The effects of local and sustained release of fibroblast growth factor on wound healing in esophageal anastomoses.

BACKGROUND/PURPOSE: Postsurgical complications, such as anastomotic leaks in patients with esophageal atresia, have remained unchanged during the last 3 decades. Growth factors enhance healing in several wound-healing models. Therefore, an experimental study was used to evaluate the effects of local and sustained release of basic fibroblast growth factor (FGF) on wound healing in esophageal anastomoses. MATERIALS AND METHODS: Twenty-four male Wistar albino rats, which were subjected to a 1-cm segmental resection of the abdominal esophagus followed by end-to-end anastomosis, were allocated into 3 groups. Group I, the control group, had no gelatin film applied to the anastomosis. In group II (gelatin film without FGF) and group III (gelatin film with FGF), anastomoses were covered with unloaded and 2.55 mug FGF-loaded gelatin films, respectively. On postoperative day 7, bursting pressures, histopathologic collagen deposition, and tissue hydroxyproline concentrations of the anastomoses were then analyzed and compared. RESULTS: Mean bursting pressures, mean submucosal and muscular collagen deposition scores, and mean tissue hydroxyproline concentrations differed significantly between groups. Mean bursting pressures were 22.5 +/- 3.1 mm Hg in group I, 29 +/- 1.6 mm Hg in group II, and 63.2 +/- 6.8 mm Hg in group III (P < .001). Mean submucosal collagen deposition scores (group I: 0.7 +/- 0.2, group II: 0.7 +/- 0.1, group III: 1.5 +/- 0.2; P = .02) and mean muscular collagen deposition scores (group I: 0.8 +/- 0.2, group II: 0.8 +/- 0.1, group III: 1.8 +/- 0.1; P = .01) were significantly higher in FGF animals than the other in the other 2 groups. Mean tissue hydroxyproline concentrations were 2.4 +/- 0.5 microg/mg in group I, 3.9 +/- 0.4 microg/mg in group II, and 6.0 +/- 1.0 microg/mg in group III (P = .007). CONCLUSION: Local and sustained release of FGF enhanced wound healing in esophageal anastomoses in this animal model.

Evaluation of cellular response to collagen membranes enriched with fibronectin light and transmission electron microscope study.

This study was undertaken to evaluate the biocompatibility, cellular reaction and resorption characteristics of a type I bovine collagen membrane material either enriched with or without fibronectin solution in vivo using light (LM) and transmission electron microscopy (TEM). Experimental osseous dehiscence defects were surgically produced bilaterally on the labial aspect of the mandibular 2nd, 3rd, and 4th premolar teeth in four mongrel dogs. Collagen membranes rehydrated with fibronectin solution (group FM) and membranes rehydrated with saline (group M) were placed over the bony defects. The third premolar teeth on which the flap operation was performed served as control (group C), with no membrane placed. Flaps were positioned slightly coronally and sutured. Gingival tissue samples and block biopsies were obtained from all experimental and control sites for LM and TEM evaluation at 7 days. For each group, morphometric analysis was performed and the numbers of macrophages in the most coronal area of the free gingiva were counted. Postoperative healing was uneventful during the experimental period, and all membranes remained covered. Light microscopic evaluation revealed similar resorption patterns in the most coronal area of the membranes both enriched with and without fibronectin solution within the first 7 days. The mean numbers of macrophages were higher in experimental groups than in the control group. In TEM evaluation, more excessive intracellular macrophage activity was observed in group M than group FM. As a result of these observations it may be concluded that similar resorption characteristics existed in the most coronal area in both experimental groups with LM evaluation, but with TEM it was observed that the membranes enriched with fibronectin solution were resorbed more slowly at the ultrastructural level.