INTRODUCTION: Autograft take and rapid wound closure is essential for the survival of severely burned patients. Loss of skin grafts typically occurs during the first few days after coverage, mainly due to shear forces and inadequate contact with the wound bed. Slow-clotting fibrin sealant, applied with a spray-on device, has been shown to improve healing of skin grafts in large wounds. However, its use in burn wounds has not been studied so far. STUDY AIM: To evaluate the effectiveness of sprayed fibrin sealant in excised and grafted full-thickness burns. MATERIAL AND METHODS: Ten female Yorkshire pigs (30-45 kg) received a full-thickness contact burn of approximately 15% total body surface area. The burns were excised to the level of the muscular fascia after 24 h and covered with meshed skin autograft (mesh ratio 1:3). Wounds were randomized to either fibrin sealant (n=20) or standard skin staples (n=16) for graft fixation. Fibrin sealant was used as a slow-clotting spray (4 IU thrombin/ml). Outcome measurements included clinical scoring at days 2, 5, 9 and 14 postoperatively, planimetric analysis of wound closure, and histological examination of epidermal and dermal thickness 14 days after autografting. RESULTS: In the fibrin sealant group, graft adherence scores were significantly increased (p<0.02) and graft dislocation scores significantly decreased (p<0.01) at days 2 and 5 postoperatively, when compared to controls. Planimetric analysis of remaining open mesh interstices showed acceleration of wound closure in the fibrin sealant group but did not reach statistical significance (day 14 p=0.04 at significance level p<0.025). Wound contraction, occurrence of hematoma, and dermal as well as epidermal thickness were not different between the groups at 14 days postoperatively. CONCLUSION: The results indicate that the use of slow-clotting fibrin sealant spray for autograft fixation is advantageous over skin staples. Easy handling and reduced graft dislocation at early time points are key qualities of this method.
INTRODUCTION: Autograft take and rapid wound closure is essential for the survival of severely burned patients. Loss of skin grafts typically occurs during the first few days after coverage, mainly due to shear forces and inadequate contact with the wound bed. Slow-clotting fibrin sealant, applied with a spray-on device, has been shown to improve healing of skin grafts in large wounds. However, its use in burn wounds has not been studied so far. STUDY AIM: To evaluate the effectiveness of sprayed fibrin sealant in excised and grafted full-thickness burns. MATERIAL AND METHODS: Ten female Yorkshire pigs (30-45 kg) received a full-thickness contact burn of approximately 15% total body surface area. The burns were excised to the level of the muscular fascia after 24 h and covered with meshed skin autograft (mesh ratio 1:3). Wounds were randomized to either fibrin sealant (n=20) or standard skin staples (n=16) for graft fixation. Fibrin sealant was used as a slow-clotting spray (4 IU thrombin/ml). Outcome measurements included clinical scoring at days 2, 5, 9 and 14 postoperatively, planimetric analysis of wound closure, and histological examination of epidermal and dermal thickness 14 days after autografting. RESULTS: In the fibrin sealant group, graft adherence scores were significantly increased (p<0.02) and graft dislocation scores significantly decreased (p<0.01) at days 2 and 5 postoperatively, when compared to controls. Planimetric analysis of remaining open mesh interstices showed acceleration of wound closure in the fibrin sealant group but did not reach statistical significance (day 14 p=0.04 at significance level p<0.025). Wound contraction, occurrence of hematoma, and dermal as well as epidermal thickness were not different between the groups at 14 days postoperatively. CONCLUSION: The results indicate that the use of slow-clotting fibrin sealant spray for autograft fixation is advantageous over skin staples. Easy handling and reduced graft dislocation at early time points are key qualities of this method.
Authors: Celeste C Finnerty; Karel D Capek; Charles Voigt; Gabriel Hundeshagen; Janos Cambiaso-Daniel; Craig Porter; Linda E Sousse; Amina El Ayadi; Ramon Zapata-Sirvent; Ashley N Guillory; Oscar E Suman; David N Herndon Journal: J Trauma Acute Care Surg Date: 2017-09 Impact factor: 3.313
Authors: Stefan Hacker; Rainer Mittermayr; Stefanie Nickl; Thomas Haider; Diana Lebherz-Eichinger; Lucian Beer; Andreas Mitterbauer; Harald Leiss; Matthias Zimmermann; Thomas Schweiger; Claudia Keibl; Helmut Hofbauer; Christian Gabriel; Mariann Pavone-Gyöngyösi; Heinz Redl; Erwin Tschachler; Michael Mildner; Hendrik Jan Ankersmit Journal: Sci Rep Date: 2016-04-29 Impact factor: 4.379
Authors: David M Burmeister; Randolph Stone; Nicole Wrice; Alfred Laborde; Sandra C Becerra; Shanmugasundaram Natesan; Robert J Christy Journal: Stem Cells Transl Med Date: 2018-02-18 Impact factor: 6.940
Authors: Linda Hollén; Rosemary Greenwood; Rebecca Kandiyali; Jenny Ingram; Chris Foy; Susan George; Sandra Mulligan; Francesca Spickett-Jones; Simon Booth; Anthony Sack; Alan Emond; Ken Dunn; Amber Young Journal: BMJ Open Date: 2018-06-14 Impact factor: 2.692