Cath Lab Digest

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Index: Ostomy Wound Manage. 2012;58(8):32–36.

Abstract

  Pediatric burn wounds present unique challenges. Second-degree burns may increase in size and depth, raising concerns about healing and long-term scarring. Results of a clinical study in adults with second-degree burn wounds suggest that application of basic fibroblast growth factor (bFGF) may reduce time to second-intention healing and result in a more cosmetically acceptable scar. To evaluate the effect of this treatment on pediatric patients with deep second-degree burn wounds, 20 pediatric patients ranging in age from 8 months to 3 years (average 1 year, 3 months [± 6 months]) with a total of 30 burn wounds from various causes were allocated either the growth factor (treatment, n = 15) or an impregnated gauze treatment (control, n = 15). Wounds still exudative (not healed) after 21 days were covered with a split-thickness skin graft. All wounds were clinically assessed until healed and after 1 year. A moisture meter was used to assess scars of wounds healing by secondary intention. A color meter was used to evaluate grafted wounds. Five wounds in each group required grafting. Skin/scar color match was significantly closer to 100% in the treatment than in the control group (P <0.01).

  Wounds not requiring grafting were no longer exudative after 13.8 (± 2.4) and 17.5 (± 3.1) days in the treatment (n = 10) and control group (n = 10), respectively (P <0.01). After 1 year, scar pigmentation, pliability, height, and vascularity were also significantly different (P <0.01) between the groups. Hypertrophic scars developed in 0 of 10 wounds in the treatment and in three of 10 wounds in the control group, and effective contact coefficient, transepidermal water loss, water content, and scar thickness were significantly greater in control group (P <0.01). Both the short- and long-term results of this treatment in pediatric burn patients are encouraging and warrant further research.

Keywords: comparative study, pediatrics, burns, fibroblast growth factor, scarring

Potential Conflicts of Interest: A research grant was provided to the authors by the Japanese Ministry of Education, Sports and Culture (grant numbers 21390479, 22406030).

Introduction

  Pediatric burns may be the result of scalding, fire, electrical injuries, or parental abuse; tend to affect anatomically important areas such as the head, face, hands, and perineum; and can cause infection-related sepsis.¹ Deep dermal burns (ie, partial-thickness wounds or second-degree burns reaching into more than half of the dermis) and third-degree burns require intensive treatment, including dèbridement and skin grafting. Deep second-degree pediatric burns are particularly challenging because without proper treatment, burn surface areas and depth may worsen over time and accurate evaluation becomes more difficult due to immature skin organization and other factors.²

  A case-controlled study³ of cytokine profiles in second- and third-degree pediatric burns have provided keys to the role of tumor necrosis factor-alpha (TNF-alpha) and its receptor within the cytokine system in inflammatory wound reaction; among cytokines, basic fibroblast growth factor (bFGF) demonstrated endogenous immunolocalization in the human dermis in partial-thickness burns from day 4 to day 11. In in vivo models,⁴ bFGF was shown to activate local macrophages up to the remodeling phase, which occurs several weeks after injury. A case series⁵ involving adult second-degree burn wounds has shown bFGF may be a presynthesized mediator released locally from injury sites and thus may play an important role in early wound healing; in a comparative study,⁶ early administration of bFGF resulted in better scar quality and accelerated wound healing.