Use of Fibrin Sealant for Split-Thickness Skin Grafts in Patients with Hand Burns: A Prospective Cohort Study.
Youngmin Kim, Dohern Kym, Yong Suk Cho and 4 others
PMID 30371521WHAT IT FOUND
In 40 adults with hand burns, graft fixation with a tourniquet and fibrin sealant was associated with less blood loss, less transfusion, slightly better graft take, and lower postoperative pain than epinephrine tumescence with staples.
Key findings
01The tourniquet/fibrin sealant group had less estimated blood loss (287.5 vs 812.5 mL), less transfusion (0.2 vs 1.9 units), and better graft take (99.2% vs 98.2%) than the epinephrine group.
02Postoperative pain was lower in the tourniquet/fibrin sealant group.
03Hematoma and seroma complications were fewer in the tourniquet/fibrin sealant group (10% vs 35%) but not statistically significant.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 40 patients were studied at one center, and they were assigned alternately rather than randomly, so selection bias is possible. The tourniquet/fibrin sealant group received several components at once, including tourniquet, fibrin sealant, compression, diluted thrombin, sutures, and adhesive strips, so the effect of any one part cannot be isolated. Estimated blood loss was judged subjectively by a surgeon and an anesthesiologist, not measured by an objective method alone. Patients were adults with hand burns involving at least three fingers and no more than 20% total body surface area, excluding inhalation injury, pregnancy, diabetes, acute kidney injury, and cardiac problems, so results may not apply to other burn patients. Hematoma and seroma rates were lower in the fibrin sealant group (10% vs 35%) but this was not statistically significant.
The easy way to misread this
Do not conclude that fibrin sealant alone caused the benefit. The tourniquet/fibrin sealant group also received tourniquet, compression, diluted thrombin, sutures, and adhesive strips, while the epinephrine group received epinephrine tumescence and staples, so the contribution of any single component cannot be separated. The study was small, single-center, and not randomized.