London, United Kingdom From the Department of Plastic Surgery, St. Thomas' Hospital, and the School of Public Health, Imperial College London, St. Mary's Hospital.
Plast Reconstr Surg. 2013 Jul;132(1):139e-146e. doi: 10.1097/PRS.0b013e318299c6f4.
Pain at split skin graft donor sites is common. Fibrin sealant has been demonstrated to reduce time to hemostasis at wound sites, and patients receiving this treatment were incidentally noted to report less pain. This study aimed to evaluate pain and incapacity in split skin graft donor sites treated with and without fibrin sealant.
Fifty patients requiring thigh donor-site split skin grafts were prospectively randomized to receive either a self-adhesive fabric dressing alone or fibrin sealant plus the self-adhesive fabric dressing as primary donor-site dressings. External secondary dressings were the same. Patients were blinded with regard to treatment group. Using visual analogue scales (scored 0 to 5), patients rated their donor-site pain and incapacity for 14 days postoperatively. Secondary endpoints were length of hospital stay and duration of requirement for dressings.
Forty patients were included in the study analysis and completed self-reported pain and incapacity scores. Twenty received the fibrin sealant plus self-adhesive fabric dressing and 20 received the fabric dressing only (controls). Patients using the fibrin sealant plus the dressing reported significantly less pain (mean score, 0.42 versus 1.60, p < 0.001) and significantly less incapacity (mean score, 0.48 versus 1.71, p < 0.001). Patients allocated to the fibrin sealant group recorded shorter lengths of stay and faster time to discontinuation of dressing, though statistical significance was not achieved.
Patients whose split skin graft donor sites were dressed with fibrin sealant plus self-adhesive fabric dressing experienced significantly less pain and incapacity than patients with self-adhesive fabric dressings alone, allowing a more rapid return to normal activity.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
切取皮片供区疼痛较为常见。纤维蛋白胶已被证实可减少创面止血时间，且接受该治疗的患者报告疼痛减轻。本研究旨在评估接受和不接受纤维蛋白胶治疗的切取皮片供区的疼痛和失能情况。
50 例需要大腿供区切取皮片的患者前瞻性随机分为单独使用自粘织物敷料或纤维蛋白胶加自粘织物敷料作为主要供区敷料。外部二级敷料相同。患者对治疗组进行了盲法。患者术后 14 天使用视觉模拟评分（评分 0-5）评定供区疼痛和失能程度。次要终点为住院时间和敷料需求持续时间。
40 例患者纳入研究分析并完成了自我报告的疼痛和失能评分。20 例患者接受纤维蛋白胶加自粘织物敷料，20 例患者仅接受织物敷料（对照组）。使用纤维蛋白胶加敷料的患者报告疼痛明显减轻（平均评分 0.42 对 1.60，p < 0.001），失能明显减轻（平均评分 0.48 对 1.71，p < 0.001）。分配到纤维蛋白胶组的患者住院时间更短，停止敷料的时间更快，但未达到统计学意义。
与单独使用自粘织物敷料的患者相比，使用纤维蛋白胶加自粘织物敷料处理切取皮片供区的患者疼痛和失能明显减轻，可更快恢复正常活动。
临床问题/证据水平：治疗性，II 级。
