Quantitative justification of the advantage of 3d bioprinting over conventional skin transplantation in the reconstruction of burn defects

Aim: To quantify, using published clinical outcome data, the advantage of 3D-bioprinted and bioengineered autologous skin constructs over conventional autologous skin grafting in the reconstruction of burn defects. Materials and Methods: PubMed/MEDLINE, Scopus, Web of Science, the Cochrane Library and ClinicalTrials.gov were searched for records published between 1 January 2015 and 28 February 2026;. Three concept blocks were combined with AND, synonyms within each block with OR: (i) skin graft, autograft, donor site; (ii) burn, thermal injury, full-thickness defect, contracture; (iii) bioprinting, bioengineered skin, skin substitute, dermo-epidermal graft. Randomised trials, cohorts, registries and reviews with pooled data were eligible; excluded were case reports under five patients, in-vitro-only endpoints, no extractable outcome, or non-English records. The tissue economy ratio (TER) is the area of defect closed per unit area of donor tissue harvested, cm2/cm2. The iatrogenic donor burden (IDB) is the donor wound area per 100 cm2 closed, IDB = 100/TER; both are computed only from reported values. Quantitative variables are presented as mean (standard deviation [SD]), median (interquartile range [IQR]), or the min-max range across studies, per how the source reported them; qualitative variables as absolute and relative frequencies. Results: Forty-six sources were included. Conventional grafting was associated with graft failure in up to 32.3% of patients, post-grafting infection in 41.4%, hypertrophic scarring of the grafted burn area in 8%–67% of patients and of the donor site in 28%-64%, contracture at discharge in 38%-54%, and contracture recurrence in 27.1% of patients at 1 year. In a randomised intra-patient comparison, the tissue economy ratio was 10.76 for a bioengineered autologous dermoepidermal construct versus 1.70 for meshed split-thickness skin grafting, representing a 6.3-fold difference. This corresponded to 9.3 cm² versus 58.8 cm² of donor wound created per 100 cm² of defect closed, respectively, representing an 84.2% relative reduction in donor wound area. Conclusions: The advantage of the bioprinting-based approach is structural and quantifiable rather than marginal and is greatest in patients with the least donor-tissue reserve. Its adoption is limited less by demonstrated efficacy than by challenges related to vascularisation of large constructs, manufacturing lead times, and regulatory classification.