Da. Gilpin et al., RECOMBINANT HUMAN GROWTH-HORMONE ACCELERATES WOUND-HEALING IN CHILDREN WITH LARGE CUTANEOUS BURNS, Annals of surgery, 220(1), 1994, pp. 19-24
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%.