Recombinant human growth hormone accelerates wound healing in children with large cutaneous burns

D. A. Gilpin, R. E. Barrow, R. L. Rutan, L. Broemeling, David Herndon

Research output: Contribution to journalArticle

158 Citations (Scopus)

Abstract

Objective: Two forms of recombinant growth hormone that accelerate the healing of skin graft donor sites in severely burned children were evaluated. Summary Background Data: Growth hormone has been shown to reduce wound healing times in burned pediatric patients. Through genetic engineering, several different forms have been synthesized; however, not all are marketed currently. Two forms of growth hormone were used in these studies, Protropin (Genentech, Inc., San Francisco, CA), a commercially available product that possesses a N-terminal methionine residue not found in the second form Nutropin (Genentech, Inc., San Francisco, CA), which, as yet, is not commercially available. Through the use of recombinant human growth hormone, rapid wound healing may reduce the hypermetabolic period, the risk of infection, and accelerate the healing of donor sites used for grafting onto burned areas. The two structurally different forms of growth hormone were tested for their efficacy in healing donor sites in severely burned children. Methods: Forty-six children, with a >40% total body surface area and >20% total body surface area full-thickness burn were entered in a double-blind, randomized study to receive rhGH within 8 days of injury. Twenty received (0.2 mg/kg/day) Nutropin or placebo by subcutaneous or intramuscular injection beginning on the morning of the initial excision. Eighteen patients who failed the entry criteria for receiving Nutropin received Protropin therapeutically (0.2 mg/kg/day). Donor sites were harvested at 0.006 to 0.010 inches in depth and dressed with Scarlet Red impregnated line mesh gauze (Sherwood Medical, St. Louis, MO). The initial donor site healing time, in days, was reached when the gauze could be removed without any trauma to the healed site. Results: Donor sites in patients receiving Nutropin (n = 20) or Protropin (n = 18) healed at 6.8 ± 1.5 and 6.0 ± 1.5 (mean ± SD) days, respectively, whereas those receiving placebo (n = 26) had a first donor site healing time of 8.5 ± 2.3 days. Both groups receiving rhGH showed a significant reduction in donor site healing time compared with placebo at p < 0.01. When subgroups were compared, no difference in healing times could be shown with regards to age or time of admission after injury. Conclusion: Our results indicate that both forms of rhGH are effective in reducing donor site healing time compared with placebo and suggest that accelerating wound healing is of clinical benefit because the patients' own skin becomes rapidly available for harvest and autografting. With this increase in the rate of wound healing, the total length of hospital stay can be reduced by more than 25%.

Original languageEnglish (US)
Pages (from-to)19-24
Number of pages6
JournalAnnals of Surgery
Volume220
Issue number1
StatePublished - Jul 1994

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Human Growth Hormone
Burns
Wound Healing
Growth Hormone
Tissue Donors
Skin
Placebos
San Francisco
Body Surface Area
Length of Stay
Wounds and Injuries
Genetic Engineering
Autologous Transplantation
Intramuscular Injections
Subcutaneous Injections
Double-Blind Method
Methionine
Pediatrics
Transplants

ASJC Scopus subject areas

  • Surgery

Cite this

Gilpin, D. A., Barrow, R. E., Rutan, R. L., Broemeling, L., & Herndon, D. (1994). Recombinant human growth hormone accelerates wound healing in children with large cutaneous burns. Annals of Surgery, 220(1), 19-24.

Recombinant human growth hormone accelerates wound healing in children with large cutaneous burns. / Gilpin, D. A.; Barrow, R. E.; Rutan, R. L.; Broemeling, L.; Herndon, David.

In: Annals of Surgery, Vol. 220, No. 1, 07.1994, p. 19-24.

