Using fibrin sealant for skin graft fixation to avoid sedation in children with burns: a prospective study

2020 ◽  
Vol 29 (11) ◽  
pp. 642-648
Author(s):  
Kelly AA Kwa ◽  
Anouk Pijpe ◽  
Dirk de Korte ◽  
Annabel Snoeks ◽  
Roelf S Breederveld ◽  
...  
Keyword(s):  
Fibrin Sealant ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
Wound Complications ◽  
Control Group ◽  
Skin Grafts ◽  
Skin Staples ◽  
Graft Take ◽  
Significant Difference ◽  
Sealant Group

Objective: To investigate whether a fibrin sealant, Fitrix (Sanquin Blood Supply Foundation, The Netherlands), for fixation of skin grafts in children with burn wounds is less invasive and equally effective in comparison with skin staples. Method: A single-centre prospective observational cohort study was conducted. Children requiring skin grafting after burns were included and received the fibrin sealant. This group was compared with a retrospective control group of children whose skin grafts were fixed with skin staples. Study outcomes were graft take, graft dislocation, other wound complications, healing and need for sedation. Results: In the fibrin sealant and the control groups, 17 and 27 patients were included, respectively. The percentage of total body surface area (%TBSA) grafted was smaller (p=0.028) in the fibrin sealant group (median 1.0, interquartile range (IQR) 1.5 versus 2.0, IQR 2.5). There was no significant difference in graft take or wound healing. There were two graft dislocations in the fibrin sealant group and none in the control group. Other complications included a patient with graft failure in the fibrin sealant group, and another patient with a vanishing graft and wound infection in the control group. There were fewer sedations in the fibrin sealant group compared with the control group (one versus 20, p<0.0001). Conclusion: The fibrin sealant used in this study was non-inferior for the fixation of skin grafts in comparison with skin staples, and avoided sedation procedures.

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.

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.

Use of Mechanical Stretching to Treat Skin Graft Contracture

2020 ◽  
Vol 41 (4) ◽  
pp. 892-899
Author(s):  
Jinfeng Zhou ◽  
Youcai Zhao ◽  
Wengbo Yang ◽  
Qianming Du ◽  
Jun Yin ◽  
...  
Keyword(s):  
Skin Graft ◽  
Smooth Muscle Actin ◽  
Picric Acid ◽  
Skin Grafting ◽  
Control Group ◽  
Skin Grafts ◽  
Alpha Smooth Muscle Actin ◽  
Treatment Measures ◽  
And Function ◽  
Mechanical Stretching

Abstract After transplantation, skin grafts contract to different degrees, thus affecting the appearance and function of the skin graft sites. The exact mechanism of contracture after skin grafting remains unclear, and reliable treatment measures are lacking; therefore, new treatment methods must be identified. Many types of centripetal contraction forces affect skin graft operation, thus leading to centripetal contracture. Therefore, antagonizing the centripetal contraction of skin grafts may be a feasible method to intervene in skin contracture. Here, the authors propose the first reported mechanical stretching method to address contracture after skin grafting. A full-thickness skin graft model was established on the backs of SD rats. The skin in the experimental group was stretched unilaterally or bidirectionally with a self-made elastic stretching device, whereas the skin was non-stretched in the control group. The rats were sacrificed 2 weeks after stretching. The area, length, and width of the skin were measured. The grafts were cut and fixed with formalin. Routine paraffin sections were stained with hematoxylin-eosin, picric acid-Sirius red, Victoria blue, and anti-alpha-smooth muscle actin (SMA). Mechanical stretching made the graft lengthen in the direction of the stress and had an important influence on collagen deposition and alpha-SMA expression in the graft. This method warrants further in-depth study to provide a basis for clinical application.

The Violated Neck: Cervical Node Biopsy Prior to Definitive Treatment

1986 ◽  
Vol 94 (6) ◽  
pp. 605-610 ◽  
Author(s):  
K. Thomas Robbins ◽  
Randolph Cole ◽  
Jeffrey Marvel ◽  
Robert Fields ◽  
Patricia Wolf ◽  
...  
Keyword(s):  
Distant Metastases ◽  
Subsequent Treatment ◽  
Response To Treatment ◽  
Definitive Treatment ◽  
Wound Complications ◽  
Control Group ◽  
Time Interval ◽  
Adequate Treatment ◽  
Node Biopsy ◽  
Significant Difference

The intent of this study was to determine whether open neck biopsy for patients with squamous cell carcinoma metastatic to the neck influenced the biologic course of the disease or the response to treatment. One hundred ninety-two patients, treated over a 10-year period at M.D. Anderson Hospital and Tumor Institute, were reviewed; 102 of the 139 patients, whose primary site of disease was identified prior to definitive treatment, were matched with a control group of 204 patients. The results showed no significant difference in wound complications, neck recurrence, distant metastases, and 5-year survival. Also, time interval from the biopsy to subsequent treatment and the type of node biopsy did not appear to have any significant detrimental effect. On the basis of these findings, we conclude that, although it is important to refrain from proceeding with an open biopsy until a complete head and neck evaluation has been done, violation of the neck does not signify a poorer prognosis—provided adequate treatment is subsequently given.

