Topical haemostatic agents for skin wounds: a systematic review

BMC Surgery

Research Article

Marieke D Groenewold¹  Astrid J Gribnau²  Dirk T Ubbink³ 

[1] Department of Quality Assurance & Process Innovation, Academic Medical Center, Amsterdam, The Netherlands;Department of Surgery, Havenziekenhuis, Rotterdam, The Netherlands;Departments of Quality Assurance & Process Innovation and Surgery, Academic Medical Center, Amsterdam, The Netherlands;

关键词: Blood Loss;    Thrombin;    Donor Site;    Mean Difference;    Fibrin Sealant;   

DOI  :  10.1186/1471-2482-11-15

 received in 2011-01-11, accepted in 2011-07-12,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundVarious agents and techniques have been introduced to limit intra-operative blood loss from skin lesions. No uniformity regarding the type of haemostasis exists and this is generally based on the surgeon's preference. To study the effectiveness of haemostatic agents, standardized wounds like donor site wounds after split skin grafting (SSG) appear particularly suitable. Thus, we performed a systematic review to assess the effectiveness of haemostatic agents in donor site wounds.MethodsWe searched all randomized clinical trials (RCTs) on haemostasis after SSG in Medline, Embase and the Cochrane Library until January 2011. Two reviewers independently assessed trial relevance and quality and performed data analysis. Primary endpoint was effectiveness regarding haemostasis. Secondary endpoints were wound healing, adverse effects, and costs.ResultsNine relevant RCTs with a fair methodological quality were found, comparing epinephrine, thrombin, fibrin sealant, alginate dressings, saline, and mineral oil. Epinephrine achieved haemostasis significantly faster than thrombin (difference up to 2.5 minutes), saline or mineral oil (up to 6.5 minutes). Fibrin sealant also resulted in an up to 1 minute quicker haemostasis than thrombin and up to 3 minutes quicker than placebo, but was not directly challenged against epinephrine. Adverse effects appeared negligible. Due to lack of clinical homogeneity, meta-analysis was impossible.ConclusionAccording to best available evidence, epinephrine and fibrin sealant appear superior to achieve haemostasis when substantial topical blood loss is anticipated, particularly in case of (larger) SSGs and burn debridement.

【 授权许可】

Unknown   
© Groenewold et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.