Skin graft fixation by slow clotting fibrin sealant applied as a thin layer

Mittermayr, Rainer; Wassermann, Esther; Thurnher, Martin; Simunek, Manuela; Redl, Heinz

doi:10.1016/j.burns.2005.10.010

Cited by 56 publications

(41 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To ensure that clotting occurs quickly and effectively, fibrin glues contain very high amounts of fibrinogen and thrombin, up to 60 mg ml K1 fibrinogen and 300 IU ml K1 thrombin after mixing (Buchta et al 2004(Buchta et al , 2005. Current clinical uses include mesh fixation for inguinal hernia repair, severed sciatic nerve reattachment, stabilization of microsurgical anastomoses and skin graft adhesion (Martins et al 2005;Mittermayr et al 2006;Andree et al 2008). Using fibrin glue instead of sutures or staples enhances healing, minimizes scarring, eases application and in the case of Wagner et al (2007) hernia repair lowers the risk of nerve injury and postoperative neuralgia (Santoro et al 2007).…”

Section: Haemostatic Glue and Wound Repairmentioning

confidence: 99%

Fibrin gels and their clinical and bioengineering applications

Janmey

Winer

Weisel

2008

J. R. Soc. Interface.

579

461

View full text Add to dashboard Cite

Fibrin gels, prepared from fibrinogen and thrombin, the key proteins involved in blood clotting, were among the first biomaterials used to prevent bleeding and promote wound healing. The unique polymerization mechanism of fibrin, which allows control of gelation times and network architecture by variation in reaction conditions, allows formation of a wide array of soft substrates under physiological conditions. Fibrin gels have been extensively studied rheologically in part because their nonlinear elasticity, characterized by soft compliance at small strains and impressive stiffening to resist larger deformations, appears essential for their function as haemostatic plugs and as matrices for cell migration and wound healing. The filaments forming a fibrin network are among the softest in nature, allowing them to deform to large extents and stiffen but not break. The biochemical and mechanical properties of fibrin have recently been exploited in numerous studies that suggest its potential for applications in medicine and bioengineering.

show abstract

Section: Haemostatic Glue and Wound Repairmentioning

confidence: 99%

Fibrin gels and their clinical and bioengineering applications

Janmey

Winer

Weisel

2008

J. R. Soc. Interface.

579

461

View full text Add to dashboard Cite

show abstract

“…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. 19 The thin layer proved to be superior to sutures with respect to hematoma formation, graft dislocation, graft take and wound healing.…”

Section: Discussionmentioning

confidence: 98%

“…16 -18 In fact, the low thrombin concentration in FS 4IU not only allows more time for placement and manipulation of skin grafts but also has been reported to result in less graft dislocation, better graft take rate, and better wound healing. 14,19 Although a low thrombin concentration is beneficial for skin grafting procedures, the reduction of thrombin concentration to less than effective levels will ablate the adhesive effect of FS 4IU. This effect was highlighted by the two cases in which the thrombin solution was inadvertently diluted approximately 100-fold compared with the intended concentration.…”

Section: Discussionmentioning

confidence: 99%

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

Gibran

Luterman

Herndon

et al. 2007

Journal of Burn Care & Research

View full text Add to dashboard Cite

We undertook a multicenter, randomized, controlled, phase 1/2 clinical study to investigate the safety and efficacy of a fibrin sealant containing 4 IU/ml thrombin (FS 4IU) for the attachment of autologous sheet grafts in patients with deep partial-thickness or full-thickness burn wounds. Fibrin sealant (FS 4IU) was compared with staples for adherence of sheet grafts in 40 patients. Patients had to have burn wounds measuring 40% TBSA or less with two comparable test sites measuring between 1% and 4% TBSA each. Wound beds were prepared before treatment assignment, which was randomized. Percent area of hematoma/seroma at Day 1 (P = .0138) and questionable viability at Day 5 (P = .0182) were significantly less for FS 4IU-treated sites. Median percent area of graft survival on Day 14 was 100% for both treatments (P = .3525). The percentage of completely closed sites generally was greater for FS 4IU-sites on Days 5 to 91; the maximum difference occurred at Day 28 (79.5% vs 59%; P = .0215). The safety profile of FS 4IU was excellent as indicated by the lack of any related serious adverse experiences. These findings indicate that FS 4IU is safe and effective for fixation of skin grafts, with outcomes similar to or better than staple fixation. The data suggest that FS 4IU is a promising candidate for further clinical studies focusing on skin graft adhesion and burn wound healing.

show abstract

“…2 Fibrin sealant is used for graft fixation and for reducing hematoma, but it is expensive and not available in all countries. 1 In graft surgery, while providing hemostasis in recipient bed, graft contact with the recipient bed should not be blocked. Thus, a rapidly absorbable agent is required.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have investigated the effect of hematomas on graft necrosis and associated preventative measures. [1][2][3] Smahel 4 reported that hematomas could obstruct graft nutrition and revascularization and result in graft failure. Other reports highlight infection as a reason for graft failure.…”

mentioning

confidence: 99%

Preventing Graft Loss Caused by Hematoma

Benlier

Taş

Usta

2014

Journal of Burn Care & Research

View full text Add to dashboard Cite

Hematoma is a common reason for graft loss. This study was intended to investigate the effects of microporous polysaccharide hemospheres (MPH; Arista® AH; Medafor, Inc.) on graft survival, the effect of MPH on graft loss caused by hematoma, and the correlation between neutrophil accumulation and graft survival. A total of 35 adult male Wistar rats were separated into five groups of seven as follows: control 1, saline, MPH, control 2 (hematoma group), and MPH + hematoma. All graft dressing was removed on the fifth postoperative day and graft survival percentage measured. Histopathological and semiquantitative analysis, including inflammatory cell infiltration and subcutaneous inflammation based on neutrophil count, was performed. Graft survival significantly improved in the MPH group (97.86 ± 1.676) compared with the control 1 (91.14 ± 3.671; P = .004) and saline groups (91.57 ± 4.791; P = .014). There was no significant increase in graft survival in the saline group compared with the control 1 group or in the MPH + hematoma group (19.57 ± 14.707) compared with the control 2 group (20.71 ± 16.869; P > .05). The neutrophil count was highest in the control 2 group (177.43 ± 22.464) and significantly decreased in the MPH group (33. 71 ± 8,674) compared with the control 1 group (66.14 ± 5.872; P = .001) and the saline group (65.57 ± 3.309; P= .001). There was no significant decrease in neutrophil count in the MPH + hematoma group (160.00 ± 27.952) compared with the control 2 group (P > .05). It seems that MPH can increase the graft survival, and there is an inverse relationship between graft survival and neutrophil accumulation.

show abstract

Skin graft fixation by slow clotting fibrin sealant applied as a thin layer

Cited by 56 publications

References 22 publications

Fibrin gels and their clinical and bioengineering applications

Fibrin gels and their clinical and bioengineering applications

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

Preventing Graft Loss Caused by Hematoma

Contact Info

Product

Resources

About