Einfluss der V.A.C.®-Therapie auf Zytokine und Wachstumsfaktoren in Traumatischen Wunden

Zusammenfassung

Ziel der Untersuchung: Klinisch beobachtet man eine beschleunigte Wundheilung bei Patienten, die mit der Vacuum Assisted Closure(V.A.C.®)-Therapie behandelt werden. Die Ursachen dafür auf zellulärer Ebene sind bislang wenig erforscht. In dieser Studie wurden die Serumspiegel proinflammatorischer Interleukine (IL-6, IL-8, IL-10) und Wachstumsfaktoren (VEGF, FGF-2) mit denen in der Wundflüssigkeit verglichen. Basismethodik: Insgesamt wurden 21 Patienten mit traumatischen primär nicht zu verschliessenden Wunden in diese Studie aufgenommen. Die Weichteildefekte (n = 21) wurden primär mit Epigard® als temporäre Wunddeckung behandelt. Während der ersten Second-Look Operation nach 2,0 ± 0,2 Tagen wurde bei 13 Patienten Epigard® für weitere 2,5 ± 0,4 Tage als Weichteildeckung verwendet (Gruppe A), während bei 8 Patienten V.A.C.® zur Wundkonditionierung für 2,4 ± 0,3 Tage zur Anwendung kam (Gruppe B). Insgesamt wurden 428 Serum- und Wundflüssigkeitsproben aus dem ersten und zweiten Verbandwechsel asserviert. Die Zytokine (IL-6, IL-8, IL-10) und Wachstumsfaktoren (VEGF, FGF-2) wurden in Wundflüssigkeit und in den dazu parallel gesammelten Serumproben mittels ELISA bestimmt. Hauptbefunde: Bei allen Zytokinen und Wachstumsfaktoren wurden signifikant niedrigere Serumspiegel im Vergleich zur Wundflüssigkeit gemessen. Beim ersten Verbandwechsel nach Weichteildeckung mittels Epigard® wurden folgende Werte [Mittelwert (SEM)] in den Wundflüssigkeiten ermittelt: IL-6 49 816 (19 889) pg/ml, IL-8 54 (16) ng/ml, IL-10 314 (44) pg/ml, VEGF 4 746 (766) pg/ml, FGF-2 494 (89) pg/ml. Während des zweiten Verbandwechsels fanden sich in Gruppe A folgende Werte: IL-6 7 218 (2 542) pg/ml, IL-8 69 (27) ng/ml, IL-10 261 (58) pg/ml, VEGF 3 551 (661) pg/ml, FGF-2 355 (67) pg/ml. In Gruppe B wurden folgende Werte gemessen: IL-6 16 966 (4 124) pg/ml [p = 0,02], IL-8 223 (91) ng/ml [p = 0,03], IL-10 233 (76) pg/ml [p = 0,38], VEGF 7 490 (1 565) pg/ml [p = 0,01], FGF-2 352 (43) pg/ml [p = 0,48]. Schlussfolgerungen: Die erhöhten Spiegel von IL-6, IL-8 und VEGF in Wunden von V.A.C.® behandelten Patienten könnten die lokale Entzündungsreaktion und anschließende Angiogenese beschleunigen und so mitverantwortlich sein für die beschleunigte Wundheilung.

Abstract

Objective: Clinical observations have shown an accelerated woundhealing in wounds of patients treated by Vacuum Assisted Closure (V.A.C.®)-therapy. The mechanisms of improved wound healing on cellulary level have been hitherto less investigated. In this study the levels of proinflammatory interleukins (IL-6, IL-8, IL-10) and growth factors (VEGF, FGF-2) in serum and wound were monitored. Methods: The study included 21 patients with traumatic wounds that could not be closed during the first surgical intervention. The soft tissue defects (n = 21) were closed temporarily by Epigard®. During the first second-look operation after 2.0 ± 0.2 days in an average, Epigard® was used for another 2.5 ± 0.4 days as temporary soft tissue coverage in 13 patients (group A). In the remaining 8 patients the wound conditioning was done by V.A.C.® for 2.4 ± 0.3 days (group B). A total of 428 samples of serum and wound fluid samples were collected during the first and second look operation. Levels of IL-6, IL-8, IL-10, VEGF and FGF were measured specific by ELISA. Results: In all interleukins and growth factors there were significant lower serum level concentrations compared with those in wound fluids. During the first temporary dressing change after wound coverage with Epigard® the wound samples showed the following levels [Mean (SEM)]: IL-6 49 816 (19 889) pg/ml, IL-8 54 (16) ng/ml, IL-10 314 (44) pg/ml, VEGF 4 746 (766) pg/ml, FGF-2 494 (89) pg/ml. During the second dressing changes we monitored the following levels in group A: IL-6 7 218 (2 542) pg/ml, IL-8 69 (27) ng/ml, IL-10 261 (58) pg/ml, VEGF 3 551 (661) pg/ml, FGF-2 355 (67) pg/ml. In group B the samples of the wound fluid showed the following results: IL-6 16 966 (4 124) pg/ml [p = 0.02], IL-8 223 (91) ng/ml [p = 0.03], IL-10 233 (76) pg/ml [p = 0.38], VEGF 7 490 (1 565) pg/ml [p = 0.01], FGF-2 352 (43) pg/ml [p = 0.48]. Conclusion: The increased local release of IL-6, IL-8 and VEGF in wounds after V.A.C.®-therapy may be involved in the accumulation of neutrophil granulocytes and angiogenesis, which seams to play a crucial role for the accelerated granulation tissue formation after V.A.C.®-therapy compared to wounds treated by Epigard®.

Schlüsselwörter

Vacuum assisted closure - V.A.C.® - Trauma - IL-6, IL-8 - VEGF - Weichteilverletzung

Key words

vacuum assisted closure - V.A.C.® - trauma - IL-6, IL-8 - VEGF - soft tissue injury

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