066 Fixation of Autologous Skin Grafts Without Staples or Sutures – Experimental Study

Abstract

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/cm2; FS 0.15 ml/cm2(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 5th, 14th and 21st postoperative day. Results: Hematoma formation on day of surgery was more pronounced in the suture group (FS 0.05 ml/cm2 vs. suture, p < 0.05), similar the situation on the 5th 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/cm2 group. The FS 0.05 ml/cm2 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/cm2 group with a healed wound area of 99.7 (3.6/0.3). Corresponding values in the FS 0.15 ml/cm2 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/cm2) 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.