Correlation of Procalcitonin and Cytokine Expression with Dehiscence of Wartime Extremity Wounds

Forsberg, Jonathan Agner; Elster, Eric A.; Andersen, Romney C.; Nylen, Eric; Brown, Trevor S.; Rose, Matthew W.; Stojadinovic, Alexander; Becker, Kenneth L.; McGuigan, Francis Xavier
March 2008
Journal of Bone & Joint Surgery, American Volume;Mar2008, Vol. 90-A Issue 3, p580
Academic Journal
Background: Despite technological advances in the treatment of severe extremity trauma, the timing of wound closure remains the subjective clinical decision of the treating surgeon. Traditional serum markers are poor predictors of wound-healing. The objective of this study was to evaluate the cytokine and chemokine profiles of severe extremity wounds prior to closure to determine if wound effluent markers can be used to predict healing. Methods: Serum and effluent (exudate) samples were collected prospectively from adult volunteers with multiple high-energy penetrating extremity wounds sustained during military combat. Samples were collected prior to definitive wound closure or flap coverage. Wounds were followed clinically for six weeks. The primary clinical outcome measures were wound-healing and dehiscence. Control serum samples were collected from normal age and sex-matched adult volunteers. All samples were analyzed for the following cytokines and chemokines: procalcitonin; eotaxin; granulocyte macrophage colony stimulating factor; interferon (IFN)-γ interleukin (IL)-1 through 8, 10, 12, 13, and 15; IFN-γ inducible protein-10; monocyte chemotactic protein-1; macrophage inflammatory protein-1α; the protein regulated on activation, normal T expressed and secreted (RANTES); and tumor necrosis factor (TNF)-α. Results: Fifty wounds were analyzed in twenty patients. Four of the fifty wounds dehisced. An increased rate of wound dehiscence was observed in patients with a concomitant closed head injury as well as in those with an associated arterial injury of the affected limb (p < 0.05). Among the serum chemokines and cytokines, only serum procalcitonin levels correlated with wound dehiscence (p < 0.05). Effluent analysis showed that, compared with wounds that healed, wounds that dehisced were associated with elevated procalcitonin, decreased RANTES protein, and decreased IL-13 concentrations (p < 0.05).


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