Inventi Impact: Cosmetic Surgery
TOPICAL HAEMOSTATIC AGENTS FOR SKIN WOUNDS:A SYSTEMATIC REVIEW
Marieke D Groenewold, Astrid J Gribnau, Dirk T Ubbink
Background: Various 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.
Methods: We 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.
Results: Nine 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.
Conclusion: According 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
CC Compliant Citation: Groenewold et al.: Topical haemostatic agents for skin wounds: a systematic review. BMC Surgery 2011 11:15.