Background: Various agents and techniques have been introduced to limit intra-operative blood loss from skin\r\nlesions. No uniformity regarding the type of haemostasis exists and this is generally based on the surgeon�s\r\npreference. To study the effectiveness of haemostatic agents, standardized wounds like donor site wounds after\r\nsplit skin grafting (SSG) appear particularly suitable. Thus, we performed a systematic review to assess the\r\neffectiveness of haemostatic agents in donor site wounds.\r\nMethods: We searched all randomized clinical trials (RCTs) on haemostasis after SSG in Medline, Embase and the\r\nCochrane Library until January 2011. Two reviewers independently assessed trial relevance and quality and\r\nperformed data analysis. Primary endpoint was effectiveness regarding haemostasis. Secondary endpoints were\r\nwound healing, adverse effects, and costs.\r\nResults: Nine relevant RCTs with a fair methodological quality were found, comparing epinephrine, thrombin, fibrin\r\nsealant, alginate dressings, saline, and mineral oil. Epinephrine achieved haemostasis significantly faster than\r\nthrombin (difference up to 2.5 minutes), saline or mineral oil (up to 6.5 minutes). Fibrin sealant also resulted in an\r\nup to 1 minute quicker haemostasis than thrombin and up to 3 minutes quicker than placebo, but was not\r\ndirectly challenged against epinephrine. Adverse effects appeared negligible. Due to lack of clinical homogeneity,\r\nmeta-analysis was impossible.\r\nConclusion: According to best available evidence, epinephrine and fibrin sealant appear superior to achieve\r\nhaemostasis when substantial topical blood loss is anticipated, particularly in case of (larger) SSGs and burn\r\ndebridement.
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