Fibrin sealant for split-thickness skin graft fixation in burn wounds - An ancillary postulated role in scar modulation

Abstract

• The percentage of graft take at the end of 15th post-operative day was higher in fibrin sealant group. • At end of six months, modified Vancouver scar scale score was better in fibrin sealant group. • Fibrin sealant group, less resting pain over the skin grafted site was reported. • Histopathological and immuno-histochemical staining showed better scar characteristics in fibrin sealant group at the end of six months follow up. Burn care was revolutionized by critical care and excision surgeries which drastically improved the survival rates of the patients. Another cornerstone and basic surgery in all these patients is the skin grafting. Traditionally skin grafts are fixed using sutures, staplers and cyanoacrylate glue. The study was conducted to compare the efficacy and effects of fibrin sealant and cyanoacrylate glue in graft fixation and scar characteristics after skin grafting in post burn raw areas. The study was conducted as a retrospective comparative cohort study with prospective follow-up conducted at a tertiary burn care centre in India over a period of one year which included patients between 18–50 years who presented with post burn raw areas and underwent skin graft fixation with fibrin sealant or cyanoacrylate glue. Data from 40 patients were collected and analyzed in the study. Group 1 (Fibrin sealant) and group 2 (Cyanoacrylate glue) included 20 patients each. The percentage of graft take at the end of 15th post-operative day was higher in group 1 in comparison to group 2 (95 % and 90.2 % respectively). Two patients had graft failure (Mean - 26.75 %) in group 1 in comparison to five in group 2 (Mean - 38.16 %). At end of six months, on modified Vancouver scar scale in categories of pigmentation, vascularity, thickness and pliability - the subjective scorings were better in group 1 overall. Histopathological and immuno-histochemical staining showed better scar characteristics in group 1. The use of fibrin sealant has shown better results when compared to cyanoacrylate glue in the fixation of skin grafts in post burn raw areas. The superior scores in clinical and histopathological scar characteristics in fibrin sealant group may indicate the role of Fibrin sealant in scar modulation.