An evaluation of fibrin tissue adhesive concentration and application thickness on skin graft survival

Objectives: To examine the effects of fibrinogen concentration and applicat ion thickness of fibrin tissue adhesive on skin graft survival. Study Desig n: Prospective controlled study. Methods: Ten domestic pigs were included i n the study. A 20 x 5-cm area of skin was harvested bilaterally along the f lanks of the animals using a Padgett dermatome, The harvested grafts were t rimmed into four 4 x 4-cm squares. Donor sites were treated according to gr oup assignment and the non-meshed grafts were placed on the side opposite t heir initial orientation and secured with staples. Both single- and multipl e-donor human fibrin tissue adhesive preparations, with low and high averag e fibrinogen concentrations of 30 mg/mL and 60 mg/mL, were used. Adhesive p reparations were applied in either a thin layer (0.015 mL/cm(2)) or a thick layer (0.06 mL/cm(2)) using a spray applicator. A constant thrombin concen tration of 10 U/mL; was used in the study. No adhesive was used in the cont rol group and grafts were stabilized with staples. No topical dressings wer e applied to any of the treatment sites. Animals were sacrificed 4 weeks af ter graft application. Results: Based on statistical analysis, thickness of adhesive application had a significant effect on skin graft survival. Perc ent mean graft survival in the control and thin application groups was foun d to be 92% and 97.8% respectively; the mean survival rate in the thick app lication group was 63,1%. Fibrinogen concentration, when evaluated independ ently within the thin and thick application groups, was found to have no si gnificant effect on graft survival. Conclusion: Independent of fibrinogen c oncentration, a thin layer of fibrin tissue adhesive, when applied between two opposing surfaces, does not interfere with and may support the healing process, whereas a thick layer of adhesive inhibits skin graft healing.