83 Multicenter Evaluation of the Use of Nebulized Heparin for Inhalation Injury (HIHI2 Study)

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S53-S54
Author(s):  
Courtney Cox ◽  
Allyson M McIntire ◽  
Kimberly Bolton ◽  
David Foster ◽  
Andrew Fritschle ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Total Body Surface Area ◽  
Inhalation Injury ◽  
Control Group ◽  
Minor Bleeding ◽  
Bleeding Events ◽  
Significant Difference ◽  
Dosing Strategies ◽  
History Of ◽  
Or History

Abstract Introduction Inhalation injury (IHI) causes significant morbidity and mortality secondary to local compromise of the respiratory system as well as systemic effects limiting perfusion and oxygenation. Nebulized heparin reduces fibrin cast formation and duration of mechanical ventilation in patients with IHI. To date, no study has compared both dosing strategies of 5,000 and 10,000 units to a matched control group. The objective of this study is to compare heparin 5,000 and 10,000 units to a historical control and determine which dosing strategy improves lung function and decreases mechanical ventilation duration. Methods This multicenter, retrospective, case-control study included adult patients with bronchoscopy-confirmed IHI. Each control patient, matched according to age and percent of total body surface area (TBSA), was matched to a patient who received 5,000 units and a patient who received 10,000 units of nebulized heparin, according to each institution’s inhalation injury protocol. Patients were excluded if they were pregnant, incarcerated, died within 72 hours of admission, terminally weaned for reasons other than burn or IHI, had a documented allergy to heparin or history of heparin-induced thrombocytopenia, history of pulmonary hemorrhage within 3 months, or history of a clinically important bleeding disorder. The primary endpoint of the study was total duration of mechanical ventilation (excluding patients who died or were not extubated). Secondary endpoints included 28-day mortality, ventilator-free days in the first 28 days, difference in lung injury scores, length of hospitalization, incidence of bronchoscopy, incidence of ventilator-associated pneumonia, and rate of bleeding events. Results Thirty-five matched patient trios met inclusion criteria. Groups were well-matched for age (p=0.975) and TBSA (p=0.855). When excluding patients who died or were never extubated, patients who received nebulized heparin, either 5,000 or 10,000 units, had 8–11 less days on the ventilator compared to controls (p=0.001). Mortality ranged from 3–14% overall, and no statistical difference was observed between groups. No major or minor bleeding events related to nebulized heparin were reported. Conclusions Mechanical ventilation days were significantly decreased in patients who received 5,000 or 10,000 units of nebulized heparin. There was no statistically significant difference in mortality between groups, supporting that either 5,000 units or 10,000 units of nebulized heparin should be used in IHI treatment. Applicability of Research to Practice To our knowledge, no previously published studies have simultaneously compared dosing strategies of 5,000 and 10,000 units to a control group. These results support the use of nebulized heparin for IHI to reduce the duration of mechanical ventilation.

A Prospective Clinical Study of the Effect of Recombinant Human Growth Hormone in Wound Healing of Severely Burned Children

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Salah Nasser Mohamed ◽  
Nahed Samir Boghdady ◽  
Mina Agaiby Estawrow ◽  
Mariam Loutfy Ahmed Mohamed
Keyword(s):  
Growth Hormone ◽  
Wound Healing ◽  
Recombinant Human Growth Hormone ◽  
Total Body Surface Area ◽  
Human Growth ◽  
Control Group ◽  
P Value ◽  
Significant Difference ◽  
The Mean ◽  
Total Body

