3 Length of hospital stay in days Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 2. Gentamicin iontophoresis vs routine care
Comparison 3. Bioengineered skin substitute vs topical antibiotic

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain in minor burns during facial care Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2 Pain in minor burns between facial care Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3 Pain in major burns during facial care Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4 Pain in major burns between facial care Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5 Pain during facial care Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

6 Pain between facial care Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

7 Length of hospital stay in days Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 3. Bioengineered skin substitute vs topical antibiotic
Comparison 4. Biological skin substitute vs SSD

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Hypertrophic scar formation Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 4. Biological skin substitute vs SSD