Mullens Cody L, Messa Charles A, Kozak Geoffrey M, Rhemtulla Irfan A, Fischer John P
Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pa.
Plast Reconstr Surg Glob Open. 2019 May 16;7(5):e2187. doi: 10.1097/GOX.0000000000002187. eCollection 2019 May.
Split-thickness skin grafting (STSG) is a commonly used tool in the plastic surgeon's reconstructive armamentarium. Fibrin glue (FG) consists of a combination of clotting factors and thrombin whose key properties include adherence and hemostasis. This preliminary study aimed to assess clinical outcomes and cost of FG for STSG fixation in a general wound reconstruction.
A retrospective review was conducted in all patients undergoing STSG placement by a single surgeon (JPF) from January 2016 to March 2018. Twenty patients were identified and matched by wound location and wound size. Patients were then divided into 2 groups based on the method of STSG fixation: FG (n = 10) or suture only (SO) (n = 10).
In patients with FG fixation, we observed trends of decreased adjusted operative times (34.9 versus 49.4 minutes, = 0.612), a similar length of stay (2.8 versus 3.5 days, = 0.306), and liberation from the use of negative pressure wound therapy (0 versus 10 wounds, < 0.0001). There were no observed differences between the 2 groups in terms of graft-related complications at 180 days (1 complication FG versus 0 complications SO). Time to 100% graft take was also not different (20.2 versus 29.4 days, = 0.405). Additionally, total direct cost ($16,542 FG versus $24,266 SO; = 0.545) and total charges ($120,336 FG versus $183,750 SO; = 0.496) were not statistically different between the FG and SO groups.
In this preliminary comparative assessment, FG for STSG fixation has shown no difference in clinical outcomes to SO fixation, trends of decreased operative time, and afforded complete liberation from negative pressure wound therapy dressings.
分层皮片移植（STSG）是整形外科医生重建手术工具库中常用的一种方法。纤维蛋白胶（FG）由凝血因子和凝血酶组成，其关键特性包括黏附性和止血性。这项初步研究旨在评估在一般伤口重建中使用FG固定STSG的临床效果和成本。
对2016年1月至2018年3月由同一位外科医生（JPF）进行STSG移植的所有患者进行回顾性研究。根据伤口位置和伤口大小确定并匹配了20名患者。然后根据STSG固定方法将患者分为两组：FG组（n = 10）或仅用缝线组（SO组）（n = 10）。
在FG固定的患者中，我们观察到调整后的手术时间有缩短趋势（34.9分钟对49.4分钟，P = 0.612），住院时间相似（2.8天对3.5天，P = 0.306）且无需使用负压伤口治疗（0处伤口对10处伤口，P < 0.0001）。两组在180天时与移植相关的并发症方面未观察到差异（FG组1例并发症对SO组0例并发症）。移植完全成活的时间也无差异（20.2天对29.4天，P = 0.405）。此外FG组与SO组之间的总直接成本（FG组16,542美元对SO组24,266美元；P = 0.545）和总费用（FG组120,336美元对SO组183,750美元；P = 0.496）在统计学上无差异。
在这项初步的对比评估中，FG用于STSG固定在临床效果上与SO固定无差异，有手术时间缩短的趋势，且完全无需使用负压伤口治疗敷料。
