Topical haemostatic agents for skin wounds: a systematic review

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.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.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 debridement.Limitation of intra-operative blood loss from skin lesions is an important aspect of surgical procedures [1]. Effective and fast haemostasis results in less time spent in the operating room, a more favourable outcome for the patient being under anaesthesia, and an uneventful wound healing process. When substantial blood loss is encountered, haemostasis can play a crucial role in avoiding major haemostatic disturbances [2].In order to minimize blood loss, for example in patients with large burns after excision of these burns, several treatment options have been introduced such as intravenous vasoconstrictive agents, tourniquets, topical haemostatic agents or subcutaneous agents (i.e. the tumescent technique, frequently used for varicectomy or suction lipectomy) [3-7].Unfortunately, haemostasis is an understudied subject in the