Fixation of split-thickness skin graft using fast-clotting fibrin glue containing undiluted high-concentration thrombin or sutures: a comparison study

Abstract

ObjectiveFor skin defects caused by full-thickness burns, trauma, or tumor tissue excision, skin grafting is one of the most convenient and useful treatment methods. In this situation, graft fixation is important in skin grafting. This study was performed to compare the effectiveness of skin graft fixation between high-concentration fibrin sealant and sutures. There have been numerous studies using fibrin sealant for graft fixation, but they utilized slow-clotting fibrin sealant containing less than 10 IU/mL thrombin.MethodTwenty-five patients underwent split-thickness skin grafting using fast-clotting fibrin sealant containing 400 IU/mL thrombin, while 30 patients underwent grafting using sutures. Rates of hematoma/seroma formation, graft dislocation, graft necrosis, and graft take were investigated postoperatively. The graft surface area was calculated using Image J software (National Institutes of Health, Bethesda, MD, USA).ResultAfter 5 days, rates of hematoma/seroma formation and graft dislocation were 7.84 and 1.29% in group I, and 9.55 and 1.45% in group II, respectively. After 30 days, rates of graft necrosis and graft take were 1.86 and 98.14% in group I, and 4.65 and 95.35% in group II. Undiluted fibrin sealant showed significantly superior results for all rates (p < 0.05) except graft dislocation.ConclusionWhen high-concentration fast-clotting fibrin sealant was applied to skin grafts without dilution, no difficulty was experienced during surgery. Sealant showed superior results compared with sutures and had an excellent graft take rate.Level of evidenceII.

To Glue or Not to Glue? Analysis of Fibrin Glue for Split-thickness Skin Graft Fixation

“…Despite the small cohort, lack of matched study participants, and short-term follow-up, the group anecdotally noted reduction in operating room duration, better hemostasis, and better graft fixation in the FG group. Han et al 31 developed a similar prospective study with 30-day follow-up, which found statistically significant reductions in collection formation and graft necrosis and increased graft take, with FG fixation methods. The group concluded that FG’s utility in STSG fixation was superior to suture- or staple-only fixation, despite the short-term follow-up analyses and lack of cost data.…”

Systematic review of fibrin glue in burn wound reconstruction

“…In the plastic surgery literature, fibrin glue has been used for haemostasis at skin grafting donor sites in two RCTs, one of which reported a small beneficial effect and the other no effect. In the burns literature, several groups have reported improved wound healing, graft adherence, reduced blood loss and improved haemostasis with fibrin glue. Additional advantages may include the use of fibrin glue for skin graft attachment in areas that are hard to graft such as the face, eyelids and ears, and areas of high mobility, use in diabetics and smokers, and improved functional outcomes with fibrin glue use.…”

“…Fibrin glue has been described widely for skin grafting, most extensively for SSG attachment following burn surgery. Studies suggest a number of benefits, including improved graft take, reduced haematoma formation, improved donor‐site haemostasis and improved functional outcomes.…”

Morphology of a fibrin nanocoating influences dermal fibroblast behavior

“…1 Fibrin is often applied in regenerative medicine to support wound healing. To accelerate wound healing, fibrin is mostly used in the form of a sealant, 4,5 a gel, [6][7][8] a glue, 9,10 or microbeads. 11 It is directly applied into the wound and is seeded with skin cells.…”