CHARACTERIZATION OF GROWTH-HORMONE ENHANCED DONOR SITE HEALING IN PATIENTS WITH LARGE CUTANEOUS BURNS

Background Human growth hormone is an anabolic agent that attenuates i njury-induced catabolism and stimulates protein synthesis. Recombinant human growth hormone (rhGH) administered therapeutically to patients with massive burns has been shown to increase the rate of skin graft d onor site healing. It has been postulated that growth hormone affects wound healing and tissue repair by stimulating the production of insul in-like growth factor-1 (IGF-1) by the liver to increase circulating I GF-1 concentrations. The mechanism by which it improves wound healing, however, remains in question. The authors hypothesize that rhGH up-re gulates IGF-1 receptors and IGF-1 revels both systemically and locally in the wound site to stimulate cell mitosis and increase synthesis of laminin, collagen types IV and VII, and cytokeratin. This hypothesis was tested in nine patients with burns covering > 40% of total body su rface area. Objective The authors assessed the efficacy of rhGH in pro moting several major building materials in the donor site of patients with massive burns. Methods Ten massively burned patients with full-th ickness burns covering more than 40% of total body surface area were p articipants in a placebo-controlled prospective study to determine the efficacy of 0.2 mg/kg/day rhGH on donor site wound healing and to ide ntify some of the major components involved in wound healing and its i ntegrity. Results Donor sites in burn patients receiving rhGH showed a n increased coverage by the basal lamina of 26% for placebo to 68% cov erage of the dermal-epidermal junction. Insulin-like growth factor-1 r eceptors and laminin, types IV and VII collagen, and cytokeratin-14 al l increased significantly. Healing times of the donor sites were signi ficantly decreased compared with patients receiving placebo. Conclusio n Results indicate that growth hormone or its secondary mediators may directly stimulate the cells of the epidermis and dermis during wound healing to produce the structural proteins and other components needed to rebuild the junctional structures.