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Fixation of Autologous Skin Grafts Without Staples or Sutures – Experimental Study
Author(s) -
Mittermayr R.,
Wassermann E.,
Thurnher M.,
Simunek M.,
Redl H.
Publication year - 2004
Publication title -
wound repair and regeneration
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.847
H-Index - 109
eISSN - 1524-475X
pISSN - 1067-1927
DOI - 10.1111/j.1067-1927.2004.0abstractbm.x
Subject(s) - medicine , surgery , fibrous joint , hematoma , seroma , fibrin , fixation (population genetics) , dorsum , wound healing , sealant , anatomy , chemistry , complication , population , environmental health , immunology , organic chemistry
The objective of the study was to evaluate the efficacy of skin graft fixation with fibrin sealant (FS) alone by means of spray application with a low setting time (thrombin concentration 4–5 IU/ml) in comparison to point suture fixation as a clinical reference method. Furthermore, the influence of two different quantities of FS were tested.
Material and Methods : On the dorsum of 6 male pigs four full‐thickness wounds (8 × 4 cm) were excised in each animal. Randomly the four defects were divided into 3 groups (FS 0.05 ml/cm 2 ; FS 0.15 ml/cm 2 (Tisseel, Baxter AG, Vienna, Austria); Suture) and covered with autologous split thickness skin grafts. Outcome measurements included hematoma/seroma formation, graft dislocation, wound contraction, graft take rate and healed wound area. Observational time points were the 5 th , 14 th and 21 st postoperative day.
Results : Hematoma formation on day of surgery was more pronounced in the suture group (FS 0.05 ml/cm 2 vs. suture, p < 0.05), similar the situation on the 5 th postoperative day but without statistical significance. Graft dislocation revealed marked but not significant extended area in the suture group vs. the FS 0.05 ml/cm 2 group. The FS 0.05 ml/cm 2 graft take on day 5 was found to be enhanced in comparison to the suture group. Excellent wound healing was notable on final observation day in the FS 0.05 ml/cm 2 group with a healed wound area of 99.7 (3.6/0.3). Corresponding values in the FS 0.15 ml/cm 2 was 96.9 (4.7/2.1) and 95.9 (2.7/2.1) for the suture group. Values represents median (Q1/Q3).
Conclusion : The application of a thin layer of FS (0.05 ml/cm 2 ) in a low setting rate (4–5 IU thrombin) in split thickness skin transplantation via a spray device shows comparable results to those yielded with suture point fixation (surrogate for staples). Advantages are e.g. better cosmetic results and initial hemostasis with minimizing the incidence of early hematoma formation. Equal properties of manufactured low thrombin (4 IU; Canada) preparation vs. 500 IU (US) diluted to a 5 IU thrombin solution was also demonstrated.