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American Association for Hand Surgery

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Decreasing Burn Wound Conversion with Tacrolimus Microcapillary Hydrogel Dressing
Colin G White-Dzuro, BA1, Christopher Kalmar, MD2, Wesley P. Thayer, MD, PhD3, Alonda Pollins, MLI1, Leon M Bellan, PhD1 and John A Rector, BS1, (1)Vanderbilt University, Nashville, TN, (2)Vanderbilt University Medical Center, Nashville, TN, (3)Department of Plastic Surgery, Vanderbilt University, Nashville, TN

Background
Burns occur most commonly on the hands in both adult and pediatric populations. Delays in treatment of burn injuries can lead to significant morbidity, loss of function, and poor aesthetic appearance. Preventing post-injury conversion from partial- to full-thickness burns may help mitigate these sequelae. The pathophysiology of burn wound conversion remains unknown, but an overactive immune response is thought to be implicated. The purpose of this study was to determine whether downregulating immune response via tacrolimus can decrease burn wound conversion.
Materials and Methods
Thirty young (8 weeks) and thirty old (66 weeks) mice received partial thickness burns, and then six mice were placed into each of the experimental and treatment groups. Mice of the experimental groups were then treated with either (1) topical tacrolimus ointment + microcapillary hydrogels or (2) intraperitoneal injection of tacrolimus solution. The control groups received (1) intraperitoneal injection of saline, (2) hydrogel only, or (3) no treatment. On post-burn day 3, mice were euthanized, and tissue samples were obtained for immunohistochemical assessment.
Results
Age had a detrimental effect on burn wound conversion, such that older mice without treatment (449mm ± 38) had significantly deeper wounds than younger mice without treatment (152mm ± 18, p<.001). The application of microcapillary hydrogel significantly reduced burn depth in both young (82mm ± 7, p=0.003) and old populations (302mm ± 15, p=0.007) as compared to no treatment.
The addition of tacrolimus ointment followed by microcapillary hydrogel application significantly improved burn depth in the old population (90mm ± 24, p<0.001) compared to hydrogel alone, but did not significantly improve burns within the young population (65mm ± 6). However, tacrolimus and hydrogel application was able to mitigate the detrimental effects of older age on wound conversion, such that burn wounds of older mice treated with tacrolimus hydrogel dressing had similar burn depths as younger mice (p=0.242).
Conclusion
Utilizing a combination treatment of tacrolimus and microcapillary hydrogel is able to rescue the negative effects of aging and prevent partial- to full-thickness burn wound conversion. Hopefully these findings will encourage deeper investigation into the possible therapeutic advantages of utilizing immunosuppressive agents to decrease morbidity after burn injuries. Future research will need to specifically investigate IL-2 as an inhibitory target in the acute inflammatory cascade of burn injury.


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