Use of fibrin sealant in thermal injury.
Fibrin glue is hemostatic in skin grafting and other therapeutic situations. This prospective, open-labeled comparative study involved thermally injured patients: 34 patients received fibrin sealant (FS) and 61 did not, at Loyola University Medical Center, Maywood, Illinois, and Shriners Burn Institute, Cincinnati, Ohio. FS-treated patients were 23.6 +/- 16.8 years old, versus 20.8 +/- 16.8 years for controls. The percentage of total body surface areas burn was 10.0% +/- 4.5% in the study patients versus 10.9% +/- 7.9% in the controls. The FS group did not receive packed red blood cell transfusions, albumin infusion, or topical bovine thrombin (TBT). The control group received 1.56 +/- 2.1 units of packed red blood cells, 186 +/- 194 ml 5% albumin, and TBT (20,000 units) 2.6 +/- 0.8 kits during excision and grafting procedures. The estimated blood loss/graft ration was 0.50 +/- 0.30 ml/cm2 (median = 0.46) for the study group versus 0.98 +/- 2.4 ml/cm2 (median = 0.56) for the control group (p = 0.14); for patients more than 16 years of age, this difference was significant (p = 0.03). FS may be a viable alternative to standard hemostatic techniques, because it reduced the need for blood transfusion, alloantigen exposure, and blood-borne viral infection risk. FS also eliminated the need for TBT and epinephrine, did not have an adverse impact on the surgical outcome, and tended to improve the cost differential.
McGill
V
V
Department of Surgery, Loyola University Medical Center, Maywood, IL 60153, USA.
Kowal-Vern
A
A
Lee
M
M
Greenhalgh
D
D
Gomperts
E
E
Bray
G
G
Gamelli
R
R
D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D017848:Blood-Borne Pathogens; D002056:Burns / Q000150:complications / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006489:Hemostatic Techniques; D017721:Hospital Costs; D006801:Humans; D017053:Infection Control; D007902:Length of Stay; D008297:Male; D016038:Skin Transplantation; D016896:Treatment Outcome
D015718:Fibrin Tissue Adhesive