Research output: Contribution to journalArticle

Gilpin, DA, Barrow, RE, Rutan, RL, Broemeling, L & Herndon, D 1994, 'Recombinant human growth hormone accelerates wound healing in children with large cutaneous burns', Annals of Surgery, vol. 220, no. 1, pp. 19-24.
Gilpin DA, Barrow RE, Rutan RL, Broemeling L, Herndon D. Recombinant human growth hormone accelerates wound healing in children with large cutaneous burns. Annals of Surgery. 1994 Jul;220(1):19-24.
Gilpin, D. A. ; Barrow, R. E. ; Rutan, R. L. ; Broemeling, L. ; Herndon, David. / Recombinant human growth hormone accelerates wound healing in children with large cutaneous burns. In: Annals of Surgery. 1994 ; Vol. 220, No. 1. pp. 19-24.
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title = "Recombinant human growth hormone accelerates wound healing in children with large cutaneous burns",
abstract = "Objective: Two forms of recombinant growth hormone that accelerate the healing of skin graft donor sites in severely burned children were evaluated. Summary Background Data: Growth hormone has been shown to reduce wound healing times in burned pediatric patients. Through genetic engineering, several different forms have been synthesized; however, not all are marketed currently. Two forms of growth hormone were used in these studies, Protropin (Genentech, Inc., San Francisco, CA), a commercially available product that possesses a N-terminal methionine residue not found in the second form Nutropin (Genentech, Inc., San Francisco, CA), which, as yet, is not commercially available. Through the use of recombinant human growth hormone, rapid wound healing may reduce the hypermetabolic period, the risk of infection, and accelerate the healing of donor sites used for grafting onto burned areas. The two structurally different forms of growth hormone were tested for their efficacy in healing donor sites in severely burned children. Methods: Forty-six children, with a >40{\%} total body surface area and >20{\%} total body surface area full-thickness burn were entered in a double-blind, randomized study to receive rhGH within 8 days of injury. Twenty received (0.2 mg/kg/day) Nutropin or placebo by subcutaneous or intramuscular injection beginning on the morning of the initial excision. Eighteen patients who failed the entry criteria for receiving Nutropin received Protropin therapeutically (0.2 mg/kg/day). Donor sites were harvested at 0.006 to 0.010 inches in depth and dressed with Scarlet Red impregnated line mesh gauze (Sherwood Medical, St. Louis, MO). The initial donor site healing time, in days, was reached when the gauze could be removed without any trauma to the healed site. Results: Donor sites in patients receiving Nutropin (n = 20) or Protropin (n = 18) healed at 6.8 ± 1.5 and 6.0 ± 1.5 (mean ± SD) days, respectively, whereas those receiving placebo (n = 26) had a first donor site healing time of 8.5 ± 2.3 days. Both groups receiving rhGH showed a significant reduction in donor site healing time compared with placebo at p < 0.01. When subgroups were compared, no difference in healing times could be shown with regards to age or time of admission after injury. Conclusion: Our results indicate that both forms of rhGH are effective in reducing donor site healing time compared with placebo and suggest that accelerating wound healing is of clinical benefit because the patients' own skin becomes rapidly available for harvest and autografting. With this increase in the rate of wound healing, the total length of hospital stay can be reduced by more than 25{\%}.",
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AU - Herndon, David

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N2 - Objective: Two forms of recombinant growth hormone that accelerate the healing of skin graft donor sites in severely burned children were evaluated. Summary Background Data: Growth hormone has been shown to reduce wound healing times in burned pediatric patients. Through genetic engineering, several different forms have been synthesized; however, not all are marketed currently. Two forms of growth hormone were used in these studies, Protropin (Genentech, Inc., San Francisco, CA), a commercially available product that possesses a N-terminal methionine residue not found in the second form Nutropin (Genentech, Inc., San Francisco, CA), which, as yet, is not commercially available. Through the use of recombinant human growth hormone, rapid wound healing may reduce the hypermetabolic period, the risk of infection, and accelerate the healing of donor sites used for grafting onto burned areas. The two structurally different forms of growth hormone were tested for their efficacy in healing donor sites in severely burned children. Methods: Forty-six children, with a >40% total body surface area and >20% total body surface area full-thickness burn were entered in a double-blind, randomized study to receive rhGH within 8 days of injury. Twenty received (0.2 mg/kg/day) Nutropin or placebo by subcutaneous or intramuscular injection beginning on the morning of the initial excision. Eighteen patients who failed the entry criteria for receiving Nutropin received Protropin therapeutically (0.2 mg/kg/day). Donor sites were harvested at 0.006 to 0.010 inches in depth and dressed with Scarlet Red impregnated line mesh gauze (Sherwood Medical, St. Louis, MO). The initial donor site healing time, in days, was reached when the gauze could be removed without any trauma to the healed site. Results: Donor sites in patients receiving Nutropin (n = 20) or Protropin (n = 18) healed at 6.8 ± 1.5 and 6.0 ± 1.5 (mean ± SD) days, respectively, whereas those receiving placebo (n = 26) had a first donor site healing time of 8.5 ± 2.3 days. Both groups receiving rhGH showed a significant reduction in donor site healing time compared with placebo at p < 0.01. When subgroups were compared, no difference in healing times could be shown with regards to age or time of admission after injury. Conclusion: Our results indicate that both forms of rhGH are effective in reducing donor site healing time compared with placebo and suggest that accelerating wound healing is of clinical benefit because the patients' own skin becomes rapidly available for harvest and autografting. With this increase in the rate of wound healing, the total length of hospital stay can be reduced by more than 25%.

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