Glue in Skin Grafts for Skin Cancer

Brief Name: Fibrin Glue Generic Name: Two-Component Fibrin Sealant, Vapour heated and solvent detergent treated Dose: Dependent on area of skin graft to be treated, in 5mL aliquots Duration: Administered once, intraoperatively Mode: Topical, between skin graft and graft bed. Administered by trained general surgeon or plastic/reconstructive surgeon. Procedure: As per the usual surgical procedure, the patient will usually have a general anaesthetic (sometimes a local anaesthetic) and their skin cancer will be excised as usual and skin graft prepared as usual. Patients will then either have their graft affixed with the fibrin glue or sutures/staples as per the randomisation code. Each procedure is variable time length mostly depending on the number of lesions to be excised but usually each lesion takes 30-40 minutes. To ensure fidelity patients will only be operated on by two surgeons (one general one plastic) who are both trained in use of glue. Fibrin glue was initially used for haemostatic purposes (to stop bleeding intraoperatively), because when it is introduced to a wound with Thrombin, Factor XIII and Calcium it mimics the final events in the clotting cascade, turning fibrinogen into fibrin. Originally spun from plasma intraoperatively, commercial preparations are now available which produce high concentrations of fibrin and can be used as an adhesive. Fibrin glue has been investigated for use in skin grafts relating to burns and shown no inferiority to staples/sutures in terms of wound closure. Specifically, fibrin glue adheres the entire surface of the graft to the site and significantly reduces the formation of haematoma or seroma immediately post-op which commonly results in graft failure.