Abstract
Introduction
A critical component of split-thickness skin grafting is the fixation of the skin graft to the wound site. Graft displacement can result in graft failure, especially during the initial 48–72 hours following application. The most common method of securing grafts is with the use of staples, sometimes with the addition of fibrin glue in order to aid both graft adhesion and homeostasis. The use of staples, however, is associated with significant levels of patient discomfort, especially during staple removal. A possible alternative to staples is the use of liquid adhesives, in combination with steri-strips, to anchor the edges of skin grafts to intact skin. Certain liquid adhesives, such as gum-based resins, are cheaper to use than staples and offer the potential to secure small split-thickness skin grafts without the associated pain of staples. In this pilot study, we examined the effectiveness of using a combination of gum-based resin (Gum Mastic-Storax-Msal-Alcohol), fibrin glue, and steri-strips to secure partial-thickness grafts in 8 patients without the use of staples or sutures.
Methods
Patients were included in the study who required split-thickness skin grafts to treat wounds involving less than or equal to 15% total surface body area and whose wounds were not located in areas prone to graft displacement, such as the axilla and groin. For each patient, skin grafts were secured using fibrin glue (sprayed over the entire wound), and a combination of liquid adhesive and steri-strips applied around the wound perimeter. The success of each graft was determined by the percentage of graft take.
Results
From January 1st, 2020 to April 30th, 2020, 8 patients were identified who fit the inclusion criteria. Five of the patients received grafts to their lower extremities, two patients received grafts to their upper extremities, and one of the patients received a graft to the torso. The average wound site that was grafted was 116.7 cm2. Average graft take among the 8 patients was 96.9%, with a range of 90%-100%. No complications at the graft site were noted, such as hematomas or any other event that resulted in graft displacement or failure.
Conclusions
The results of the study demonstrate that a combination of liquid adhesive, fibrin glue, and steri-strips, can be used as an effective alternative to staples in small split-thickness skin grafts. The use of liquid adhesive in place of staples was advantageous because it eliminated to need for staple removal, which resulted in less discomfort for the patient and less work for the nursing staff.
To Tie or Not to Tie-Over Full-Thickness Skin Grafts in Dermatologic Surgery: A Systematic Review of the Literature
