An Evaluation of Fibrin Tissue Adhesive Concentration and Application Thickness on Skin Graft Survival

Abstract

Objectives:To examine the effects of fibrinogen concentration and application thickness of fibrin tissue adhesive on skin graft survival. Study Design: Prospective controlled study. Methods: Ten domestic pigs were included in the study. A 20 ؋ 5-cm area of skin was harvested bilaterally along the flanks of the animals using a Padgett dermatome. The harvested grafts were trimmed into four 4 ؋ 4-cm squares. Donor sites were treated according to group assignment and the non-meshed grafts were placed on the side opposite their initial orientation and secured with staples. Both single-and multiple-donor human fibrin tissue adhesive preparations, with low and high average fibrinogen concentrations of 30 mg/mL and 60 mg/ mL, were used. Adhesive preparations were applied in either a thin layer (0.015 mL/cm 2 ) or a thick layer (0.06 mL/cm 2 ) using a spray applicator. A constant thrombin concentration of 10 U/mL was used in the study. No adhesive was used in the control group and grafts were stabilized with staples. No topical dressings were applied to any of the treatment sites. Animals were sacrificed 4 weeks after graft application. Results: Based on statistical analysis, thickness of adhesive application had a significant effect on skin graft survival. Percent mean graft survival in the control and thin application groups was found to be 92% and 97.8% respectively; the mean survival rate in the thick application group was 63.1%. Fibrinogen concentration, when evaluated independently within the thin and thick application groups, was found to have no significant effect on graft survival. Conclusion: Independent of fibrinogen concentration, a thin layer of fibrin tissue adhesive, when applied between two opposing surfaces, does not interfere with and may support the healing process, whereas a thick layer of adhesive inhibits skin graft healing.

Comparative study between fibrin glue and platelet rich plasma in dogs skin grafts

“…Moreover, the FG group continued to present the best assessment. These results can be compared with those of O'Grady et al 17 , who concluded that using thick layers of fibrin glue between the receptor bed and the graft could result in graft adhesion failure.…”

Comparison of Fibrin Sealant and Staples for Attaching Split-Thickness Autologous Sheet Grafts in Patients With Deep Partial- or Full-Thickness Burn Wounds: A Phase 1/2 Clinical Study

“…The actual dosing volume used in the study (0.02 Ϯ 0.010 ml/cm 2 ; range, 0.007-0.042 ml/cm 2 ) was based on the investigator's judgment and appeared to be safe and efficacious for affixing skin grafts and supporting wound healing in this cohort of patients. Consistent with these findings, O'Grady et al 20 reported superior skin graft survival in a pig model when adhesive preparations containing 10 IU/ml thrombin were applied by spraying in a thin layer (0.015 ml/cm 2 ) compared with a thick layer (0.06 ml/cm 2 ). Another study using a porcine skin grafting model compared sutures with a thin layer (0.05 ml/cm 2 ) and a thick layer (0.15 ml/cm 2 ) of sprayed fibrin sealant containing 4 to 5 IU/ml thrombin.…”

Fixation of split-thickness skin graft using fast-clotting fibrin glue containing undiluted high-concentration thrombin or sutures: a comparison study

“…Because fibrin sealant biodegrades within 2 weeks, foreign bodies, such as sutures and staples, are not left in the wound, especially in the granulation bed. In addition, patients often report severe pain when staples are removed, and occasionally, an anesthetic procedure is required (O’Grady et al 2000; Batra et al 2016; Himel et al 1994; Best et al 1995; Ghosh et al 2015). Because fibrin sealant adheres to the entire surface, hematoma/seroma formation is significantly reduced compared with point-fixation sutures or staples (Cha et al 2012; Gibran et al 2007; Llanos et al 2006; Myer et al 2015; Mabrouk et al 2013).…”