Effect of using fibrin tissue adhesive and oxidized absorbable cellulose polymer hemostatic agent on flap viability in wide tissue defects closed with tight flap

Flaps are among the methods frequently used for closure of skin defects. There are many factors affecting success in flap surgery. One of these factors is organic/inorganic materials which are used perioperatively. These materials used on flap area affect wound healing and flap viability. Large defects on lumbar area may occur after meningomyelocele sac excision of neonatal patients with spine and spinal cord defects. In cases smaller flaps than skin defects, partial or complete necrosis occurrence and requirement of a revision surgery after tight wound closure is a serious problem. In our study, we aimed to present the effects of individual and combined use of fibrin tissue adhesive and absorbable oxidized cellulose polymer hemostatic agent which are used during closure of these types of defects on flap and wound healing. A total of 32 Wistar Albino type female rats aged 16-18 weeks were classified into four groups. A full-thickness skin defect was created on the back of all subjects. Then, a Limberg skin flap with a 1:4 of width-length ratio was outlined and elevated after defect creation. In first group, there was no additional procedure after suturation of flap to its new location. Flaps were sutured to their new locations after applying absorbable cellulose polymer hemostatic agent in second group, fibrin tissue adhesive in third group, both of the agents in fourth group. Wound areas had been followed with closed wound dressing after completion of surgical procedures. Flaps used for closing defects were excisied and evauated by macroscopically measuring flap survival at postoperative 7th day. In addition, wound healing was also microscopically evaluated. In conclusion, it was found that both of the agents which are used during flap surgery are beneficial for both wound healing and flap viability when used individually or combined.