Abstract Background A burn is a thermal injury caused by biological, chemical, electrical and physical agents with local and systemic repercussions. There are several ways of classifying burns: Classification by mechanism or cause, depth and extent of burn . Objectives The objective of this study was to determine the safety and efficacy of using recombinant human growth hormone (rhGH) in the treatment of pediatric burn victims and their probable effect on accelerating burn wound healing. Patients and Methods This study was an Interventional randomized controlled Double Blind Study in which Patients subdivided randomly into 2 groups: Group A received somatotropine hormone after their 3 days of resuscitation besides their conventional treatment during their stay in the Burn ICU. Group B received the conventional treatment only in the Burn ICU. Results The comparison between the GH group and the control group showed that that there was statistically significant difference found between the two studied groups regarding TBSA of burn at 3rd week. The mean TBSA in GH group was ( 9.06 ± 7.47 ) while in the control group (13.94 ± 11.96) with P value (0.041). There was highly statistically significant difference found between the two studied groups regarding Insulin like growth factor .the mean Insulin like growth factor in GH group was (16.48 ± 11.40) while in the control group(2.77 ± 0.64) with P value(0.000). Conclusion The use of recombinant Growth hormone with a dose of 0.2 mg/Kg SQ 2 days per week with 3 days time interval in pediatric burn patients after their primary resuscitation from the burn injury, shows a marvelous improvement concerning the total body surface area of burn(TBSA) as the patient received the growth hormone showed a decrease total body surface area of burn(TBSA) than the control group. This may be accounted for the faster wound healing and readiness for grafting .

scholarly journals Octyl-2-cyanoacrylate tissue adhesive without subcuticular suture for wound closure after total hip arthroplasty: a prospective observational study on thirty-two cases with controls for 3 months follow-up

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Li-Shen Wang ◽  
Xin-Yu Wang ◽  
Hao-tian Tu ◽  
Yi-Fan Huang ◽  
Xin Qi ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Tissue Adhesive ◽  
Wound Complications ◽  
Subcuticular Suture ◽  
Total Hip ◽  
Skin Staples ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background Whether using tissue adhesive alone after subcutaneous suture can close the skin incision with safety as well as cosmetic appearance after total hip arthroplasty was not clear. Methods A prospective study was conducted. The same surgical methods were consistent throughout the entire study. After implanting prosthesis, the joint capsule was reconstructed. Fascial and subcutaneous layer were respectively closed by continuous running barbed suture. Patients were randomized allocated to group A with octyl-2-cyanoacrylate tissue adhesive alone, to group B with tissue adhesive after continuous subcuticular suture, or to group C with skin staples. Time of closure, drainage, pain, wound complications, and cosmesis were compared. All data were analyzed statistically. Results There was no significant difference in drainage, Visual Analog Scale score or early wound complications between the three groups. However, there was significant difference in time of closure (P = 0.013). In pairwise comparison, time of closure in groups A and B was significantly longer than those in group C (P = 0.001 and P = 0.023, respectively); time of closure in group A was significantly shorter than those in group B (P = 0.003). Patient and Observer Scar Assessment Scale total scores were not significantly different at 6 weeks and 3 months postoperatively (P = 0.078 and P = 0.284, respectively). Conclusion Tissue adhesive without subcuticular suture was similar with a combination of subcuticular suture and tissue adhesive as well skin staples in terms of safety and cosmetic appearance after total hip arthroplasty.

643 The Use of Topical Exogenous Nutrient Supplementation to Improve Graft Take on an Avascular Wound Bed

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S167-S168
Author(s):  
Laura Cooper ◽  
Phillip Kemp Bohan ◽  
Anders H Carlsson ◽  
Rodney K Chan ◽  
Tyler Everett
Keyword(s):  
Graft Survival ◽  
Skin Graft ◽  
Skin Grafting ◽  
Dermal Substitute ◽  
Skin Grafts ◽  
Pressure Therapy ◽  
Nutrient Supplementation ◽  
Successful Model ◽  
Dermal Substitutes ◽  
Graft Take

Abstract Introduction Skin graft survival relies on imbibition, inosculation, and revascularization from the wound bed. When a wound bed is poorly vascularized, as in the case of exposed fascia, tendon or bone, skin grafting may be delayed until the wound bed improves. We propose that topical nutrient supplementation may be able to increase take of skin grafts applied over an avascular wound bed. Methods Twenty full-thickness 5cm-diameter wounds were created on the dorsum of anesthetized swine and a dermal substitute (0.4mm, 0.8mm, 1.2mm, or 1.6mm thick) was placed on each wound. Negative pressure therapy with and without intermittent (3x per day) saline instillation was applied. Wounds were analyzed using a non-contact 3D camera at day 7 and day 14. Results Dermal substitutes of 0.8mm, 1.2mm, and 1.6mm thicknesses inhibited graft take significantly (p&lt; 0.01, p=0.02, p&lt; 0.01, respectively) for all wounds treated with wound vac alone. Addition of the normal saline instill showed a significant improvement in graft take (p=0.03) over wound vac alone for the wounds treated with the 0.8mm dermal substitute. Wounds covered with 1.2mm and 1.6mm dermal substitute continued to show significantly decreased graft take (p=0.03 and p=0.02, respectively). Wounds with 0.4mm dermal substitute showed similar graft take to control for both the wound vac and wound vac + instill treatments. Conclusions Dermal substitutes ≥0.8mm create a successful model of an avascular wound bed. Vac + instill treatment overcame the impedance of an avascular wound bed only for the 0.8mm dermal substitute thickness. This thickness of dermal substitute creates an ideal avascular wound bed model from which to conduct further studies incorporating topical nutrients instilled directly onto skin grafts placed onto avascular wound beds. Applicability of Research to Practice Single-stage skin grafting procedures onto avascular wound beds may become feasible with topical nutrient supplementation providing the environment to maintain graft survival until the wound bed is able to support the skin graft.

