The impact of negative pressure wound therapy on epidermal stem cells and keratinocyte growth factor in deep dermal burn injury: An experimental study.

Abstract

Burns are the fourth most common accidental injury worldwide, predominantly occurring in developing countries. Wound healing in burns involves reduced cytokine secretion but increased chemokine and growth factor production compared to surgical wounds. Keratinocyte growth factor (KGF) regulates epidermal regeneration, an essential process in wound healing; while epidermal stem cells (ESCs) play a crucial role in wound closure and have potential for cell therapy. Negative pressure wound therapy (NPWT) promotes healing by improving blood flow, enhancing re-epithelialization, and reducing infection risk. This study investigates the effects of NaCl 0.9 %, intermittent and continuous NPWT, and silver sulfadiazine on ESC and KGF levels in deep dermal burns. Six male Yorkshire pigs received 20 deep dermal burns on the flank and dorsum, divided into four treatment groups: NaCl 0.9 %, continuous NPWT, intermittent NPWT, and silver sulfadiazine. Samples were collected on days 1, 3, 7, 14, and 21. ESCs were evaluated using CK19 immunohistochemistry as a marker. KGF levels were measured via ELISA. Data were analyzed with ANOVA, with significance set at p < 0.05. Continuous NPWT showed the highest ESC counts at the wound edge on all observation days and at the wound center on days 3 and 21, though without statistical significance. KGF levels differed significantly among the groups on days 1, 3, and 7 (p < 0.05), with the continuous NPWT group consistently showing the highest KGF levels. Statistical analysis revealed that treatment, observation day, and KGF levels significantly influenced ESC counts, accounting for 45 % of the variability (p < 0.05). The continuous NPWT group demonstrated significantly elevated KGF levels on days 1, 3, and 7, which corresponded to a significant increase in ESC. Further research is warranted to confirm these findings.