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December 1988

Early Burn Wound Excision and Skin Grafting Postburn Trauma Restores In Vivo Neutrophil Delivery to Inflammatory Lesions

Author Affiliations

From the Department of Surgery (Drs Tchervenkov, Epstein, and Alexander) and Medicine and Radiology (Silberstein), University of Cincinnati.

Arch Surg. 1988;123(12):1477-1481. doi:10.1001/archsurg.1988.01400360047007

• This study assessed the effect of early vs delayed post-burn wound excision and skin grafting on the in vivo neutrophil delivery to a delayed-type hypersensitivity (DTH) reaction and a bacterial skin lesion (BSL). Male Lewis rats were presensitized to keyhole-limpet hemocyanin. Group 1 comprised sham controls. Groups 2 through 4 were given a 30% 3° scald burn, but the burn wounds were excised, and skin was grafted on days 1, 3, and 7, respectively, after the burn. Group 5 comprised burn controls. Twelve days after burn trauma, all rats were injected at different intervals (during a 24-hour period) with a trio of intradermal injections of keyhole-limpet hemocyanin, Staphylococcus aureus 502A, and saline at different sites. In vivo neutrophil delivery to these dermal lesions was determined by injecting indium In 111 oxyquinoline—labeled neutrophils isolated from similarly treated groups of rats. Neutrophil delivery to DTH and BSL lesions was restored to normal by excision and skin grafting of the burn wound one day after burn trauma. Waiting three days after burn trauma to excise and skin graft the wound partially, but not completely, restored the in vivo neutrophil delivery to DTH and BSL lesions. Waiting one week to excise and skin graft a burn wound resulted in no improvement in neutrophil delivery to DTH and BSL dermal lesions. It was concluded that burn wound excision and skin grafting immediately after burn trauma restored in vivo neutrophil delivery to a BSL and DTH dermal lesion. This may, in part, explain the beneficial effect of early aggressive burn wound débridement in patients with burn injuries.

(Arch Surg 1988;123:1477-1481)