This study aims to compare the efficacy of NuStat, a new haemostatic agent based on bamboo cellulose that proposes to activate the clotting cascade, against more traditional methods of haemostasis during burn surgery. The authors argue the requirement for further research due to the fact that little development has occurred in this area; alongside the problems associated with excess blood loss in burns patients undergoing excision, which is quoted to be between 196-269ml per percentage area. The authors state the study was conducted at a single centre, using 20 patients (16 men, four women), who had sustained extremity burns of less than 10% total body surface area (TBSA) and required surgery. All patients received epinephrine tumescence and their donor and graft sites were divided into two equal halves to be treated with either NuStat or epinephrine / thrombin soaks left in situ in five minute cycles until clinical evidence of haemostasis had occurred in a randomised process. Bandages were weighed to assess blood loss. Evaluating the methodology critically; the authors themselves acknowledge the relatively low numbers of trial participants (20), this leaves the study somewhat underpowered. This is especially true in an area such as this where differences between treatments are likely to be subtle and small study numbers may mask any treatment effects. This study also limits the treatment area to the extremities and to burns of under 10%. Again this may make detecting small treatment effects difficult due to subtle differences in the weight of bandages, any discrepancy in weight would possibly be much more apparent in say a 40-50% burn. Also a rather minor observation is that the authors say that the study areas are randomised to either treatment but make no mention of how this is achieved.
The methodology of how the two comparable areas are measured is not described. If it is done by visual estimation this may result in some errors. Overall, however, this is a well-written paper that has been conducted in an area that has received little interest or development in the recent past whilst other areas of burns surgery continue to evolve. The authors have managed the tricky problem that is conducting a randomised trial in surgical subjects well and report their findings of no statistical difference in treatments honestly, which is somewhat of a rarity in medical literature where authors often seem to be discouraged from reporting negative trial results. From the study results it would certainly appear that further work should be encouraged with this technique. – MJH
