Boccara David, De Runz Antoine, Bekara Farid, Chaouat Marc, Mimoun Maurice
From the Plastic, Reconstructive and Cosmetic and Burn Surgery Unit, Hôpital Saint Louis, Paris, France.
J Burn Care Res. 2017 Sep/Oct;38(5):283-289. doi: 10.1097/BCR.0000000000000503.
The aim of this study was to evaluate the benefit of using a new slow-setting fibrin sealant compared with staples for adherence of split-thickness skin grafts on the backs of hands and fingers. Staple removal is often painful for patients. Twenty-eight patients were included for a graft total of 34 hands. The authors chose to test this sealant on zones that are often difficult to graft given their varied topographies. Its low concentration of thrombin (4 IU/ml) compared with other sealants provides it with prolonged polymerization time (60 seconds) making it easier to use in this location. All 34 grafts had taken at 5 days postoperatively and no graft required revision surgery. Six of our patients had sealant on one hand and staples on the other hand. All of the patients reported less pain on the sealant hand with a mean visual analog scale inferior to 2.6 times less (Mann-Whitney U test, P = .0035). Eighteen months after treatment, all of the patients had acceptable function and esthetic aspect of their hands with no difference noted between glued or stapled hands. The only notable drawbacks to the use of this sealant are the preparation and application time which is longer than with staples, the need to evacuate small seromas under the graft and obstruction of the drainage points by the sealant. The use of Artiss Sealant enabled us to reduce the amount of care and to decrease the pain because there was no staple removal.
本研究的目的是评估与吻合钉相比，使用一种新型慢凝纤维蛋白密封剂对手背和手指进行中厚皮片移植固定的益处。对于患者来说，拆除吻合钉往往很痛苦。本研究纳入了28例患者，共34只手进行移植。鉴于不同的解剖结构，作者选择在通常难以进行移植的区域测试这种密封剂。与其他密封剂相比，其低浓度的凝血酶（4 IU/ml）使其聚合时间延长（60秒），更便于在此部位使用。所有34例移植皮片在术后5天均已成活，无需进行翻修手术。我们的6例患者一只手使用密封剂，另一只手使用吻合钉。所有患者均报告使用密封剂的那只手疼痛较轻，平均视觉模拟评分低2.6倍（曼-惠特尼U检验，P = 0.0035）。治疗18个月后，所有患者手部功能和美观均可接受，使用密封剂或吻合钉的手之间无差异。使用这种密封剂唯一明显的缺点是准备和应用时间比使用吻合钉长，需要排出移植皮片下的小血清肿，且密封剂会阻塞引流点。使用Artiss密封剂使我们能够减少护理量并减轻疼痛，因为无需拆除吻合钉。
