Wound Bed Regeneration by Autologous Unfractionated Bone Marrow Transplantation

The basic fibroblast growth factor (bFGF) is known to proliferate and maintain the adult stem cells. The human mesenchymal stem cells (hMSCs) are very homogenous and constitute of euchromatin nuclei in 10% fetal bovine serum (FBS) and induce the heterochomatin nuclei by bone morphogenetic protein.
In order to further investigate other growth factor, other cell types like bFGF, keratinocytes, dermal fibroblasts and endothelial cells, the cellular and molecular analyses are performed in vitro assay systems.
The various doses of bFGF (0.25–25 μg/ml) significantly proliferate the hMSCs in time‐dependent manner in s serum‐free medium. The ultra‐structure by electron microscopy revealed the very small, round and immature both cytoplasmic and nuclear structure resembling the 10% FBS‐cultured cells. The hMSCs and bFGF and other cells are co‐cultured in 8 μm‐pore chamber systems for 16‐hour incubation. The hMSCs successfully migrate through the pore when keratinocytes, dermal fibroblasts, endothelial cells or bFGF (345.0 ± 68.86, 63.8 ± 16.50, 36.2 ± 9.60, 12.0 ± 4.89, p < 0.01) are placed lower chamber. The clear cellular attachment between hMSCs and keratinocytes is observed in the monolayer co‐culture by electron microscopy.
The hMSCs are stimulated by bFGF and interact with other cell types such as keratinocytes, dermal fibroblasts and endothelial cells in vitro.     

Negative‐Pressure Dressings in the Treatment of Infected Pressure Ulcers

Objective:  Effects of platelet derived wound healing factor (PDWHF)¹⁾ with or without cultured cells on angiogenesis in treatment of defected wounds using artificial dermis (AD) were investigated in rat experimental model.
Methods:  Wistar strain rats were used for this study. The PDWHF was prepared from platelets. The endothelial cells and fibroblasts were prepared from thoracic aorta and back skin respectively. Two sites of 2.5 × 2.5 cm full‐thickness wounds were created on back of the animals. Artificial dermis (TERUDERMIS^®, TERUMO Co, Japan) were grafted to the wounds. Prior to the AD grafts, following 4 groups were established, control group: AD alone (n = 6), PDWHF group: AD treated with PDWHF (0.1 ml/cm²)(n = 6), cultured cells group: disperse of 1 × 10⁵ cultured endothelial cells and fibroblasts between AD and wound (n = 6) and combination group: combination of PDWHF and cultured cells (n = 6). Five days after surgery, degree of angiogenesis was evaluated by gross inspection and histological study. Evans blue perfusions test was performed to evaluate the degree of new capillary formation in the generated dermis quantitatively.
Results:  The combination group showed vascular invasion into AD 5 days after surgery. In this group, the absorbance of the Evans blue extracted from the grafted dermis was highest among the group.
Conclusion:  The result of the present study revealed that treatment with PDWHF combined with cultured endothelial cells and fibroblasts accelerate the wound angiogenesis. This method may be beneficial to shorten the period between the AD grafts and the secondary skin grafting.     

004Topical Zinc Oxide for Open Pilonidal Wounds

Extended healing time and lack of documented effective treatments of sacrococcygeal pilonidal disease create substantial problems. Locally applied zinc oxide has been reported to promote wound healing. We have compared topical zinc oxide (3%) with placebo meshes for pilonidal wounds healing by secondary intention in a randomized, double‐blind, placebo‐controlled multicenter trial. Sixty‐four consecutive patients, 53 males, aged between 18 and 60 years (median 26 years) with excised pilonidal wounds were centrally randomized to local zinc oxide (30 mg/g, n = 33) or to placebo (n = 31) mesh treatment. Patients were followed with strict recording of beneficial and harmful effects. The median healing times were 54 days (42–71 days, interquartile range, n = 33) for the zinc group and 62 days (55–82 days, n = 31) for the placebo group. This difference was not statistically different (p = 0.32). Based on Cox regression analysis initial wound volume influenced healing negatively (p = 0.016) while smoking (p = 0.011) was associated with faster wound healing. Significantly (p < 0.01) more placebo (n = 12) than zinc oxide‐treated patients (n = 3) needed antibiotics postoperatively. Although topical zinc oxide increased (p < 0.001) wound fluid zinc levels (1830 ± 405 μM, mean ± SEM) compared with placebo (3.1 ± 1.6 μM) serum‐zinc levels did not differ significantly between the zinc (13.5 ± 0.4 μM) and placebo (12.8 ± 0.4 μm) groups on postoperative day 7. No adverse events were recorded. Topical zinc oxide treatment did not accelerate time to closure of open pilonidal wounds but was associated with reduced antibiotic usage.     

