Thermal or burn injuries cause coagulative necrosis of the epidermis and underlying tissues and the resultant wounds can be long lasting and highly painful. Depending on the depth of a burn, management ranges from local wound care to surgical intervention. When presented with deep-partial thickness and full-thickness burns, autologous skin grafting has been the mainstay of management to prevent scarring and promote healing. However, since the early 2000s, there has been increasing interest in reducing, if not eliminating, the need for autologous grafting considering the morbidity and pain associated with donor site harvesting, lack of appropriate donor sites in the case of larger burns, and to improve overall cosmetic outcomes. In this article, we discuss the available products on the market for the treatment of thermal burn injuries, explore the data advocating for their use and discuss their limitations, and highlight the unique efficacy of intact fish skin grafts, in particular, in this specific patient population.