Elsevier

Burns

Volume 40, Issue 7, November 2014, Pages 1375-1383
Burns

Stromal vascular fraction improves deep partial thickness burn wound healing

https://doi.org/10.1016/j.burns.2014.01.023Get rights and content

Abstract

Objective

The practice of early burn wound excision and wound closure by immediate autologous skin or skin substitutes is the preferred treatment in extensive deep partial and full-thickness burns. To date there is no proven definite medical treatment to decrease burn wound size and accelerate burn wound healing in modern clinical practice. Stromal vascular fraction is an autologous mixture that has multiple proven beneficial effects on different kinds of wounds. In our study, we investigated the effects of stromal vascular fraction on deep partial-thickness burn wound healing.

Methods

In this study, 20 Wistar albino rats were used. Inguinal adipose tissue of the rats was surgically removed and stromal vascular fraction was isolated. Thereafter, deep second-degree burns were performed on the back of the rats by hot water. The rats were divided into two groups in a randomized fashion. The therapy group received stromal vascular fraction, whereas the control group received only physiologic serum by intradermal injection. Assessment of the burn wound healing between the groups was carried out by histopathologic and immuno-histochemical data.

Results

Stromal vascular fraction increased vascular endothelial growth factor, proliferating cell nuclear antigen index, and reduced inflammation of the burn wound. Furthermore, vascularization and fibroblastic activity were achieved earlier and observed to be at higher levels in the stromal vascular fraction group.

Conclusions

Stromal vascular fraction improves burn wound healing by increasing cell proliferation and vascularization, reducing inflammation, and increasing fibroblastic activity.

Introduction

Burn trauma is one of the most devastating injuries that a person can experience. Scalding and flame burns are the most common causes of burns in general population. Early tangential or full-thickness excision of severe deep partial and full-thickness burn wounds with immediate closure by auto skin grafting is the golden standard in burn treatment used for reducing the burn mortality, morbidity, complications and shortening the duration of therapy and hospital stay [1], [2].

Stromal vascular fraction (SVF) provides a rich source of adipose derived stem cells (ADSCs) which differentiate into lineages of adipocytes, osteoblasts, chondrocytes, myocytes and neuron-like cells [3], [4], [5]. Stromal vascular fraction of adipose tissue which acts as a source of ADSCs have anti-apoptotic [6], anti-oxidant [7], anti-inflammatory, immune modulatory via direct immune suppressive/tolerance inducing ability [8], [9]. Since angiogenesis is a critical component of wound healing, ADSCs are angiogenic to hypoxic stimuli by upregulating angiogenic gene expression of vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF), basic fibroblast growth factor (bFGF), platelet-derived growth factor B (PDGFB) [10]. Adipose derived stem cells can also promote wound healing via stimulating collagen synthesis of human dermal fibroblasts (HDF) [11], [12], [13], [14], [15], [16], [17] and may be an alternative to bone marrow derived mesenchymal stem cells.

Currently, there is no efficient and cost-effective treatment that can accelerate burn wound healing, decrease the size of burn wound excision area and reduce the tissue necrosis by preventing conversion of deep partial thickness to full-thickness burns. The aim of this study was to investigate the effects of SVF on deep partial thickness burn wound healing except epithelization.

Section snippets

Materials and methods

The study was supported by the Scientific Research Projects Unit of Erciyes University and it was conducted in accordance with ethical standards after approval by our Local Ethics Committee for Laboratory Animals at Experimental and Clinical Research Center (No: 10/29; 03/10/2010).

Histopathologic evaluation

Biopsies were taken sequentially from each quadrant of 7 cm circular burn under general anesthesia at 3, 7, 10 and 14 days, respectively. In order to decrease the inflammatory response biopsy donor site it was closed primarily after each biopsy (Fig. 5). Sizes of the biopsies were 5 mm × 10 mm × 5 mm, which were prepared by 5μ sections from the specimens embedded in paraffin blocks and stained with hematoxylin–eosin. Histologic analysis of the specimens performed under light microscope on hematoxylin

Histopathologic results

We evaluated the healing process with regard to inflammation, vascularization, and fibroblastic proliferation. Therapy and control groups were compared with each other for each parameter.

Discussion

We preferred scalding to create deep second-degree burns on rats’ back skin which induces homogenous burns with the same depth. In the literature, various temperatures and durations have been reported creating deep second-degree burn models [26], [27], [28], [29]. We used bottles with the mouth opening area of 7 cm2 which created approximately 2% TBSA burn. We could have used the immersion method as well, but this would cause leakage of hot water and provides less control over the size of the

Conclusion

We showed that applying SVF intradermally into the deep partial thickness burns will help and accelerate burn wound healing and may reduce the need for skin grafting, decrease the length of hospital stay, morbidity, mortality and expenditure of burn therapy by increasing cell proliferation, vascularization, fibroblastic activity and reducing inflammation.

Conflict of interest statement

All authors of this manuscript did not receive any funding for this study from any organization except “Scientific Research Projects Unit of Erciyes University”.

Funding

No funding received for this study from any organization except “Scientific Research Projects Unit of Erciyes University”.

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