Changes in the plasma cytokine and growth factor profile are associated with impaired healing in pediatric patients treated with INTEGRA® for reconstructive procedures
Nessler, M., Puchala, J., Wood, F.M., Wallace, H.J., Fear, M.W., Nessler, K., & Drukala, J. (2012). Changes in the plasma cytokine and growth factor profile are associated with impaired healing in pediatric patients treated with INTEGRA® for reconstructive procedures. Burns, Online First. doi:10.1016/j.burns.2012.09.001
Methods: Large full thickness skin defects caused by trauma or surgery require skin grafting, often in conjunction with dermal scaffolds such as INTEGRA®. Due to the size and severity of these procedures, complications such as infection may occur. This can lead to poor healing outcomes.
Objective: To identify early biomarkers of complications during INTEGRA® healing.
Methods: Levels of EGF, TGF-β1, FGF-2, VEGF, IFN-α, GM-CSF, IL-4 and IL-8 were measured pre-surgery and at days 1, 7 and 25 post-surgery in peripheral blood of 15 pediatric patients treated with INTEGRA® for reconstructive procedures. The levels of these molecules were analysed with respect to the occurrence of complications.
Results: Complications (local infection) occurred in a group of 4 patients. This resulted in a reduced INTEGRA® take rate comparing to the group without complications (71.5 ± 5.4% vs. 98.1 ± 0.7%). In cases with complications there were significantly higher plasma concentrations of IL-4 and FGF-2 on day 7 (p = 0.037 and p = 0.008 respectively). Other markers were not significantly different between groups or at very low level at all time-points. WCC and CRP remained within normal ranges at all time-points.
Conclusions: This data suggests that elevated levels of IL-4 and FGF-2 at early time-points after surgery may predict the development of complications in patients with INTEGRA®. This may enable early interventions to prevent complications in procedures involving the use of INTEGRA®.