Intraperitoneal adhesions following surgical procedures cause considerable morbidity. Hyaluronic acid/carboxymethylcellulose (HA/CMC) films have been shown to be effective agents in decreasing adhesion formation. However, when there is an inadvertent leak of bowel contents into the peritoneum due to incomplete anastomosis, adhesion formation about a defect in order to prevent further leakage and to promote healing of the wound is important for the prevention of morbidity and mortality. The purpose of this study was to determine if an antiadhesion film (HA/CMC) impairs these potentially beneficial adhesions to bowel anastomoses, thus predisposing them to enteric leaks with subsequent peritonitis. Sixty-four rabbits were divided in two groups, each undergoing a complete or partial (90% anastomosis to simulate anastomotic leak) large bowel anastomosis. Half of each of the above groups were treated by wrapping a HA/CMC film over the anastomosis and the other half were untreated controls. These two subgroups were then further divided equally and sacrificed at either 7 or 14 days for evaluation of anastomosis integrity and strength. The average anastomotic bursting pressures did not change significantly between those groups treated with HA/CMC when compared to untreated controls at 7 or 14 days or in the complete or partial anastomosis group (Student's t test). Adhesion formation to the anastomosis was not impaired in either group independent of HA/CMC film application. This study suggests that while HA/CMC film has been shown to decrease adhesions in other models, healing of a rabbit colonic anastomosis even in the presence of an anastomotic defect takes place, further suggesting that the stimulus for adhesion formation can overcome the antiadhesion properties of HA/CMC.(ABSTRACT TRUNCATED AT 250 WORDS)

Endogenous HB-EGF significantly enhances healing by restitution, prolongs survival, and enhances angiogenesis in mice subjected to intestinal I/R injury. These findings support our hypothesis that HB-EGF administration may improve outcome in patients with intestinal I/R injury, including necrotizing enterocolitis.

We sought to study whether the application of a novel silver impregnated antimicrobial dressing (Aquacel Ag, ConvaTec, Princeton, NJ) affects the hospital length of stay in pediatric patients with partial-thickness burns. A retrospective review of Burn Registry Data from a large children's hospital burn unit was conducted to answer this question. Pediatric patients admitted with partial-thickness burns treated with Aquacel Ag from January 2005 through August 2005 were included in the study (n = 39). The comparison group of patients treated with silver sulfadiazine (SSD; Par Pharmeceuticals, Woodcliff, NJ) cream was matched for age and %TBSA burned from the same time period the previous year (n = 40). Analysis was conducted for intent to treat. Mean length of stay for control patients treated with SSD was significantly longer (8.36 days) compared with Aquacel Ag-treated patients (4.48 days; p = .002, t-test for unequal variances). Length of stay for both groups was significantly associated with %TBSA burned (p < .001, r2 = .38). Post-hoc analysis controlling for %TBSA burned revealed an adjusted mean length of stay for the control group that was longer than that of the Aquacel Ag group (5.9 days vs. 3.8 days, respectively). These data confirm that application of a new burn dressing (Aquacel Ag) reduces hospital length of stay. Reduction in the complexity and number of dressing changes needed with use of Aquacel Ag, in combination with significantly reduced length of stay, should result in a significant cost savings in the care of this patient population.

Hypertrophic scars cause cosmetic disfigurement and limited mobility in burn patients. To better understand the molecular pathophysiology of hypertrophic scar formation, microarray analyses were performed on normal skin and hypertrophic scars from four burn patients. Microarray analyses were determined in an effort to identify genes whose expression discriminated between normal skin and mature, hypertrophic scars. Surgical biopsies were obtained from two pediatric and two adult patients 6 to 15 months after burn injury. Total RNA was isolated from the samples and subjected to microarray analysis using the Affymetrix U95Av2 GeneChip. Results from this analysis revealed 31 probe sets representing genes that were consistently up-regulated at least two-fold in hypertrophic scar specimens from all four patients and four probe sets that were down-regulated. The significance analysis of microarrays algorithm also identified 35 probe sets whose increased expression resulted in the hierarchal clustering of the hypertrophic scar and normal tissue, seven of which were identical to the six genes identified by paired analyses. These six genes all displayed elevated levels of expression in the scar tissue. Proteins encoded by the genes identified included germline oligometric matrix protein, matrix metalloproteinase-16, collagen type 1alpha, pleiotrophin, and thrombospondin-4. Although the results presented here suggest that there may be unique patterns of gene expression in hypertrophic scars that may be important in the evaluation and treatment of hypertrophic scarring, the results must be confirmed with larger datasets.