Use of fibrin glue in the treatment of decubital ulcers in patients after brain damage, as a stage of conservative treatment

Abstract

BACKGROUND: Patients with brain damage require specific treatment for decubitus ulcers. Given the seriousness of their condition and decompensation of concomitant pathology, surgical treatment is not always possible. Conservative therapy can take a long time, which is aggravated by the unsolvable problem of patient immobilization, microcirculatory tissue disorders, and inevitable chronicity of the purulent–inflammatory process. Most authors and practitioners are inclined toward a combined approach in the treatment of decubitus ulcers.

AIM: To evaluate the results of using fibrin glue in the treatment of bedsores in patients with severe brain damage.

MATERIALS AND METHODS: The article presents the experience of using fibrin glue in the conservative treatment of bedsores. The study included patients in a chronic critical state because of severe brain damage, with a decubitus ulcers area of >80 cm² (stage III according to the Agency For Health Care Policy and Research classification). In the main group, treatment included the use of fibrin glue in accordance with the Russian Federation Patent No. 2777483 dated 08/04/2022. In the control group, treatment included standard dressings with levomekol ointment. Both groups received treatment for 21 days. Changes in the wound process were assessed using the Bates–Jensen scale and cytological examination at control points.

RESULTS: The study analyzed 58 patients, who were divided into two groups: group 1 (main) included 32 patients (15 men, 17 women), and group 2 (control) included 26 patients (12 women, 14 men). In the main group, after 1 week of applying dressings with fibrin glue, positive changes were noted, such as active marginal epithelialization, disappearance of “undermining” and swelling of wound edges, appearance of “juicy” bright granulations, and absence of exudates. After 2–2.5 weeks, epithelialization exceeded 50% of the total area of the decubitus ulcers (56.2% of cases), and exudation was completely absent. In a cytological study, the percentage of cells responsible for tissue proliferation increased and inflammation decreased in the main group. No significant effect was noted in the control group. In 7.7% of cases, 50% epithelialization was noted on days 28–35; in three patients, re-infection of the decubitus ulcers occurred, and ischemia developed, which significantly lengthened the total duration of inpatient treatment and rehabilitation by 1.0–1.5 months.

CONCLUSION: The use of fibrin glue promotes decubitus ulcers epithelization, thereby reducing their size, up to complete healing.

Keywords

fibrin glue / activation / decubital ulcer / chronic critical condition / epithelization

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