The relationship between protease/anti-protease profile, angiogenesis and re-epithelialisation in acute burn wounds.
In the management of partial thickness burns, it is difficult to balance between conservative management and surgical intervention. Our hypothesis was that a triangular relationship exists between protease/anti-protease profile at the burn wound surface, angiogenesis and re-epithelialisation. By manipulation of the biochemical profile at the wound level, we determined to affect the nature and extent of angiogenesis and resulting re-epithelialisation. We performed a randomised longitudinal observational study on partial thickness burns in adult patients presenting to two regional burns units. Our results demonstrated that a high-protease wound environment is associated with lower levels of the angiogenic factor VEGF, a lower more uniform change in wound bloodflow and a uniform well healed wound with an architecturally normal epidermis. In addition, we found that a low protease wound environment is associated with higher levels of the angiogenic factor VEGF, a higher wound bloodflow throughout the wound healing period and a more chaotic, hypercellular, overkeratinised, and chaotic thickened epidermis.
Caulfield
Robert H
RH
Stoke Mandeville Burns & Reconstructive Surgery Research Trust, Aylesbury, UK. rcaulfield@talk21.com
Tyler
Michael P H
MP
Austyn
Jon M
JM
Dziewulski
Peter
P
McGrouther
Duncan A
DA
D000293:Adolescent; D000328:Adult; D000368:Aged; D047070:Bandages, Hydrocolloid; D002056:Burns / Q000201:enzymology* / Q000628:therapy; D002452:Cell Count; D004847:Epithelial Cells / Q000502:physiology; D006801:Humans; D007150:Immunohistochemistry; D017078:Laser-Doppler Flowmetry; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D018919:Neovascularization, Physiologic / Q000502:physiology*; D010447:Peptide Hydrolases / Q000378:metabolism*; D012867:Skin / Q000098:blood supply*; D014945:Wound Healing / Q000502:physiology*; D055815:Young Adult
D010447:Peptide Hydrolases