Fibrin sealant improves graft adherence in a porcine full-thickness burn wound model

Ludwik Branski, Rainer Mittermayr, David Herndon, Marc G. Jeschke, Martina Hofmann, Oscar E. Masters, William Norbury, Daniel L. Traber, Stefan Tangl, Heinz Redl

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Introduction: Autograft take and rapid wound closure is essential for the survival of severely burned patients. Loss of skin grafts typically occurs during the first few days after coverage, mainly due to shear forces and inadequate contact with the wound bed. Slow-clotting fibrin sealant, applied with a spray-on device, has been shown to improve healing of skin grafts in large wounds. However, its use in burn wounds has not been studied so far. Study aim: To evaluate the effectiveness of sprayed fibrin sealant in excised and grafted full-thickness burns. Material and methods: Ten female Yorkshire pigs (30-45 kg) received a full-thickness contact burn of approximately 15% total body surface area. The burns were excised to the level of the muscular fascia after 24 h and covered with meshed skin autograft (mesh ratio 1:3). Wounds were randomized to either fibrin sealant (n = 20) or standard skin staples (n = 16) for graft fixation. Fibrin sealant was used as a slow-clotting spray (4 IU thrombin/ml). Outcome measurements included clinical scoring at days 2, 5, 9 and 14 postoperatively, planimetric analysis of wound closure, and histological examination of epidermal and dermal thickness 14 days after autografting. Results: In the fibrin sealant group, graft adherence scores were significantly increased (p < 0.02) and graft dislocation scores significantly decreased (p < 0.01) at days 2 and 5 postoperatively, when compared to controls. Planimetric analysis of remaining open mesh interstices showed acceleration of wound closure in the fibrin sealant group but did not reach statistical significance (day 14 p = 0.04 at significance level p < 0.025). Wound contraction, occurrence of hematoma, and dermal as well as epidermal thickness were not different between the groups at 14 days postoperatively. Conclusion: The results indicate that the use of slow-clotting fibrin sealant spray for autograft fixation is advantageous over skin staples. Easy handling and reduced graft dislocation at early time points are key qualities of this method.

Original languageEnglish (US)
Pages (from-to)1360-1366
Number of pages7
JournalBurns
Volume37
Issue number8
DOIs
StatePublished - Dec 2011

Fingerprint

Fibrin Tissue Adhesive
Swine
Transplants
Wounds and Injuries
Skin
Autografts
Burns
Autologous Transplantation
Body Surface Area
Fascia
Thrombin
Hematoma
Equipment and Supplies
Survival

Keywords

  • Autograft
  • Pig
  • Skin substitute
  • Wound healing

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Branski, L., Mittermayr, R., Herndon, D., Jeschke, M. G., Hofmann, M., Masters, O. E., ... Redl, H. (2011). Fibrin sealant improves graft adherence in a porcine full-thickness burn wound model. Burns, 37(8), 1360-1366. https://doi.org/10.1016/j.burns.2009.08.011

Fibrin sealant improves graft adherence in a porcine full-thickness burn wound model. / Branski, Ludwik; Mittermayr, Rainer; Herndon, David; Jeschke, Marc G.; Hofmann, Martina; Masters, Oscar E.; Norbury, William; Traber, Daniel L.; Tangl, Stefan; Redl, Heinz.

In: Burns, Vol. 37, No. 8, 12.2011, p. 1360-1366.

Research output: Contribution to journalArticle

Branski, L, Mittermayr, R, Herndon, D, Jeschke, MG, Hofmann, M, Masters, OE, Norbury, W, Traber, DL, Tangl, S & Redl, H 2011, 'Fibrin sealant improves graft adherence in a porcine full-thickness burn wound model', Burns, vol. 37, no. 8, pp. 1360-1366. https://doi.org/10.1016/j.burns.2009.08.011
Branski L, Mittermayr R, Herndon D, Jeschke MG, Hofmann M, Masters OE et al. Fibrin sealant improves graft adherence in a porcine full-thickness burn wound model. Burns. 2011 Dec;37(8):1360-1366. https://doi.org/10.1016/j.burns.2009.08.011
Branski, Ludwik ; Mittermayr, Rainer ; Herndon, David ; Jeschke, Marc G. ; Hofmann, Martina ; Masters, Oscar E. ; Norbury, William ; Traber, Daniel L. ; Tangl, Stefan ; Redl, Heinz. / Fibrin sealant improves graft adherence in a porcine full-thickness burn wound model. In: Burns. 2011 ; Vol. 37, No. 8. pp. 1360-1366.
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abstract = "Introduction: Autograft take and rapid wound closure is essential for the survival of severely burned patients. Loss of skin grafts typically occurs during the first few days after coverage, mainly due to shear forces and inadequate contact with the wound bed. Slow-clotting fibrin sealant, applied with a spray-on device, has been shown to improve healing of skin grafts in large wounds. However, its use in burn wounds has not been studied so far. Study aim: To evaluate the effectiveness of sprayed fibrin sealant in excised and grafted full-thickness burns. Material and methods: Ten female Yorkshire pigs (30-45 kg) received a full-thickness contact burn of approximately 15{\%} total body surface area. The burns were excised to the level of the muscular fascia after 24 h and covered with meshed skin autograft (mesh ratio 1:3). Wounds were randomized to either fibrin sealant (n = 20) or standard skin staples (n = 16) for graft fixation. Fibrin sealant was used as a slow-clotting spray (4 IU thrombin/ml). Outcome measurements included clinical scoring at days 2, 5, 9 and 14 postoperatively, planimetric analysis of wound closure, and histological examination of epidermal and dermal thickness 14 days after autografting. Results: In the fibrin sealant group, graft adherence scores were significantly increased (p < 0.02) and graft dislocation scores significantly decreased (p < 0.01) at days 2 and 5 postoperatively, when compared to controls. Planimetric analysis of remaining open mesh interstices showed acceleration of wound closure in the fibrin sealant group but did not reach statistical significance (day 14 p = 0.04 at significance level p < 0.025). Wound contraction, occurrence of hematoma, and dermal as well as epidermal thickness were not different between the groups at 14 days postoperatively. Conclusion: The results indicate that the use of slow-clotting fibrin sealant spray for autograft fixation is advantageous over skin staples. Easy handling and reduced graft dislocation at early time points are key qualities of this method.",
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AU - Mittermayr, Rainer

