Hyaluronic acid in incision wound fluid: A clinical study with the Cellstick® device in children

Abstract

When inserted into a human incision wound, the Cellstick device harvests inflammatory cells and collects wound fluid, reflecting time-related changes in cell populations and in wound fluid composition. Hyaluronic acid has been postulated to be an important factor in scar reduction in wound healing and in scarless fetal wound healing. The aim of this work was to determine the concentration and variation of hyaluronic acid and proportions of wound cells in closed surgical wounds in children at two time points. The Cellstick device was inserted subcutaneously into the wound at the end of an elective inguinal hernia operation on 37 healthy boys, and the devices were removed 3+/-1 or 24+/-3 hours after surgery. Haluronic acid concentration was measured from the wound fluid and a differential count of the wound cells was performed. There was a significant decrease in hyaluronic acid concentration from 3+/-1 to 24+/-3 hours after surgery (p<0.001, Kruskal-Wallis anova). The variance of hyaluronic acid concentration in wound fluid differed between the wounds at the two time points (p<0.01, Levene test for homogeneity of variance). A positive correlation between hyaluronic acid concentration and patient age (r=0.91, p<0.05, Spearman) at 3+/-1 hours post surgery and between HA and wound lymphocytes (r=0.38, p<0.05, Spearman) was also found. We conclude that the hyaluronic acid concentration in wound fluid peaks early in children and decreases significantly by 3 to 24 hours after surgery, and the concentrations in the wound fluid of healthy boys are more variable 3 hours than at 24 hours after surgery.

Extracellular matrix metabolites as potential biomarkers of disease activity in wound fluid: lessons learned from other inflammatory diseases?

“…Although subtle variations on this method have been reported, this technique generally involves (i) ensuring that wounds are free of clinical signs of infection, (ii) irrigating the wound bed with saline solution, (iii) the application of the occlusive dressing for the required duration, (iv) withdrawal of fluid from beneath the dressing with a syringe and needle, avoiding injury to underlying granulation tissue, and (v) the subsequent application of a new dressing. Other techniques which have also proved useful include the collection of wound fluid directly from the wound bed with blunt‐end glass microcapillaries, 46 the absorption of fluid from the wound bed directly onto dressings (such as Allevyn ™ ; Smith & Nephew) 14 and the use of a Cellstick ® (Cellomeda Oy, Turku, Finland) device, consisting of a silicone rubber tube with a viscose cellulose sponge at the end, inserted subcutaneously between the wound edges 47,48 . The two latter techniques are subsequently followed by wound fluid elution.…”

Occlusive dressing-induced secretomes influence the migration and proliferation of mesenchymal stem cells and fibroblasts differently

“…Fibroplasia and the creation of granulation tissue are mainly dependent on fibroblasts, which are the dominant cell type by day 4 of wound healing and peak at 7–14 days after injury [29, 30]. Platelet-derived growth factor (PDGF), basic fibroblast growth factor (bFGF), and transforming growth factor-β (TGF-β) modulate the initial migration and proliferation of fibroblasts, which then reorganize and replace the provisional matrix through synthesis and the release of collagen [31, 32]. Finally, in remodeling which takes up to 2 years, the provisional matrix is restructured by matrix metalloproteinases to increase tensile strength, resulting in a scar [3].…”

Quantification and Stratification: Wound Research in the Future

“…Although it is often thought that acute wounds and chronic wounds are unrelated entities, the above methods have been used to document in humans the effects of uremia, steroids, 7 hypoxia, low blood volume, warmth, smoking, age and growth hormone, arginine administration, nutrition, magnitude of injury or operation, and others. [8][9][10][11][12][13][14] All these data affect management of chronic wounds. Substances measured include collagen and its types, cell infiltration, DNA, total protein deposition, proteoglycans, and angiogenesis.…”