012Microvascular Endothelial Cell Migration in Scaffolds of Electrospun Collagen

Introduction:  Chronic, nonhealing wounds are often observed in tissues with poor oxygen supply. Impaired reepithelialization is a hallmark of these wounds; however, the pathogenesis of the retarded reepithelialization in chronic, ischemic wounds remains poorly understood. Transforming Growth Factor beta (TGF‐beta) is involved in both normal and hypoxic wound healing response and exogenous overexpression of Smad3, a TGF‐beta signaling intermediate, has been known to accelerate reepithelialization. In a recent study, Ad‐Smad3 injection in the rabbit ear dermal ulcer model showed enhanced reepithelialization and granulation tissue area suggesting a positive effect of Smad3 on wound healing. However, little is known about the role of Smad3 in the ischemic wound healing process. In this study we examined the effect of Smad3 in an ischemic wound model.
Methods:  Ad‐Smad3 or LacZ (10⁸ pfu/wound) empty vector was injected in either ear of White New Zealand Rabbits. Twenty‐four hours later, these ears were rendered ischemic using an established model and four 7‐mm full‐thickness punch wounds were made on each ear.
Results:  Histological evaluation showed a highly significant increase in reepithelialization, epithelial ingrowth and percentage of epithelialization in Ad‐Smad3 transfected wounds versus ischemic wounds transfected with LacZ‐empty vector (p < 0.01).
Conclusion:  Our data confirm the enhancing effect of Smad3 on reepithelialization in an ischemic wound model. The deficiency in reepithelialization, as evident in chronic ischemic wounds, could thus be ameliorated by excess Smad3. Therapeutic interventions using overexpressed Smad3 may improve wound healing through accelerated epithelialization in chronic wounds.     

109Near Infrared Spectroscopy of Partial Thickness Burns

Impaired wound healing is a problem for immobilized patients, diabetics, and the elderly. The 43 amino acid angiogenic peptide thymosin β₄ has previously been found to promote accelerated dermal wound repair in rats, aged mice and db/db diabetic mice, and corneal repair in normal rats. It has been found in great abundance in wound fluid. Here, we hypothesized that thymosin β₄ may regulate matrix metalloproteinase (MMP) expression in cells that are involved in wound repair. Western blot analysis of keratinocytes, endothelial cells, and fibroblasts that were treated with increasing concentrations of thymosin β₄ showed changes in the expression of the MMP‐1, −2, and −9. Zymographic analysis of whole excised mouse wounds taken after homogenization also showed changes in MMP‐2 and‐9 expression over a 3‐day period. These results were confirmed in 2‐day‐old wounds by RT‐PCR. We conclude that part of the wound healing activity of thymosin β₄ resides in its ability to increase protease activity. Since thymosin β₄‐induced protease activity can be further controlled by inflammatory cytokines, a regulatory role for thymosin β₄ is proposed in wound healing. These studies suggest that thymosin β₄ may play a pivotal role in extracellular matrix remodeling during wound repair and may be effective in the treatment of chronic wounds in humans.     

Topkin<Superscript>®</Superscript>—Eine resorbierbare Folie aus Lactid-Caprolacton

The resorbable film Topkin (Biomet-Merck), which consists of a copolymer composed of D,D-lactide and ε-caprolactone was applied to 71 split skin donor sites and 42 split skin grafting sites as wound coverage. The split skin donor sites had an area of up to 900 cm², and the recipient soft tissue defects covered up to 1200 cm². For comparison 29 grafting sites were covered with grease gauze dressings. In the split skin donor sites, there were two complications (hematoma, local infection). In split skin grafting sites five complications (one hypertrophic granulation, two residual defects, one local infection, and one scar formation) were observed. Of the 29 patients whose split skin grafting sites were treated with conventional grease gauze bandages, 8 experienced wound healing problems (four residual defects, three superficial graft necroses, and one local infection). Substantial scarring was observed in four wounds. There was no significant difference in wound healing time between treatment with the film and treatment with grease gauze. The maximal pain ratings during the film treatment was 10.9 for the split skin donor sites and 2.9 for the contaminated wounds. Time expenditure for care of the wounds was 4 min/day in the first 20 patients and, after modification of the regime, 2 min/day in the remaining patients.     

