The Use of Fibrin Sealant for Securing Skin Grafts to the Hand and Upper Extremity: An Evaluation of Functional Outcomes
Tyler Evans, MD1; Sarah E. Sasor, MD2; Brett C Hartman, DO2; Joshua M Adkinson, MD2; Rajiv Sood, MD1; (1)Division of Plastic Surgery, Indiana University School of Medicine, Indianapolis, IN, (2)Indiana University, Indianapolis, IN
Introduction: The traditional approach to skin grafting of partial and full thickness burns to the hand and upper extremity consists of split thickness (STSG) secured mechanically with sutures or staples. This study utilized Artiss™ (Baxter), a fibrin sealant made from human plasma consisting of a combination of low concentration thrombin solution and a sealer protein solution (fibrinogen and a synthetic aprotinin fibrinolysis inhibitor) on patients with appropriate wounds to secure STSG for coverage of their burn wounds. A standard post-operative hand therapy protocol was modified to initiate early active range of motion on post-operative day (POD) 1. Outpatient occupational therapy (OOT) outcomes following STSG to patients' hands and upper extremities secured with Artiss were compared to STSG secured with staples.
Methods: Thirteen patients whose STSGs were secured with Artiss (20 sites) were matched with thirteen patients whose STSGs were secured with staples (21 sites). Patients were matched by total body surface area treated with STSG and treatment sites. A review of prospectively gathered data was performed on both treatment groups to obtain QuickDASH outcome measurement scores, pain levels (0-10 scale), grip strength, return to full active range of motion and demographic information.
Results: The 20 Artiss treatment sites consisted of hands (n=18), hand/wrist (n=1), and wrist (n=1). The 24 staple treatment sites consisted of hands (n=18), hand/wrist (n=2), and wrist (n=1). The Artiss treatment group required 12.3 weeks less OOT and achieved full AROM 64.45 weeks earlier than the staple treatment group. Both of these differences were statistically significant. The Artiss group initiated OOT with a greater functional QuickDASH score than the staple group and rated their pain as being less than the staple group at their first OOT visit.
Conclusions: The use of Artiss™ (fibrin tissue adhesive) represents a major advance for the fixation of hand and upper extremity grafts with immediate graft adherence. Early (POD 1) active and passive range of motion can be initiated without fear of graft shear or loss. This early range of motion greatly impacts a patient's functional outcome secondary to earlier return to full AROM, less loss of grip strength and lower pain rating at initial evaluation status post graft. The patient additionally benefits from less occupational therapy and earlier discharge.
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