CYTOLOGICAL AND CYTOKINE CRITERIA FOR MONITORING WOUND HEALING DURING CONVENTIONAL SURGICAL TREATMENT OF DEGREE II-IIIB BURNS

Objective: to describe how degree II, IIIA and IIIB (superficial, deep partial-thickness and full-thickness) ther­mal burns heal under conventional local treatment, using imprint cytology, microbial contamination and cytokines in wound washings, and to define criteria of uncomplicated healing. Methods. Forty-five patients (15 per degree; burn area 7-15 % of body surface) received antiseptics and dry wound management under the eschar. On days 1, 3, 5, 7 and 15 (day 20 in degree IIIA-IIIB burns) imprint smears were examined and contamination was graded; IL-1β, TNF-α, IL-10, MMP-9 and TGF-β1 in wound washings were measured by ELISA. Results. The greatest changes occurred on days 3-7. Neutrophil destruction peaked on day 3 in degree II burns (65.7±4.4 units) and on day 5 in degree IIIA and IIIB burns (104.7±7.0 and 109.5±7.1 units). Heavy contamination (+++/++++) disappeared by day 7 in degree II and by day 15 in degree IIIA burns but persisted on day 15 in 53 % of patients with degree IIIB burns. Peak IL-1β on day 5 was 41.33±2.71, 125.51±8.58 and 247.90±16.05 pg/ml, and the IL-10 minimum was 2.81±0.23, 1.66±0.18 and 1.43±0.13 pg/ml, respectively (p<0.05). In degree IIIB burns TGF-β1 was 4.7-9.8 times lower than in degree II, and the IL-1β/IL-10 and MMP-9/TGF-β1 ratios remained high on day 20 (12.8 and 5.9). Conclusions. The deeper the burn, the stronger and longer the inflammation in the wound. We propose criteria of uncomplicated healing that can be used to assess new local treatments.