Sticking to What Matters: A Matched Comparative Study of Fibrin Glue and Mechanical Fixation for Split-Thickness Skin Grafts in the Lower Extremity

2021 ◽  
pp. 153473462110477
Author(s):  
Sammy Othman ◽  
Charles A. Messa ◽  
Omar Elfanagely ◽  
Bradford Bormann ◽  
Joseph A. Mellia ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Fibrin Glue ◽  
Operative Time ◽  
Standard Of Care ◽  
Lower Number ◽  
Skin Grafts ◽  
Vacuum Assisted Closure ◽  
Postoperative Wound ◽  
Thickness Skin ◽  
Significant Difference

Background: Split-thickness skin grafts (STSGs) remain a valuable tool in the reconstructive surgeons’ armamentarium. Staple or suture mechanical fixation (MF) serves as the gold standard of care, though fibrin glue (FG) has gained popularity as a fixation modality. We compare STSG outcomes following application of FG versus MF through a study of lower extremity wounds. Methods: A retrospective review (2016-2019) of patients who underwent a STSG was performed. Two cohorts consisting of patients undergoing a STSG with FG or MF (suture or staple) were matched according to wound size, wound location, and body mass index. Results: A total of 67 patients with 79 wounds were included (FG: n = 30, wounds = 39; MF: n = 37; wounds = 40). There was no significant difference between groups regarding time to 100% graft take (FG: 39 days, MF: 35.1 days; P < .384) or 180-day graft complications (FG: 10.3%, MF: 15%; P < .737). Adjusted operative time for FG (51.8 min) was lower than for MF cases (67.5 min) at a level that approached significance ( P < .094). FG patients were significantly less likely to require a postoperative wound vacuum-assisted closure (VAC) (FG: 16.7%; MF: 76.7%; P < .001) and required a significantly lower number of 30-day postoperative visits (FG: 1.5 ± .78 visits; MF: 2.5 ± .03 visits; P < .001). The MF group had higher mean aggregate charges ($211,090) compared with the FG group (mean: $149,907), although these were not statistically significant ( P > .05). Conclusion: The use of FG for STSG shows comparable clinical outcomes to MF, with a significantly decreased need for postoperative wound VAC, the number of 30-day postoperative visits, and a lower wound-adjusted operative time.

668 Fixation of Split-Thickness Skin Grafts with Liquid Adhesive and Fibrin Glue in Place of Staples

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S190-S191
Author(s):  
Joshua Frost ◽  
Nathan Hallier ◽  
Tanir Moreno ◽  
Jared Covell ◽  
Ryan Keck ◽  
...  
Keyword(s):  
Fibrin Glue ◽  
Skin Grafting ◽  
Skin Grafts ◽  
Inclusion Criteria ◽  
Intact Skin ◽  
Body Area ◽  
Wound Site ◽  
Graft Take ◽  
Thickness Skin ◽  
Split Thickness Skin Grafting

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.

Comparison of a new hydro-surgical technique to traditional methods for the preparation of full-thickness skin grafts from canine cadaveric skin and report of a single clinical case

2012 ◽  
Vol 25 (01) ◽  
pp. 42-48 ◽  
Author(s):  
S. C. Ralphs ◽  
G Coronado ◽  
D. C. Sweet ◽  
J. Ward ◽  
C. P. Bloch ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Skin Graft ◽  
Clinical Case ◽  
Subcutaneous Tissue ◽  
Skin Grafts ◽  
Full Thickness ◽  
Preparation Methods ◽  
Full Thickness Skin ◽  
Thickness Skin ◽  
Significant Difference

SummaryObjective: To compare the hydro-surgical technique to traditional techniques for removal of subcutaneous tissue in the preparation of full-thickness skin grafts.Study design: Ex vivo experimental study and a single clinical case report.Sample population: Four canine cadavers and a single clinical case.Methods: Four sections of skin were harvested from the lateral flank of recently euthanatized dogs. Traditional preparation methods used included both a blade or scissors technique, each of which were compared to the hydro-surgical technique individually. Preparation methods were compared based on length of time for removal of the subcutaneous tissue from the graft, histologic grading, and measurable thickness as compared to an untreated sample.Results: The hydro-surgical technique had the shortest skin graft preparation time as compared to traditional techniques (p = 0.002). There was no significant difference in the histological grading or measurable subcutaneous thickness between skin specimens.Clinical significance: The hydro-surgical technique provides a rapid, effective debridement of subcutaneous tissue in the preparation of full-thickness skin grafts. There were not any significant changes in histological grade and subcutaneous tissue remaining among all treatment types. Additionally the hydro-surgical technique was successfully used to prepare a full-thickness meshed free skin graft in the reconstruction of a traumatic medial tarsal wound in a dog.Presented at the ACVS symposium during the resident seminar, Seattle, Washington,USA on October 22, 2010.

