gms | German Medical Science

27. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Verbrennungsbehandlung (DAV 2009)

14.01. bis 17.01.2009, Leogang, Österreich

A qualitative and quantitative analysis of protein substitution in human burn wounds

Meeting Abstract

  • M. Lehnhardt - Department of Plastic Surgery, Burn Center, Handsurgery, Sarcoma Reference Center, Bergmannsheil, Bochum
  • H. Joneidi-Jafari - Department of Plastic Surgery, Burn Center, Handsurgery, Sarcoma Reference Center, Bergmannsheil, Bochum
  • A. Daigeler - Department of Plastic Surgery, Burn Center, Handsurgery, Sarcoma Reference Center, Bergmannsheil, Bochum
  • D. Tilkom - Department of Plastic Surgery, Burn Center, Handsurgery, Sarcoma Reference Center, Bergmannsheil, Bochum
  • J. Hauser - Department of Plastic Surgery, Burn Center, Handsurgery, Sarcoma Reference Center, Bergmannsheil, Bochum
  • O. Goertz - Department of Plastic Surgery, Burn Center, Handsurgery, Sarcoma Reference Center, Bergmannsheil, Bochum
  • W. Klatte - Department of Plastic Surgery, Burn Center, Handsurgery, Sarcoma Reference Center, Bergmannsheil, Bochum
  • U. Fischer - Department of Plastic Surgery, Burn Center, Handsurgery, Sarcoma Reference Center, Bergmannsheil, Bochum
  • H. U. Steinau - Department of Plastic Surgery, Burn Center, Handsurgery, Sarcoma Reference Center, Bergmannsheil, Bochum

DAV 2009. 27. Jahrestagung der deutschsprachigen Arbeitsgemeinschaft für Verbrennungsbehandlung. Leogang, Österreich, 14.-17.01.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09dav38

DOI: 10.3205/09dav38, URN: urn:nbn:de:0183-09dav381

Published: March 19, 2009

© 2009 Lehnhardt et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Introduction: In patients suffering from major burn wounds of more than 15% TBSA mediator associated reactions lead to capillary leak (CL), protein loss and SIRS resulting in edema, microcirculation disorders, ischemia and elevated risk of infections. Therapeutic considerations led to substitution of protein solutions to compensate the disadvantages of protein deficiency.

However, little is known about the efficiency of protein substitution and the secretion profiles of protein fractions in human burn wounds. Therefore we quantified and qualified the systemic and local protein loss in burn patients during protein substitution, comparing fresh frozen plasma (FFP) and the human serum protein solution Biseko.

Material and Methods: In 40 Patients suffering from second-degree burns wounds with a TBSA between 20 and 60%, immediately after admission a wound surface area of 15x15mm was enclosed with a cutaneous vinyl wound chamber. Wound fluid (WF) and serum samples were collected in 8h intervals for 2 days and in 24h intervals for further 4 days post-trauma. Samples were centrifuged, shock frozen and stored at -82°C until total protein, albumin, the immunoglobulins -A, -G, -M, PT, PTT, AT III and Fibrinogen, CRP, and Leucocytes were measured. Protein substitution started 24h post-trauma. In a randomized pattern patients received same volumes of FFP or Biseko.

Results: During the first 24h post-trauma protein levels in serum were significantly lower than physiological levels while WF protein levels were elevated and remained high. Total protein (TP) and albumin (AL) accumulated in high concentrations on the wound surface (average accumulation on 10% burnt TBSA within 8h). With beginning of FFP-substitution on day 2 post trauma, serum protein concentrations increased from 1,7g to 3,9g and albumin concentration from 1,3g to 3,4g. Wound fluid concentrations of protein and albumin revealed a similar change pattern.. Substitution of Biseko resulted in an increase of serum protein concentration from 1,8g to 4,5g and albumin from 0,9g to 3,4g (Wound fluid: total protein 24h: 0.65g; 48h: 1.1g; albumin 24h:0.55g; 48h:0.95). Coagulation parameters showed more physiological serum-values compared to FFP-substitution. Igs showed higher serum-levels in the Biseko-group, whereas in the wound fluid there no significant difference was detected. CRP and WBC values indicated a significantly lower systemic inflammation in the Biseko-group.

Conclusions: Application of Biseko-protein compilation not only leads to a significant increase of protein and albumin concentrations but also to a significantly more physiological level of coagulation parameters and lowered infection parameters in peripheral blood.

This might help reducing the negative cascades mentioned above. Furthermore higher serum IGs could help to decrease potential immunodeficiency.