title: Fibrin sealant improves graft adherence in a porcine full-thickness burn wound model.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To evaluate the effectiveness of sprayed fibrin sealant in excised and grafted full-thickness burns.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Shriners Hospital for Children and University of Texas Medical Branch, Galveston, TX, USA.
authors.forename: Ludwik K
authors.initials: LK
authors.lastname: Branski
authors.forename: Rainer
authors.initials: R
authors.lastname: Mittermayr
authors.forename: David N
authors.initials: DN
authors.lastname: Herndon
authors.forename: Marc G
authors.initials: MG
authors.lastname: Jeschke
authors.forename: Martina
authors.initials: M
authors.lastname: Hofmann
authors.forename: Oscar E
authors.initials: OE
authors.lastname: Masters
authors.forename: William B
authors.initials: WB
authors.lastname: Norbury
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Traber
authors.forename: Stefan
authors.initials: S
authors.lastname: Tangl
authors.forename: Heinz
authors.initials: H
authors.lastname: Redl
mesh_terms: D000818:Animals; D002056:Burns / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage / Q000627:therapeutic use*; D006085:Graft Survival; D023421:Models, Animal; D016038:Skin Transplantation / Q000379:methods; D013552:Swine; D014945:Wound Healing
chemical_list: D015718:Fibrin Tissue Adhesive