AU - Herndon, David

AU - Jeschke, Marc G.

AU - Hofmann, Martina

AU - Masters, Oscar E.

AU - Norbury, William

AU - Traber, Daniel L.

AU - Tangl, Stefan

AU - Redl, Heinz

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N2 - Introduction: Autograft take and rapid wound closure is essential for the survival of severely burned patients. Loss of skin grafts typically occurs during the first few days after coverage, mainly due to shear forces and inadequate contact with the wound bed. Slow-clotting fibrin sealant, applied with a spray-on device, has been shown to improve healing of skin grafts in large wounds. However, its use in burn wounds has not been studied so far. Study aim: To evaluate the effectiveness of sprayed fibrin sealant in excised and grafted full-thickness burns. Material and methods: Ten female Yorkshire pigs (30-45 kg) received a full-thickness contact burn of approximately 15% total body surface area. The burns were excised to the level of the muscular fascia after 24 h and covered with meshed skin autograft (mesh ratio 1:3). Wounds were randomized to either fibrin sealant (n = 20) or standard skin staples (n = 16) for graft fixation. Fibrin sealant was used as a slow-clotting spray (4 IU thrombin/ml). Outcome measurements included clinical scoring at days 2, 5, 9 and 14 postoperatively, planimetric analysis of wound closure, and histological examination of epidermal and dermal thickness 14 days after autografting. Results: In the fibrin sealant group, graft adherence scores were significantly increased (p < 0.02) and graft dislocation scores significantly decreased (p < 0.01) at days 2 and 5 postoperatively, when compared to controls. Planimetric analysis of remaining open mesh interstices showed acceleration of wound closure in the fibrin sealant group but did not reach statistical significance (day 14 p = 0.04 at significance level p < 0.025). Wound contraction, occurrence of hematoma, and dermal as well as epidermal thickness were not different between the groups at 14 days postoperatively. Conclusion: The results indicate that the use of slow-clotting fibrin sealant spray for autograft fixation is advantageous over skin staples. Easy handling and reduced graft dislocation at early time points are key qualities of this method.

AB - Introduction: Autograft take and rapid wound closure is essential for the survival of severely burned patients. Loss of skin grafts typically occurs during the first few days after coverage, mainly due to shear forces and inadequate contact with the wound bed. Slow-clotting fibrin sealant, applied with a spray-on device, has been shown to improve healing of skin grafts in large wounds. However, its use in burn wounds has not been studied so far. Study aim: To evaluate the effectiveness of sprayed fibrin sealant in excised and grafted full-thickness burns. Material and methods: Ten female Yorkshire pigs (30-45 kg) received a full-thickness contact burn of approximately 15% total body surface area. The burns were excised to the level of the muscular fascia after 24 h and covered with meshed skin autograft (mesh ratio 1:3). Wounds were randomized to either fibrin sealant (n = 20) or standard skin staples (n = 16) for graft fixation. Fibrin sealant was used as a slow-clotting spray (4 IU thrombin/ml). Outcome measurements included clinical scoring at days 2, 5, 9 and 14 postoperatively, planimetric analysis of wound closure, and histological examination of epidermal and dermal thickness 14 days after autografting. Results: In the fibrin sealant group, graft adherence scores were significantly increased (p < 0.02) and graft dislocation scores significantly decreased (p < 0.01) at days 2 and 5 postoperatively, when compared to controls. Planimetric analysis of remaining open mesh interstices showed acceleration of wound closure in the fibrin sealant group but did not reach statistical significance (day 14 p = 0.04 at significance level p < 0.025). Wound contraction, occurrence of hematoma, and dermal as well as epidermal thickness were not different between the groups at 14 days postoperatively. Conclusion: The results indicate that the use of slow-clotting fibrin sealant spray for autograft fixation is advantageous over skin staples. Easy handling and reduced graft dislocation at early time points are key qualities of this method.

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