COMPARATIVE STUDY OF THE EFFECTS OF ADRENALINE VERSUS TRANEXAMIC- ACID ON SPLIT THICKNESS SKIN GRAFT DONOR SITE

Weam Ali*, Firas Melhem and Safwan Yousef

ABSTRACT

Objective: The need to find effective methods that enable us to control bleeding at the sites of split thickness skin graft extraction by comparing the effect of adrenaline and tranexamic acid application on these sites. Material and Methods: A prospective randomized clinical trial conducted in the Reconstructive Surgery Department at Tishreen University Hospital, from November 2022 to November 2023. At the end of the study, 34 patients were included. After taking the patient's consent, clinical history, and filling out the form, the patients were randomly divided into two groups. The first group: The patients who had the graft site infiltrated with a lidocaine-adrenaline solution at a concentration of 1/100,000. The second group: The patients who had the graft site infiltrated with lidocaine 2% only, with tranexamic acid given intravenously half an hour before surgery at a dose of 10 mg/kg, then a gauze impregnated with tranexamic acid was applied immediately after harvesting the graft for ten minutes. Results: The average age was similar in both groups (about 30 years). The mean operative time was similar in the two groups and was less in the TXA group, but without a statistically significant difference. Most of grafts were harvested from the lower extremity, which is the most common site for harvesting split thickness skin graft. When studying the incidence of bleeding in the study patients, it was found that the group of patients who were given TXA had less bleeding compared to the patients who were prepared with adrenaline and lidocaine, with a statistically significant difference, and thus TXA reduces the incidence of bleeding at the site of the partial-thickness skin graft. When studying the need for dressing change, we found that patients who were given intravenous TXA and had a gauze impregnated with TXA needed to change the dressing less often when compared to the rest of the study patients. Thus, the use of TXA reduces the need to change the dressing during the first day of surgery. We did not find a statistically significant difference between the two groups in terms of hemoglobin after surgery or the need for blood transfusion. We found that the use of TXA does not cause complications or serious or life-threatening side effects that prevent its use, as most of the effects that occurred were pain and edema, and their percentage was similar to that of patients in the second group. Conclusion: TXA is considered a cheap substance that has a good effect in reducing bleeding during and after surgery and does not cause side effects that prevent its use.

Keywords: Reconstructive surgery, Split thickness skin graft, Bleeding, Transaminase acid.