Correlation of Procalcitonin and Cytokine Expression with Dehiscence of Wartime Extremity Wounds

Forsberg, Jonathan A.; Elster, Eric A.; Andersen, Romney C.; Nylen, Eric; Brown, Trevor S.; Rose, Matthew; Stojadinovic, Alexander; Becker, Kenneth L.; McGuigan, Francis X.

doi:10.2106/jbjs.g.00265

Cited by 64 publications

(41 citation statements)

References 50 publications

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“…Although we observed an association between wound failure and elevated serum ProCT and effluent IL-6 at the final débridement, the results should be interpreted with caution. Nevertheless, these results are similar to those of a previous study in which we observed that ProCT, measured in the serum and the effluent, and IL-13 were associated with wound failure in combat injuries [8]. These data suggest wound failure is associated with a persistent inflammatory state.…”

Section: Discussionsupporting

confidence: 91%

“…The massive physiologic insult caused by blast wounds produces a severe and poorly regulated systemic inflammatory response [8,11]. By measuring mediators of systemic and local inflammation, preliminary data suggest it may be possible to risk-stratify patients for HO and wound failure during the débridement process [6,8,11,25].…”

Section: Introductionmentioning

confidence: 99%

“…By measuring mediators of systemic and local inflammation, preliminary data suggest it may be possible to risk-stratify patients for HO and wound failure during the débridement process [6,8,11,25]. This would allow surgeons to base decisions regarding whether to give HO prophylaxis and the timing of wound closure on objective rather than subjective data if the relationships between these mediators and outcomes of interest could be modeled.…”

Section: Introductionmentioning

confidence: 99%

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Do Inflammatory Markers Portend Heterotopic Ossification and Wound Failure in Combat Wounds?

Forsberg

Potter

Polfer

et al. 2014

Clinical Orthopaedics &Amp; Related Research

Self Cite

107

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Background After a decade of war in Iraq and Afghanistan, we have observed an increase in combat-related injury survival and a paradoxical increase in injury severity, mainly because of the effects of blasts. These severe injuries have a devastating effect on each patient's immune system resulting in massive upregulation of the systemic inflammatory response. By examining inflammatory mediators, preliminary data suggest that it may be possible to correlate complications such as wound failure and heterotopic ossification (HO) with distinct systemic and local inflammatory profiles, but this is a relatively new topic. Questions/purposes We asked whether systemic or local markers of inflammation could be used as an objective means, independent of demographic and subjective factors, to estimate the likelihood of (1) HO and/or (2) wound failure (defined as wounds requiring surgical débridement after definitive closure, or wounds that were not closed or covered within 21 days of injury) in patients sustaining combat wounds. Methods Two hundred combat wounded active-duty service members who sustained high-energy extremity The institution of one or more of the authors (JAF) has received, during the study period, funding from a grant from the Orthopaedic Trauma Research Program (OTRP) and the US Navy Bureau of Medicine and Surgery Advance Medical Development Program. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at the Naval Medical Research Center, Silver Spring, MD, USA, and the National Military Medical Center, Bethesda, MD, USA. The views expressed this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government. This study protocol was approved by the Institutional Review Boards at both the National Military Medical Center and Naval Medical Research Center in compliance with all applicable Federal regulations governing the protection of human subjects. One or more of the authors is a military service member (or employee of the U.S. Government). This work was prepared as part of his or her official duties. Title 17 U.S.C §105 provides that 'Copyright protection under this title is not available for any work of the United States Government.' Title 17 U.S.C §101 defines a U.S. Government work as a work prepared by a military service ...

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Do Inflammatory Markers Portend Heterotopic Ossification and Wound Failure in Combat Wounds?

Forsberg

Potter

Polfer

et al. 2014

Clinical Orthopaedics &Amp; Related Research

Self Cite

107

View full text Add to dashboard Cite

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“…A treating clinician's decision to surgically close a wound is commonly based on subjective and somewhat arbitrary measures, such as the patient's general condition, the appearance of bones and soft tissues, and visual signs of infection or necrosis (65), which are poor indicators of the local inflammatory condition (66). This often has led to wound dehiscence and nonhealing wounds.…”

Section: Discussionmentioning

confidence: 99%

Computational Approach To Characterize Causative Factors and Molecular Indicators of Chronic Wound Inflammation

Nagaraja

Wallqvist

Reifman

et al. 2014

The Journal of Immunology

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Chronic inflammation is rapidly becoming recognized as a key contributor to numerous pathologies. Despite detailed investigations, understanding of the molecular mechanisms regulating inflammation is incomplete. Knowledge of such critical regulatory processes and informative indicators of chronic inflammation is necessary for efficacious therapeutic interventions and diagnostic support to clinicians. We used a computational modeling approach to elucidate the critical factors responsible for chronic inflammation and to identify robust molecular indicators of chronic inflammatory conditions. Our kinetic model successfully captured experimentally observed cell and cytokine dynamics for both acute and chronic inflammatory responses. Using sensitivity analysis, we identified macrophage influx and efflux rate modulation as the strongest inducing factor of chronic inflammation for a wide range of scenarios. Moreover, our model predicted that, among all major inflammatory mediators, IL-6, TGF-β, and PDGF may generally be considered the most sensitive and robust indicators of chronic inflammation, which is supported by existing, but limited, experimental evidence.

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“…Determining the optimal timing for closure of these residual limbs is therefore difficult [3,5]. Given the large zones of injury and random pattern flaps often used for closure, potential spaces are created.…”

Section: Introductionmentioning

confidence: 99%

Fluid Collections in Amputations Are Not Indicative or Predictive of Infection

Polfer

Hoyt

Senchak

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background In the acute postoperative period, fluid collections are common in lower extremity amputations. Whether these fluid collections increase the risk of infection is unknown. Questions/purposes The purposes of this study were to determine (1) the percentage of patients who develop postoperative fluid collections in posttraumatic amputations and the natural course of the collection; (2) whether patients who develop these collections are at increased risk for infection; and to ask (3) are there objective clinical or radiologic signs that are associated with likelihood of infection when a fluid collection is present?Methods We performed a review of all 300 patients injured in combat operations who sustained at least one major lower extremity amputation (at or proximal to the tibiotalar joint) and were treated definitively at our institution between March 2005 and April 2009. We segregated the groups based on whether cross-sectional imaging was performed less than 3 months (early group) after closure, greater than 3 months (late group) after closure, or not at all (control group, baseline frequency of infection). Our primary study cohort where those patients with a fluid collection in the first three months. The clinical course was reviewed and the primary outcome was a return to the operating room for irrigation and débridement with positive cultures. For those patients with cross-sectional imaging, we also collected objective clinical parameters within 24 hours of the scan (white blood cell count, maximum temperature, presence of bacteremia, tachycardia, oxygen desaturation), extremity examination (presence of erythema, warmth, and/or drainage), and characteristics of the fluid collections seen (size of the fluid collection, Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Correlation of Procalcitonin and Cytokine Expression with Dehiscence of Wartime Extremity Wounds

Cited by 64 publications

References 50 publications

Do Inflammatory Markers Portend Heterotopic Ossification and Wound Failure in Combat Wounds?

Do Inflammatory Markers Portend Heterotopic Ossification and Wound Failure in Combat Wounds?

Computational Approach To Characterize Causative Factors and Molecular Indicators of Chronic Wound Inflammation

Fluid Collections in Amputations Are Not Indicative or Predictive of Infection

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