Topical haemostatic agents for skin wounds: a systematic review

Abstract

BackgroundVarious agents and techniques have been introduced to limit intra-operative blood loss from skin lesions. No uniformity regarding the type of haemostasis exists and this is generally based on the surgeon's preference. To study the effectiveness of haemostatic agents, standardized wounds like donor site wounds after split skin grafting (SSG) appear particularly suitable. Thus, we performed a systematic review to assess the effectiveness of haemostatic agents in donor site wounds.MethodsWe searched all randomized clinical trials (RCTs) on haemostasis after SSG in Medline, Embase and the Cochrane Library until January 2011. Two reviewers independently assessed trial relevance and quality and performed data analysis. Primary endpoint was effectiveness regarding haemostasis. Secondary endpoints were wound healing, adverse effects, and costs.ResultsNine relevant RCTs with a fair methodological quality were found, comparing epinephrine, thrombin, fibrin sealant, alginate dressings, saline, and mineral oil. Epinephrine achieved haemostasis significantly faster than thrombin (difference up to 2.5 minutes), saline or mineral oil (up to 6.5 minutes). Fibrin sealant also resulted in an up to 1 minute quicker haemostasis than thrombin and up to 3 minutes quicker than placebo, but was not directly challenged against epinephrine. Adverse effects appeared negligible. Due to lack of clinical homogeneity, meta-analysis was impossible.ConclusionAccording to best available evidence, epinephrine and fibrin sealant appear superior to achieve haemostasis when substantial topical blood loss is anticipated, particularly in case of (larger) SSGs and burn debridement.

Randomized clinical trial of donor-site wound dressings after split-skin grafting

“…Haemostasis was applied in fewer patients in the film and hydrofibre groups than in other dressing groups; however, the surgeon's decision that haemostasis was not needed was not influenced by the dressing, as the allocation was decided by randomization after haemostasis had been achieved. In the gauze, hydrocolloid and silicone groups, haemostasis was applied in about half of the patients, but time to wound healing differed considerably among these groups, indicating that the need for haemostasis did not have a substantial effect on wound healing.…”

Blood utilization in patients with burn injury and association with clinical outcomes (CME)

“…After burn injury, patients experience acute anemia associated with the surgical management of wounds, iatrogenic blood loss, and anemia of critical illness . A variety of therapeutic strategies are used in clinical practice to control perioperative bleeding including the use of local manual pressure, electrocautery, topical soaked epinephrine pads, tumescence, thrombin and fibrin sealants, tourniquets, and the application of topical hemostatic dressings . To date, there is limited literature describing the magnitude of blood utilization in the burn population …”

“…2 A variety of therapeutic strategies are used in clinical practice to control perioperative bleeding including the use of local manual pressure, electrocautery, topical soaked epinephrine pads, tumescence, thrombin and fibrin sealants, tourniquets, and the application of topical hemostatic dressings. [2][3][4] To date, there is limited literature describing the magnitude of blood utilization in the burn population. 2,[4][5][6][7][8][9] Given recent heightened concerns that blood transfusion in several clinical settings may be associated with increased morbidity and mortality, [9][10][11][12][13][14][15][16][17][18] we measured the number of red blood cell (RBC) and plasma transfusions administered within 60 days of burn injury in our institution and evaluated these data in relation to clinical variables including burn severity and mortality.…”

Comparison of hemostatic dressings for superficial wounds using a new spectrophotometric coagulation assay

“…Several available topical agents such as fibrin sealants, silicates and others improve local hemostasis [29–31]. However, study designs were not comparable and most focused on major hemorrhage in surgical intervention, severe trauma or battlefield injuries.…”

“…However, study designs were not comparable and most focused on major hemorrhage in surgical intervention, severe trauma or battlefield injuries. The prolonged bleeding of superficial everyday wounds are insufficiently analyzed [29, 32]. …”