EMERGING ROLE OF COMBINED INTRAVENOUS AND TOPICAL TRANEXAMIC ACID IN CONTROLLING SPLIT-THICKNESS SKIN GRAFT DONOR SITE BLEEDING: A COMPARATIVE CLINICAL STUDY IN A TERTIARY-CARE CENTER

Background: Control of bleeding from split-thickness skin graft (STSG) donor sites remains a perioperative challenge, particularly in large surface area grafting. Tranexamic acid (TXA) has recently gained attention as an antifibrinolytic agent with expanding applications across surgical specialties. However, evidence supporting its combined systemic and topical use in STSG donor sites remains limited. Objective: To evaluate the effectiveness and safety of a modified hemostatic protocol using combined intravenous and topical tranexamic acid compared with conventional adrenaline-based infiltration for reducing donor site bleeding in split-thickness skin grafting. Methods: A prospective comparative clinical study was conducted in the Department of Reconstructive Surgery at a tertiary-care university hospital between November 2022 and November 2023. Eighty-five patients requiring STSG were allocated into two groups. Group A received local infiltration with lidocaine–adrenaline solution (1:100,000). Group B received intravenous tranexamic acid (10 mg/kg) administered 30 minutes preoperatively, followed by topical application of TXA-impregnated gauze to the donor site after graft harvesting. Intraoperative bleeding severity, postoperative dressing change requirements, hemoglobin variation, need for transfusion, graft take, and donor site epithelialization were assessed. Results: Patients in the TXA group demonstrated significantly reduced donor site bleeding compared with the adrenaline group (p < 0.01). The requirement for dressing change within the first 24 hours postoperatively was also significantly lower in the TXA group. No statistically significant differences were observed between groups regarding postoperative hemoglobin levels, blood transfusion requirements, graft success rates, or donor site epithelialization. No thromboembolic or serious adverse events related to TXA were recorded. Conclusion: The combined intravenous and topical administration of tranexamic acid represents an emerging and effective hemostatic strategy for controlling bleeding from STSG donor sites. This modified protocol is safe, cost-effective, and suitable for implementation in tertiary-care surgical settings.