Changes in the plasma cytokine and growth factor profile are associated with impaired healing in pediatric patients treated with INTEGRA® for reconstructive procedures.

BACKGROUND

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(®).