scholarly journals Massive burns: retrospective analysis of changes in outcomes indicators across 18 years

2021 ◽  
Author(s):  
Joachim N Meuli ◽  
Olivier Pantet ◽  
Mette M Berger ◽  
Laurent Waselle ◽  
Wassim Raffoul
Keyword(s):  
Fluid Resuscitation ◽  
Total Body Surface Area ◽  
Skin Grafting ◽  
University Hospital ◽  
Skin Grafts ◽  
Early Care ◽  
Icu Stay ◽  
Total Body ◽  
Length Of Icu Stay ◽  
Over Time

Abstract Background The treatment and management of massive burns, defined as burns affecting≥ 50% of total body surface area (TBSA) has considerably changed since the 90s. This study aimed at analyzing if the length of intensive care unit (ICU) stay, the success of skin grafting operations and the mortality changed in the last 18 years. Methods Between 2000 and 2018, 77 patients were admitted for massive burns to the ICU of a university hospital. Transfers and early care withdrawal precluded inclusion for 38 patients, leaving 39 for analysis. Study variables were year of admission, demographics, burn characteristics, critical care treatment (fluid resuscitation, ventilation and nutrition) and surgical therapy. Association between outcomes and year of admission were assessed through correlation and logistic regression analysis. Potential confounders were assessed through stepwise linear regression. Results Patients’ characteristics were stable over time with a median age of 36[25.0, 48.0] years, burns 65% [55.0, 83.0] TBSA and deep burns 55% [50.0, 68.0] TBSA . Length of ICU stay remained stable at 0.97 [0.6, 1.5] days/%TBSA. Mortality was stable as well. Energy and carbohydrate delivery decreased in parallel with the number of infectious episodes per patient. Number of operations was stable but the take rate of skin grafts increased significantly. The multivariate analysis retained year of admission, weight, total number of infections, daily lipid intakes and fluid resuscitation as independent predicting variables, Conclusion Length of ICU stay and mortality did not change over time but skin grafts take rates improved significantly.

scholarly journals Evaluation of skin graft take following post-burn raw area in normovolaemic anaemia

2009 ◽  
Vol 42 (02) ◽  
pp. 195-198 ◽  
Author(s):  
Pawan Agarwal ◽  
Brijesh Prajapati ◽  
D. Sharma
Keyword(s):  
Wound Healing ◽  
Haemoglobin Level ◽  
Skin Graft ◽  
Control Group ◽  
Split Thickness Skin Graft ◽  
Graft Take ◽  
Thickness Skin ◽  
Significant Difference ◽  
Oxygen Carrying Capacity ◽  
Moderate Anaemia

ABSTRACT Background: Traditional wisdom is that wound healing is directly related to haemoglobin level in the blood; therefore blood transfusion is given in anaemic patients to raise the haemoglobin level for better wound healing. Methods: Evaluation of wound healing in the form of split thickness skin graft take was done in 35 normovolaemic anaemic patients (haemoglobin level of < 10 gm/ dl) and compared with control group (patients with haemoglobin level of 10 or > 10 gm/ dl). Results: There was no statistically significant difference in mean graft take between the two groups. Conclusion: It is not mandatory to keep haemoglobin level at or >10 g/dL or PCV value at or >30% for skin graft take, as mild to moderate anaemia per se does not cause any deleterious effect on wound healing; provided perfusion is maintained by adequate circulatory volume. Prophylactic transfusion to increase the oxygen carrying capacity of the blood for the purpose of wound healing is not indicated in asymptomatic normovolemic anaemic patients (with haemoglobin levels greater than 6g/dL) without significant cardiovascular or pulmonary disease.

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