Adjunctive Treatments

There is great interest in a pharmacological role for growth hormone (GH) and/or IGF-1 in reversal of the catabolic state and stimulation of anabolic processes. GH stimulates production of IGF-1, which improves amino acid transport and enhances glu-coneogenesis from exogenously supplied amino acids. Blood levels of IGF-1 are markedly reduced in burn patients following injury and remain so for the first week, after which levels increase; these changes correlate with IGF binding protein-3 levels. This binding protein prevents plasma proteolysis of IGF-1. GH and IGF-1 have both been used in experimental models of burn injury, and their effectiveness at limiting catabolism and enhancing mucosal proliferation is encouraging. In children GH treatment accelerates donor site healing and increases protein synthesis. GH has also been shown to exert immunomodulatory effects, which may contribute to a reduced incidence of infection. Other growth factors have also been used experimentally and in animal models improve the rate of healing and strength of burn wounds (Table 5). However, the role for such hormonal therapies has yet to be firmly established in clinical management plans.

Table 5 Growth factors identified as potential adjunctive therapy in wound healing

Growth hormone Insulin-like growth factor-1 Epidermal growth factor Transforming growth factors (a and ß) Platelet-derived growth factor Fibroblast growth factors (1-7) Erythropoeitin

Granulocyte macrophage colony-stimulating factor

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