Cost-Benefit Analysis of Outcomes From the Use of Fibrin Sealant for Fixation of Skin Grafts in Small-Size Burns Compared to Staples as Historical Controls

Butts, C. Caleb; Sahawneh, James; Duffy, Aoife; Curtis, Rigg; Mishra, Nutan; Frotan, Mohammad Amin; Hodge, Juvonda; Luterman, Arnold; Gulati, Salil

doi:10.1097/sap.0000000000000397

Cited by 22 publications

(34 citation statements)

References 10 publications

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“…Gibran and co‐workers reported 100 per cent graft survival in both groups on day 14 ( P = 0·352). Although mentioned in the methods, Butts et al . did not report rates of complete wound closure.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies considered graft loss. Butts et al . reported significantly lower graft loss rates in the fibrin glue group (less than 1 per cent versus 4 per cent for control; P = 0·03).…”

Section: Resultsmentioning

confidence: 99%

“…Boccara and co‐workers commented that seroma or serosanguinous collection was more common with fibrin glue but provided no supporting statistics. Butts et al . stated that they measured haematoma rates in their methods, but did not report these results.…”

Section: Resultsmentioning

confidence: 99%

“…Fibrin glue has been described widely for skin grafting, most extensively for SSG attachment following burn surgery. Studies suggest a number of benefits, including improved graft take, reduced haematoma formation, improved donor‐site haemostasis and improved functional outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Systematic review of fibrin glue in burn wound reconstruction

Miller

Wormald

Wade

et al. 2019

British Journal of Surgery

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Background In the reconstruction of burns using split‐skin grafts (SSGs), fibrin glue can be used to improve graft take and reduce haematoma formation, although the efficacy and cost‐effectiveness are unknown. This systematic review evaluated outcomes of fibrin glue compared with conventional SSG attachment techniques. Outcomes of interest included SSG take, haematoma formation, patient satisfaction and cost‐effectiveness. Methods This PROSPERO‐registered review was performed in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA statement. Embase, PubMed, Cochrane and http://clinicaltrial.gov databases were searched systematically. Observational and experimental studies comparing fibrin glue with other methods of SSG attachment in burn wounds were included. Risk of bias was assessed using the Cochrane risk‐of‐bias and Risk of Bias In Non‐Randomized Studies – of Intervention tools. The quality of the evidence was assessed using the GRADE tool. Results Two RCTs and four observational studies were included. Graft take at day 5 was not significantly different between groups (3 studies, 183 individuals). Fibrin glue significantly reduced the risk of postoperative haematoma in two studies and reduced patient‐reported pain in two studies, with suggested cost savings in four studies. All studies were at risk of methodological bias and the quality of the evidence was universally very low. Conclusion As the evidence is sparse, the quality very low and the risk of bias significant both within and across studies, it is not possible to make any recommendations regarding the use of fibrin glue in burn wounds.

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Section: Resultsmentioning

confidence: 99%

“…Three studies considered graft loss. Butts et al . reported significantly lower graft loss rates in the fibrin glue group (less than 1 per cent versus 4 per cent for control; P = 0·03).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Systematic review of fibrin glue in burn wound reconstruction

Miller

Wormald

Wade

et al. 2019

British Journal of Surgery

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“…In skin grafting, graft fixation is important. Use of sutures or staples is a standard method for skin fixation (Zederfeldt 1994; Waiker and Shinalingappa 2015; Butts et al 2015); however, the use of fibrin glue has also been suggested. Use of fibrin as an adhesive was introduced by Bergel in 1909, and Tidrick and Warner used fibrin for skin graft fixation for the first time in 1944 (Saltz et al 1991).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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ObjectiveFor skin defects caused by full-thickness burns, trauma, or tumor tissue excision, skin grafting is one of the most convenient and useful treatment methods. In this situation, graft fixation is important in skin grafting. This study was performed to compare the effectiveness of skin graft fixation between high-concentration fibrin sealant and sutures. There have been numerous studies using fibrin sealant for graft fixation, but they utilized slow-clotting fibrin sealant containing less than 10 IU/mL thrombin.MethodTwenty-five patients underwent split-thickness skin grafting using fast-clotting fibrin sealant containing 400 IU/mL thrombin, while 30 patients underwent grafting using sutures. Rates of hematoma/seroma formation, graft dislocation, graft necrosis, and graft take were investigated postoperatively. The graft surface area was calculated using Image J software (National Institutes of Health, Bethesda, MD, USA).ResultAfter 5 days, rates of hematoma/seroma formation and graft dislocation were 7.84 and 1.29% in group I, and 9.55 and 1.45% in group II, respectively. After 30 days, rates of graft necrosis and graft take were 1.86 and 98.14% in group I, and 4.65 and 95.35% in group II. Undiluted fibrin sealant showed significantly superior results for all rates (p < 0.05) except graft dislocation.ConclusionWhen high-concentration fast-clotting fibrin sealant was applied to skin grafts without dilution, no difficulty was experienced during surgery. Sealant showed superior results compared with sutures and had an excellent graft take rate.Level of evidenceII.

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