Recombinant human growth hormone accelerates wound healing in children with large cutaneous burns.
OBJECTIVE
Two forms of recombinant growth hormone that accelerate the healing of skin graft donor sites in severely burned children were evaluated.


BACKGROUND
Growth hormone has been shown to reduce wound healing times in burned pediatric patients. Through genetic engineering, several different forms have been synthesized; however, not all are marketed currently. Two forms of growth hormone were used in these studies, Protropin (Genentech, Inc., San Francisco, CA), a commercially available product that possesses a N-terminal methionine residue not found in the second form Nutropin (Genentech, Inc., San Francisco, CA), which, as yet, is not commercially available. Through the use of recombinant human growth hormone, rapid wound healing may reduce the hypermetabolic period, the risk of infection, and accelerate the healing of donor sites used for grafting onto burned areas. The two structurally different forms of growth hormone were tested for their efficacy in healing donor sites in severely burned children.


METHODS
Forty-six children, with a > 40% total body surface area and > 20% total body surface area full-thickness burn were entered in a double-blind, randomized study to receive rhGH within 8 days of injury. Twenty received (0.2 mg/kg/day) Nutropin or placebo by subcutaneous or intramuscular injection beginning on the morning of the initial excision. Eighteen patients who failed the entry criteria for receiving Nutropin received Protropin therapeutically (0.2 mg/kg/day). Donor sites were harvested at 0.006 to 0.010 inches in depth and dressed with Scarlet Red impregnated fine mesh gauze (Sherwood Medical, St. Louis, MO). The initial donor site healing time, in days, was reached when the gauze could be removed without any trauma to the healed site.


RESULTS
Donor sites in patients receiving Nutropin (n = 20) or Protropin (n = 18) healed at 6.8 +/- 1.5 and 6.0 +/- 1.5 (mean +/- SD) days, respectively, whereas those receiving placebo (n = 26) had a first donor site healing time of 8.5 +/- 2.3 days. Both groups receiving rhGH showed a significant reduction in donor site healing time compared with placebo at p < 0.01. When subgroups were compared, no difference in healing times could be shown with regards to age or time of admission after injury.


CONCLUSIONS
Our results indicate that both forms of rhGH are effective in reducing donor site healing time compared with placebo and suggest that accelerating wound healing is of clinical benefit because the patients' own skin becomes rapidly available for harvest and autografting. With this increase in the rate of wound healing, the total length of hospital stay can be reduced by more than 25%.
Gilpin
D A
DA
Shriners Burns Institute, Galveston, Texas.
Barrow
R E
RE
Rutan
R L
RL
Broemeling
L
L
Herndon
D N
DN
D000293:Adolescent; D000367:Age Factors; D002056:Burns / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D062109:Dermatologic Surgical Procedures; D004311:Double-Blind Method; D005260:Female; D013006:Growth Hormone / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D006728:Hormones / Q000494:pharmacology / Q000627:therapeutic use*; D019382:Human Growth Hormone; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D007279:Injections, Subcutaneous; D008297:Male; D011994:Recombinant Proteins / Q000494:pharmacology / Q000627:therapeutic use; D012720:Severity of Illness Index; D012867:Skin / Q000187:drug effects / Q000503:physiopathology; D016038:Skin Transplantation; D013526:Surgical Mesh; D013997:Time Factors; D014945:Wound Healing / Q000187:drug effects*
D006728:Hormones; D011994:Recombinant Proteins; D019382:Human Growth Hormone; D013006:Growth Hormone