Topical Tranexamic Acid on Donor Wounds in Burn Patients: A Randomized Placebo-controlled Trial

Author:

Colclough Robert N.1,Almeland Stian K.12,Brekke Ragnvald L.12,Spigset Olav34,Nordgaard Håvard45,Pleym Hilde67,Ausen Kjersti57

Affiliation:

1. Norwegian National Burn Center, Department for Plastic, Hand, and Reconstructive Surgery, Haukeland University Hospital, Bergen, Norway

2. Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway

3. Department of Clinical Pharmacology, St Olav’s University Hospital, Trondheim, Norway

4. Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway

5. Section for Plastic and Reconstructive Surgery, Clinic of Surgery, St Olav’s University Hospital, Trondheim, Norway

6. Clinic of Anesthesia and Intensive Care, St Olav’s University Hospital, Trondheim, Norway

7. Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.

Abstract

Background: Patients with major burn injuries are prone to massive blood loss owing to tangential excision of burn wounds and donor skin harvesting. In general, topical application of the antifibrinolytic drug tranexamic acid (TXA) to surgical wounds reduces bleeding; however, its effect on bleeding and re-epithelialization in superficial wounds of burns has not been explored. Methods: This study aimed to investigate the therapeutic potential of topical TXA in reducing blood loss and its effect on wound re-epithelialization in burn surgery. Split-thickness skin graft donor wounds in burn patients were paired and randomized to topical application of either TXA (25 mg/mL) or placebo. Endpoints were postoperative bleeding as measured by dressing weight gain per cm2 wound area, blood stain area per wound area, and visual evaluation of bleeding in the dressings. Healing time was recorded to analyze the effect on wound re-epithelialization. Results: There was no significant difference in bleeding or time to re-epithelialization between the TXA and placebo wounds. A post hoc subanalysis of wounds with dressing weight gain above the median, showed a significant difference in favor of TXA. However, use of tumescence may have influenced end points. No significant adverse events related to the study drugs were observed. Conclusions: This study demonstrates that topical application of TXA (25 mg/mL) to split-thickness skin graft donor wounds does not delay re-epithelialization. Although a reduction in bleeding is suggested, further studies are needed to determine the role of topical TXA in reducing bleeding in burn surgery.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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