scholarly journals Comparative study between fibrin glue and platelet rich plasma in dogs skin grafts

2012 ◽  
Vol 27 (11) ◽  
pp. 789-794 ◽  
Author(s):  
Larissa Correa Hermeto ◽  
Rafael de Rossi ◽  
Santiago Benites de Pádua ◽  
Elenir Rose Jardim Pontes ◽  
Aureo Evangelista Santana
Keyword(s):  
Fibrin Glue ◽  
Platelet Rich Plasma ◽  
Control Group ◽  
Skin Grafts ◽  
Full Thickness ◽  
Clinical Evaluations ◽  
Thickness Skin ◽  
Left Limb ◽  
The Right ◽  
Mesh Skin Graft

PURPOSE: Compare fibrin glue (Tissucol®) and platelet-rich plasma in full-thickness mesh skin grafts in dogs. METHODS: Eighteen dogs were used, divided into two groups: fibrin glue (FG) and platelet-rich plasma (PRP). In all the animals, a full-thickness 3x3 cm mesh skin graft was implanted. In the left limb, the biomaterial was place between the graft and the receptor bed, according to the group, while the right limb served as the control group. All the animals were evaluated clinically every 48 hours until the 14th day, using the variables of exudation, coloration, edema and cosmetic appearance. Three animals were evaluated histologically, on the third, seventh and tenth postoperative days, using the variables of fibroblasts, collagen, granulation tissue, microscopic integration-adherence and acute inflammation. RESULTS: Clinical evaluations showed that the group CF showed better scores for all variables compared to PRP group. On the histological evaluations PRP group had a higher presence of fibroblasts in the seventh and fourteenth days. CONCLUSION: The fibrin glue group was clinically superior to the platelet-rich group when used on full-thickness skin grafts in dogs.

Application of Topical Negative Pressure (Vacuum-Assisted Closure) to Split-Thickness Skin Grafts

2013 ◽  
Vol 70 (1) ◽  
pp. 23-29 ◽  
Author(s):  
Ernest Anthony Azzopardi ◽  
Dean E. Boyce ◽  
William A. Dickson ◽  
Elayne Azzopardi ◽  
James Hamish Ellsworth Laing ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Skin Grafts ◽  
Vacuum Assisted Closure ◽  
Topical Negative Pressure ◽  
Thickness Skin

Securing split-thickness skin grafts using negative-pressure wound therapy without suture fixation

2019 ◽  
Vol 28 (Sup8) ◽  
pp. S16-S21
Author(s):  
Yusuke Inatomi ◽  
Hideki Kadota ◽  
Kenichi Kamizono ◽  
Masuo Hanada ◽  
Sei Yoshida
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Statistical Significance ◽  
Operation Time ◽  
Control Group ◽  
Skin Grafts ◽  
Wound Therapy ◽  
Thickness Skin ◽  
Significant Difference ◽  
Suture Group

Objective: Negative-pressure wound therapy (NPWT) is generally applied as a bolster for split-thickness skin grafts (STSG) after the graft has been secured with sutures or skin staples. In this study, NPWT was applied to secure STSGs without any sutures or staples. Surgical outcomes of using NPWT without sutures was compared with a control group. Methods: Patients with STSGs were divided into two groups: a ‘no suture’ group using only NPWT, and a control group using conventional fixings. In the no suture group, the grafts were covered with meshed wound dressing and ointment. The NPWT foam was placed over the STSG and negative pressure applied. In the control group, grafts were fixed in place using tie-over bolster, securing with fibrin glue, or NPWT after sutures. Results: A total of 30 patients with 35 graft sites participated in the study. The mean rate of graft take in the no suture group was 95.1%, compared with 93.3% in the control group, with no significant difference between them. No graft shearing occurred in the no suture group. Although the difference did not reach statistical significance, mean surgical time in the no suture group (31.5 minutes) tended to be shorter than that in the control group (55.7 minutes). Conclusion: By eliminating sutures, the operation time tended to be shorter, suturing was avoided and suture removal was not required meaning that patients could avoid the pain associated with this procedure. Furthermore, the potential for staple retention and its associated complications was avoided, making this method potentially beneficial for both medical staff and patients.

