Epithelial separation theory for post-tonsillectomy secondary hemorrhage: evidence in a mouse model and potential heparin-binding epidermal growth factor-like growth factor therapy

Abstract

NA-animal studies or basic research.

Locally administered heparin-binding epidermal growth factor-like growth factor reduces radiation-induced oral mucositis in mice

“…HB-EGF was chosen as a potential therapy for this indication given its ability to promote the wound healing process in multiple stages of wound healing, including granulation, reepithelialization, tissue deposition, wound contracture, neovascularization, and remodeling [26][27][28][29] . We were also encouraged by the ability of HB-EGF to act on the oral mucosa and the demonstrated potential for translation 11,30 . We have previously shown that HB-EGF, not EGF has significantly greater ability to act on keratinocytes in vivo 9 .…”

“…The newly formed epithelium treated with HB-EGF is also less likely to show delayed epithelial separation and sloughing. HB-EGF given locally following radiation improves epithelial coverage, and the keratinocyte connections are of greater quantity and quality to prevent future separation and breakdown 11 . In our study we did not detect a difference in EGFR expression pattern between HB-EGF treated and non-treated tissue.…”

“…Given results to date with a variety of approaches to prevent and treat radiation-induced mucositis, the optimal strategy appears to be stimulation of mucosal basal cell regeneration using a local delivery method. We therefore studied the effect of a potent stimulator of keratinocyte proliferation and migration, Heparin Binding Epidermal Growth Factor Like Growth Factor (HB-EGF), since we had previously shown that HB-EGF had efficacy in oral wound healing, with demonstrated stability in saliva, and expected negligible systemic exposure when applied locally [9][10][11] . Our primary objective was to test the hypothesis that HB-EGF would have a significant beneficial effect for the prevention of radiation-induced oral mucositis in a clinically relevant animal model.…”

Does Surgical Technique Significantly Change the Rate of Post-Tonsillectomy Hemorrhage?

“…The literature has shown secondary hemorrhage to be more common than primary hemorrhage (16). A recently published paper indicates an increased risk of epithelial separation between postoperative day six and nine (16,17). Neovascularization typically begins on postoperative day seven.…”

“…Neovascularization typically begins on postoperative day seven. Both factors, increased risk of epithelial separation and neovascularization, were reported as the main pathophysiologic mechanisms of secondary hemorrhage (17). Less traumatic surgical technique reduces postoperative edema, inflammation, and granulation tissue within the wound, which is associated with improved epithelization and lower risk of separation.…”