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. 2009;13(3):R100.
doi: 10.1186/cc7932. Epub 2009 Jun 24.

Epidermal wound healing in severe sepsis and septic shock in humans

Marjo Koskela  1 , Fiia Gäddnäs, Tero I Ala-Kokko, Jouko J Laurila, Juha Saarnio, Aarne Oikarinen, Vesa Koivukangas
Affiliations

Epidermal wound healing in severe sepsis and septic shock in humans

Marjo Koskela et al. Crit Care. 2009.

Abstract

Introduction: The effect of sepsis on epidermal wound healing has not been previously studied. It was hypothesised that epidermal wound healing is disturbed in severe sepsis.

Methods: Blister wounds were induced in 35 patients with severe sepsis and in 15 healthy controls. The healing of the wounds was followed up by measuring transepidermal water loss and blood flow in the wound, reflecting the restoration of the epidermal barrier function and inflammation, respectively. The first set of suction blisters (early wound) was made within 48 hours of the first sepsis-induced organ failure and the second set (late wound) four days after the first wound. In addition, measurements were made on the intact skin.

Results: The average age of the whole study population was 62 years (standard deviation [SD] 12). The mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score on admission was 25 (SD 8). The two most common causes of infections were peritonitis and pneumonia. Sixty-six percent of the patients developed multiple organ failure. The decrease in water evaporation from the wound during the first four days was lower in septic patients than in the control subjects (56 g/m2 per hour versus 124 g/m2 per hour, P = 0.004). On the fourth day, septic patients had significantly higher blood flow in the wound compared with the control subjects (septic patients 110 units versus control subjects 47 units, P = 0.001). No difference in transepidermal water loss from the intact skin was found between septic patients and controls. Septic patients had higher blood flow in the intact skin on the fourth and on the eighth day of study compared with the controls.

Conclusions: The restoration of the epidermal barrier function is delayed and wound blood flow is increased in patients with severe sepsis.

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Figures

Figure 1
Figure 1
The decrease of transepidermal water loss (TEWL) from the first to the fourth day of the early wound. The decrease was lower in the septic group compared with controls (P = 0.004).
Figure 2
Figure 2
Skin blood flow on the fourth day of the early wound. A significant difference was found between the control group and the study group. The lower and upper edges of each box indicate the interval between the 25th and 75th percentiles. The vertical line represents the range and the horizontal line within the box represents the median of each group. BF, blood flow.
Figure 3
Figure 3
Skin blood flow on the first day of the late wound. A significant difference was found between the study group and the control group. The lower and upper edges of each box indicate the interval between the 25th and 75th percentiles. The vertical line represents the range and the horizontal line within the box represents the median of each group. BF, blood flow.
Figure 4
Figure 4
Skin blood flow on the fourth day of the study from the intact skin. The study group had significantly higher blood flow than the control subjects. The lower and upper edges of each box indicate the interval between the 25th and 75th percentiles. The vertical line represents the range and the horizontal line within the box represents the median of each group. BF, blood flow.
See this image and copyright information in PMC

References

    1. Broughton G, 2nd, Janis JE, Attinger CE. Wound healing: an overview. Plast Reconstr Surg. 2006;117:1e-S–32e-S. - PubMed
    1. Ahmed NA, McGill S, Yee J, Hu F, Michel RP, Christou NV. Mechanisms for the diminished neutrophil exudation to secondary inflammatory sites in infected patients with a systemic inflammatory response (sepsis) Crit Care Med. 1999;27:2459–2468. doi: 10.1097/00003246-199911000-00023. - DOI - PubMed
    1. Rico RM, Ripamonti R, Burns AL, Gamelli RL, DiPietro LA. The effect of sepsis on wound healing. J Surg Res. 2002;102:193–197. doi: 10.1006/jsre.2001.6316. - DOI - PubMed
    1. Fink MP, Delude R. Epithelial barrier dysfunction: a unifying theme to explain the pathogenesis of multiple organ dysfunction at the cellular level. Crit Care Clin. 2005;21:177–196. doi: 10.1016/j.ccc.2005.01.005. - DOI - PubMed
    1. Laurila JJ, Karttunen T, Koivukangas V, Laurila PA, Syrjälä H, Saarnio J, Soini Y, Ala-Kokko TI. Tight junction proteins in gallbladder epithelium: different expression in acute acalculous and calculous cholecystitis. J Histochem Cytochem. 2007;55:567–573. doi: 10.1369/jhc.6A7155.2007. - DOI - PubMed