title: Changes in the plasma cytokine and growth factor profile are associated with impaired healing in pediatric patients treated with INTEGRA® for reconstructive procedures.
abstract: 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(®).
authors.affiliation: Department of Plastic and Reconstructive Surgery, Children's Burn Centre, University Children's Hospital, Jagiellonian University Medical College, Krakow, Poland. mnessler@gmail.com
authors.forename: Michal
authors.initials: M
authors.lastname: Nessler
authors.forename: Jacek
authors.initials: J
authors.lastname: Puchala
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Wood
authors.forename: Hilary J
authors.initials: HJ
authors.lastname: Wallace
authors.forename: Mark W
authors.initials: MW
authors.lastname: Fear
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Nessler
authors.forename: Justyna
authors.initials: J
authors.lastname: Drukala
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D002809:Chondroitin Sulfates / Q000627:therapeutic use*; D003094:Collagen / Q000627:therapeutic use*; D016207:Cytokines / Q000097:blood*; D062109:Dermatologic Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000097:blood*; D008297:Male; D016038:Skin Transplantation / Q000379:methods*; D017768:Skin, Artificial; D014945:Wound Healing / Q000502:physiology*; D014947:Wounds and Injuries / Q000097:blood* / Q000601:surgery
chemical_list: D015415:Biomarkers; D016207:Cytokines; D036341:Intercellular Signaling Peptides and Proteins; C114835:integra artificial skin; D002809:Chondroitin Sulfates; D003094:Collagen