Protocol for an open randomised controlled trial investigating Fibrin Glue in Skin grafts for Skin cancer (FiGSS).

INTRODUCTION: Skin cancer is a common disease in the tropics, and oncological resection typically requires reconstruction with skin grafts. Fibrin glue, initially established as a haemostatic agent, has been studied extensively as an adhesive for skin grafts in burns. This study aims to investigate the use of fibrin as an adhesive for split skin grafts in skin cancers. METHODS AND ANALYSIS: The study design is a prospective randomised controlled trial with the aim of investigating the impact of two different methods of split skin graft fixation. The intervention of fibrin glue will be compared with the control of staples or sutures. The trial will be conducted at two sites, a public hospital and a private hospital in Townsville, Australia, over a 24-month period with 334 participants to be recruited. Consecutive patients presenting for skin excisions and grafting will be eligible to participate in this study. Randomisation will be on the level of the patient. The primary outcome is graft take based on wound healing at 1 month. Secondary outcomes will be pain on dressing changes and operative time. ETHICS AND DISSEMINATION: The study has been approved by The Townsville University Hospital Human Research Ethics Committee. Findings will be disseminated in conference presentations and journals and through online electronic media. TRIAL REGISTRATION NUMBER: ACTRN12618000484246.

Effectiveness of fibrin glue in skin graft survival: A systematic review and meta-analysis.

BACKGROUND: The objective of this study is to assess the current literature on the effectiveness of fibrin glue on survival of skin grafts. Fibrin glue is a possible alternative to secure skin grafts instead of traditional methods (i.e. sutures or staples). METHODS: Data Sources: MEDLINE, Scopus, Embase, Informit, CINAHL and the Cochrane Central Register of Controlled Trials, no limit on the earliest date of publication. STUDY ELIGIBILITY CRITERIA: Randomised, non-randomised controlled trials and cohort studies. PARTICIPANTS: and Interventions: Participants were patients with skin grafting/skin transplantation. The intervention was fibrin glue in any form (bovine, human pooled plasma or autologous) and comparator any form of affixing skin grafts (e.g. sutures or staples).Study Appraisal and Synthesis Methods: Studies were appraised using the Cochrane risk of bias tool and assessed for clinical heterogeneity. Effect sizes were calculated and illustrated with forest plots. RESULTS: 190 publications were narrowed to 15 relevant publications, of which eight were pooled in meta-analysis. The outcomes examined were: graft survival by percentage; graft survival reported as events; post-operative incidence of haematoma or seroma; pain reported after dressing changes via a visual analogue scale; length of stay in days (Glass's delta 2 was 0.48 95% CI 0.09, 0.97); and surgical time in minutes. Only length of stay showed a difference between groups and it favoured fibrin glue. CONCLUSIONS: While there may be benefits to the use of fibrin glue in skin graft patients, it is difficult to conclude this from the current evidence. Limitations were significant heterogeneity in outcomes measured and exclusion off non-English papers.

Pott's puffy tumour in an immunosuppressed adult: case report and systematic review of literature.

This case is of a 34-year-old immunocompromised male with Pott's puffy tumour, which was treated with antibiotics and endoscopic sinus surgery. Pott's puffy tumour is typically a complication of frontal sinusitis in children and immunocompromise can be a precipitating factor. A search was conducted of Embase, Medline, CINAHL, Cochrane, Google Scholar, Informit and Scopus of 'Pott's Puffy' and variations of this phrase. Initial 804 records were reviewed by title, abstract and full text. Of the unique papers identified, 155 only included paediatric patients and 128 included adult patients. After title, abstract and full-text review of 13 papers were identified describing Pott's puffy tumour in immunocompromised patients. Immunosuppression was noted as a risk factor in only a small number of cases, with diabetes mellitus being the most common. A few cases did note immunosuppression due to newer immunomodulatory agents being used for treatment of autoimmune conditions.

Ruptured Sinus of Valsalva Aneurysm Causing Acute Right Heart and Hepatorenal Failure Requiring Urgent Surgery.

A sinus of Valsalva aneurysm is a rare cardiac anomaly that may be congenital or acquired. Very rarely, they present with acute symptoms as a result of rupture into the cardiac chamber. If left untreated, they almost always result in deteriorating cardiac function. We report a patient presenting with acute right heart failure and hepatorenal syndrome requiring urgent surgery and double patch repair.