Objective: To investigate the effects of early excision and skin graft on the expression levels of Nuclear Factor kappa B (NF-κB) and Erythrogenin (EPO) in serum and Resting Energy Expenditure (REE) in patients with deep hand burn wounds.
Methods: In this study, a total of 80 patients with deep hand burn wounds who were subjected to the Burn Department of this hospital between January 2016 and January 2017 were enrolled, and divided into two groups according to the time of initial excision and skin graft: the early group (n=42), in which patients received the surgical treatment within 5 d after being burned, and the non-early group (n=38), in which patients underwent the surgery after 5 d since being burned. After debridement, exposure treatment was carried out, in which the wound surface in Grade III and the surroundings in grade II were excised, and then covered with the autologous skin. During treatment, changes in REE were monitored using a metabolic cart (MedGraphics, USA), while the changes in expression levels of NF-κB and EPO before and after excision were detected using Enzyme-Linked Immunosorbent Assay (ELISA); variations in lipopolysaccharide were also observed before and after excision using a limulus assay, and the differences in the levels of Alanine Aminotransferase (ALT) in serum were measured using an automatic biochemical analyzer before and after excision.
Results: In the early group, REEs at 1 d and 5 d were significantly lower than those in the non-early group (p<0.05), while the comparisons of REEs before and after excision, as well as at 10 d and 15 d in two groups showed no statistically significant differences (p>0.05). Before excision, there is no statistically significant differences (p>0.05) in the levels of NF-κB and EPO in serum; after excision, the level of NF-κB in the early group was significantly lower than that in the non-early group (p<0.05); while the level of EPO in the early group was significantly higher than that in the non-early group (p<0.05). Before excision, no significant differences were identified in comparison of the LPS and ALT levels in serum between two groups (p>0.05); after excision, these indexes in the early group were significantly lower than those in the non-early group (p<0.05).
Conclusion: Early excision can alleviate the hypermetabolism of patients with deep burn wounds in hand, reduce the content of NF-κB in serum and increase the level of EPO in serum with less damage to liver, which might be correlated with the control of the release of major inflammatory mediators in an early stage and the accelerated recovery in surface of deep burn wounds of patients.Author(s): Hua Guo, Zhenxia Zhao, Gangquan Chen