RECOMBINANT HUMAN GROWTH-HORMONE ACCELERATES WOUND-HEALING IN CHILDREN WITH LARGE CUTANEOUS BURNS

Objective Two forms of recombinant growth hormone that accelerate the healing of skin graft donor sites in severely burned children were eva luated. Summary Background Data Growth hormone has been shown to reduc e wound healing times in burned pediatric patients. Through genetic en gineering, several different forms have been synthesized; however, not all are marketed currently. Two forms of growth hormone were used in these studies, Protropin (Genentech, Inc., San Francisco, CA), a comme rcially available product that possesses a N-terminal methionine resid ue not found in the second form Nutropin (Genentech, Inc., San Francis co, CA), which, as yet, is not commercially available. Through the use of recombinant human growth hormone, rapid wound healing may reduce t he hypermetabolic period, the risk of infection, and accelerate the he aling of done, sites used for grafting onto burned areas. The two stru cturally different forms of growth hormone were tested for their effic acy in healing donor sites in severely burned children. Methods Forty- six children, with a >40% total body surface area and >20% total body surface area full-thickness burn were entered in a double-blind, rando mized study to receive rhGH within 8 days of injury. Twenty received ( 0.2 mg/kg/day) Nutropin or placebo by subcutaneous or intramuscular in jection beginning on the morning of the initial excision. Eighteen pat ients who failed the entry criteria for receiving Nutropin received Pr otropin therapeutically (0.2 mg/kg/day). Donor sites were harvested ai 0.006 to 0.010 inches in depth and dressed with Scarlet Red impregnat ed fine mesh gauze (Sherwood Medical, St, Louis, MO), The initial dono r site healing time, in days, was reached when the gauze could be remo ved without any trauma to the healed site. Results Donor sites in pati ents receiving Nutropin (n = 20) or Protropin (n = 18) healed at 6.8 a 1.5 and 6.0 +/- 1.5 (mean +/- SD) days, respectively, whereas those r eceiving placebo (n = 26) had a first donor site healing time of 8.5 /- 2.3 days. Both groups receiving rhGH showed a significant reduction in donor site healing time compared with placebo at p < 0.01. When su bgroups were compared, no difference in healing times could be shown w ith regards to age or lime of admission after injury. Conclusion Our r esults indicate that both forms of rhGH are effective in reducing dono r site healing time compared with placebo and suggest that acceleratin g wound healing is of clinical benefit because the patients' own skin becomes rapidly available for harvest and autografting. With this incr ease in the rate of wound healing, the total length of hospital stay c an be reduced by more than 25%.