The Use of Fibrin Sealant in Burn Treatment

Abstract

Tangential excision is currently recommended for the care of deep dermal and full thickness burn injuries. A major problem in the technique is the blood loss that occurs with the excision. This blood loss has been one of the major deter-rents to the ubiquitous acceptance of this technique. Tangential excision shortens hospital stay. The general opinion among burn surgeons is that cosmesis and function are also substantially improved.

A new technique using fibrin sealant (Tisseel, Immuno) has been tested at our institution as part of a multi-institutional trial in the United States. Burn wounds are excised with a tourniquet in place after the arm is milked of blood using an Esmark Bandage. Fibrin sealant is then applied using a spraying device. Split-thickness skin grafts are applied and a second layer of sealant is sprayed over the grafts to secure them. The tourniquet is then released. Standard, nonadherent dressings are used.

Sixteen patients were entered into the clinical study at the University of South Alabama Burn Center. The average age of the patients was 34.3 ± 5.2 years, and the average percent total body surface area burned was 24.9 ± 5.5 TBSA. There were 13 males and three females. The average area excised was 149.7 ± 26.6 square inches. There was excellent take of the grafts with rapid closure of the interstices [graft take (% ± SE) = 87.6% ± 4.38%, median = 95%], [time to interstices closure (% ± SE) = 5.6 ± .5 days, median = 6 days]. There was no slippage of the skin grafts despite the lack of use of staples or sutures. The grafts were secured soley with the fibrin sealant. Blood loss at the excision and graft site was reduced to minimal amounts (10 cc).

In summary, fibrin sealant is a dramatic and exciting new adjunct currently under evaluation in the United States for tangential excision and split-thickness skin grafts. Further studies are being developed to document efficacy and cost effectiveness.