Citation

Evans KN, Forsberg JA, Potter BK, Hawksworth JS, Brown TS, Andersen R, Dunne JR, Tadaki D, Elster EA. J. Orthop. Trauma 2012; 26(11): e204-13.

Affiliation

1Integrated Department of Orthopaedics and Rehabilitation, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889 2Regenerative Medicine Department, Combat Casualty Care, Naval Medical Research Center, 503 Robert Grant Avenue Silver Spring, Maryland 20910 3Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 4Integrated Department of Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889.

Copyright

(Copyright © 2012, Lippincott Williams and Wilkins)

DOI

10.1097/BOT.0b013e31825d60a5

PMID

22588530

Abstract

OBJECTIVE:: Heterotopic ossification (HO) develops frequently following modern high-energy penetrating war injuries. The purpose of this prospective study was to identify and characterize the unique cytokine and chemokine profile associated with the development of HO as it pertained to the systemic inflammatory response after penetrating combat-related trauma. METHODS:: Patients with high-energy penetrating extremity wounds were prospectively enrolled. Surgical débridement along with the use of a pulse lavage and vacuum-assisted-closure device was performed every 48-72 hours until definitive wound closure. Wound bed tissue biopsy, wound effluent, and serum were collected prior to each débridement. Effluent and serum were analyzed for twenty-two relevant cytokines and chemokines. Tissue was analyzed quantitatively for bacterial colonization. Correlations between specific wound and patient characteristics were also analyzed. The primary clinical outcome measure was the formation of HO as confirmed by radiographs at a minimum of two-months follow-up. RESULTS:: Thirty-six penetrating extremity war wounds in twenty-four patients were investigated. The observed rate of HO in the study population was 38%. Of the thirty-six wounds, thirteen (36%) demonstrated HO at a minimum follow-up of two months. An elevated ISS was associated with the development of HO (p=0.006). Wound characteristics that correlated with the development of HO included impaired healing (p=0.005) and bacterial colonization (p<0.001). Both serum (IL-6, IL10, and MCP-1) and wound effluent (IP-10 and MIP-1α) cytokine and chemokine bioprofiles were individually associated and suggestive of the development of HO (p<0.05). CONCLUSIONS:: A severe systemic and wound-specific inflammatory state as evident by elevated levels of inflammatory cytokines, elevated ISS, and bacterial wound colonization is associated with the development of HO. These findings suggest that the development of HO in traumatic combat-related wounds is associated with a hyper-inflammatory systemic response to injury.

Language: en