Abstract: Fibrin Tissue Sealant and Minor Skin Grafts in Burn Surgery: A Systematic Review and Meta-Analysis

BACKGROUND: The indications for use of fibrin glue in skin grafting burn patients remains understudied. The purpose of this study is to review the efficacy of fibrin tissue sealant in skin graft adherence, establish guidelines for use of fibrin tissue sealant, and review the cost effectiveness of fibrin glue. METHODS: Publications with the following criteria were included: comparative human studies, autologous skin grafts, and autologous or commercial fibrin sealant. Outcomes assessed included evidence of engraftment, wound closure, rates of hematoma/seroma, graft loss and infection. Meta-analysis obtained pooled odds ratios for outcomes of interest. Cost analysis was performed using data available in the literature. RESULTS: 7 studies and 751 interventions (fibrin) and controls (staples) were included in the final analysis. 67.6% grafts with fibrin were 100% adherent by one week, vs 55.5% (OR 1.45, p=0.086). Complete wound closure by one month was 80.2% with fibrin, vs 73.3% (OR 1.34, p=0.187). Hematoma/seroma occurred 38.2% with fibrin, vs 64.7% (OR 0.487, p=0.122). Graft loss was higher in the control group, 21% vs 12.6% (OR 0.891, p=0.604). Average cost of fibrin glue was $50 per ml, and averaged costs of stapler and staple remover was $30 USD ($10–50). CONCLUSION: Fibrin glue is as effective as staples for adhering skin grafts, and trends towards lower rates of hematoma/seroma. In topographically complex regions, fibrin glue may be a better choice for adherence of skin grafts.