Effects of a Fibrin Sealant on Skin Graft Tissue Adhesion in a Rodent Model

2016 ◽  
Vol 155 (1) ◽  
pp. 76-80 ◽  
Author(s):  
Mark D. Balceniuk ◽  
Nicholas A. Wingate ◽  
Howard Krein ◽  
Joseph Curry ◽  
David Cognetti ◽  
...  
Keyword(s):  
Fibrin Glue ◽  
Adhesion Strength ◽  
Fibrin Sealant ◽  
Control Group ◽  
Skin Grafts ◽  
Average Force ◽  
Significant Difference ◽  
And Control ◽  
Experimental Group ◽  
Adherence Strength

Objective To establish a rodent model for skin grafting with fibrin glue and examine the effects of fibrin glue on the adhesive strength of skin grafts without bolsters. Study Design Animal cohort. Setting Academic hospital laboratory. Subjects and Methods Three skin grafts were created using a pneumatic microtome on the dorsum of 12 rats. Rats were evenly divided into experimental (n = 6) and control (n = 6) groups. The experimental group received a thin layer of fibrin glue between the graft and wound bed, and the control group was secured with standard bolsters. Adherence strength of the skin graft was tested by measurement of force required to sheer the graft from the recipient wound. Adhesion strength measurements were taken on postoperative days (PODs) 1, 2, and 3. Results The experimental group required an average force of 719 g on POD1, 895 g on POD2, and 676 g on POD3, while the average force in the control group was 161 g on POD1, 257 g on POD2, and 267 g on POD3. On each of the 3 PODs, there was a significant difference in adherence strength between the experimental and control groups ( P = .036, P = .029, P = .024). Conclusion There is a significant difference in the adhesion strength of skin grafts to the wound bed in the early postoperative period of the 2 groups. In areas of high mobility, using the fibrin sealant can keep the graft immobile during the critical phases of early healing.

Skin grafting after paediatric palmar burns: an analysis of 82 patients

2019 ◽  
Vol 44 (10) ◽  
pp. 1031-1035
Author(s):  
Evi M. Morandi ◽  
Elisabeth Schwabegger ◽  
Christoph Tasch ◽  
Gerhard Pierer ◽  
Gabriel Djedovic ◽  
...  
Keyword(s):  
Burn Injury ◽  
Case Series ◽  
Skin Grafting ◽  
Standard Of Care ◽  
Burn Injuries ◽  
Skin Grafts ◽  
Level Of Evidence ◽  
Paediatric Patients ◽  
Thickness Skin ◽  
Texture Match

Contact burn injuries to the palm are common in toddlers. We report a case series of 82 paediatric patients (age 7–48 months) with contact burn injury of the palm. We share our experience and outcomes of using plantar split-thickness skin grafts for resurfacing of the paediatric palm. We found that despite the excellent colour and texture match, split-thickness skin grafts from glabrous skin during growth are prone to motion-limiting scare contracture. From this series, we conclude that full-thickness skin grafts remain the reference standard of care in paediatric patients’ hands. We recommend that children with burn scars should have regular check-up examinations until they are fully grown. Level of evidence: IV

scholarly journals Retroperitoneal endoscopic adrenalectomy vs. Conventional adrenalectomy in treatment of benign adrenal lesions: Comparative analysis

2007 ◽  
Vol 54 (2) ◽  
pp. 45-48 ◽  
Author(s):  
G. Todorov ◽  
Tc. Lukanova
Keyword(s):  
Minimally Invasive ◽  
Hospital Stay ◽  
Complication Rate ◽  
Operative Time ◽  
Standard Of Care ◽  
Postoperative Hospital Stay ◽  
Adrenal Tumors ◽  
Endoscopic Adrenalectomy ◽  
Significant Difference ◽  
Median Operative Time

Minimally invasive adrenalectomy is considered to be the standard of care for the surgical treatment of the adrenal gland? s pathology. Since the initial report of laparoscopic adrenalectomy in 1992 and of retroperitoneal endoscopic adrenalectomy in 1994, it has evolved into a feasible and safe minimally invasive procedure for benign adrenal tumors. Clinical characteristics and outcomes of 63 retroperitoneal endoscopic adrenalectomies (REAs) and 45 conventional adrenalectomies (CAs) from 1996 to 2004 were evaluated. 61 patients underwent 63 REAs. Tumor size varied from 2 to 8 cm. Median age was 48.6 years. Median operative time was 135 min (45-240), median intraoperative blood loss - 85 ml (30- 550). The complication rate was 17.77%. Median postoperative hospital stay was 5 days (2-10). 44 patients underwent 45 conventional adenalectomies. Median age was 44.5 years (16-71). Intraoperative complication rate was 17.77%, postoperative - 22.22 %, Median operative time was 120 min (75 -240). Median postoperative hospital stay was 10 days (6-21). No statistically significant difference was established between median operative times of REA- and CA-groups (p=0.91). Conventional adrenalectomy was associated with a significantly increased complication rate (p= 0.009). Hospitalization was also longer after the open technique (d). Introduced in 1994 and displaying all advantages of minimal access surgery REA has become the standard of care for benign adrenal tumors. .

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