A serum amyloid P-binding hydrogel speeds healing of partial thickness wounds in pigs

During wound healing, some circulating monocytes enter the wound, differentiate into fibroblast-like cells called fibrocytes, and appear to then further differentiate into myofibroblasts, cells that play a key role in collagen deposition, cytokine release, and wound contraction. The differentiation of monocytes into fibrocytes is inhibited by the serum protein serum amyloid P (SAP). Depleting SAP at a wound site thus might speed wound healing. SAP binds to some types of agarose in the presence of Ca²⁺. We found that human SAP binds to an agarose with a K _D of 7 × 10⁻⁸ M and a B _max of 2.1 μg SAP/mg wet weight agarose. Mixing this agarose 1 : 5 w/v with 30 μg/mL human SAP (the average SAP concentration in normal serum) in a buffer containing 2 mM Ca²⁺ reduced the free SAP concentration to ∼0.02 μg/mL, well below the concentration that inhibits fibrocyte differentiation. Compared with a hydrogel dressing and a foam dressing, dressings containing this agarose and Ca²⁺ significantly increased the speed of wound healing in partial thickness wounds in pigs. This suggests that agarose/Ca²⁺ dressings may be beneficial for wound healing in humans.     

bFGF治疗颌面颈部大面积软组织缺损

目的探讨重组牛碱性成纤维细胞生长因子（bFGF）在颌面颈部大面积软组织缺损患者治疗中对组织愈合及预防瘢痕形成的作用,为细胞因子在创伤修复的临床应用提供依据。方法通过对三例较典形病例使用重组牛碱性成纤维细胞生长因子（贝复济）治疗：一例为恶性肿瘤术后皮瓣坏死,一例为斜方肌皮瓣术区拆线后裂开,一例为严重狗咬伤伴感染的患者,创面均缺损面积较大、深度深。持续观察创面变化至创面完全愈合。结果三例患者创面均愈合良好,且无瘢痕增生及瘢痕疙瘩形成。结论重组牛碱性成纤维细胞生长因子（bFGF）对颌面颈部大面积软组织缺损,甚至是创面条件较差的情况下,也可起到良好的治疗作用,并且可有效的抑制瘢痕组织形成,细胞因子在创伤修复及预防瘢痕形成中有积极作用。     

Persistent Ischemia Impairs Myofibroblast Development in Wound Granulation Tissue a New Model of Delayed Wound Healing

Skin substitutes are slowly finding a position in the treatment of burns, scar reconstructions and chronic wounds. Some of the substitutes consist of extracellular matrix replacement material only, such as Integra and Alloderm; some include allogeneic cells (Dermagraft, Appligraf). The ideal skin substitute has not been developed yet, since none of the presently available products can ultimately prevent scar formation.
Study of the role of autologous fibroblasts in the healing process might give further insight into the scarring process and eventually lead to improved skin substitutes.
We compared wound reepithelialization of experimental wounds treated with proliferating keratinocytes and a dermal substitute with either dermal fibroblasts, adipose tissue derived fibroblasts or no fibroblasts. We also investigated the rate of keratinocyte migration of human skin equivalents cultured in vitro in the presence of dermal or adipose tissue derived fibroblasts.
We reached successful wound closure in 8 days with transfer of proliferating keratinocytes on a dermal substitute seeded with dermal fibroblasts. However, the wounds treated with substitutes which contained adipose tissue derived fibroblasts or no fibroblasts at all were not closed even after 21 days.
Keratinocytes seeded onto collagen lattices populated with either dermal or fat‐derived fibroblasts showed similar findings: a retarded migration and/or proliferation of keratinocytes on the collagen lattices with fat‐derived fibroblasts. The collagen lattices populated with fat‐derived fibroblasts also showed a marked contraction, up till 50% of the original area.
In both models, more alpha‐smooth muscle actin positive cells were found in the fibroblast population from adipose origin.
We conclude that epidermal regeneration is negatively influenced by the presence of fat‐derived fibroblasts in a dermal matrix; possibly, myofibroblasts play a role in this.     

Modulation of scarring in a liquid environment in the Yorkshire pig

Decreased inflammatory response seen in wet wound healing may be correlated with diminished scarring. This study seeks to test this hypothesis and to validate a model of scarring in the Yorkshire pig. Four Yorkshire pigs were used to create 36 dorsal wounds per pig (144 wounds total) in the following groups: full-thickness excisional, partial thickness, meshed split-thickness skin grafts, sheet split-thickness skin grafts, minced skin, and incisional wounds. Wounds were randomized into wet and dry groups. Wet wounds were enclosed in polyurethane chambers with 2 mL of normal saline. Dry wounds were covered with regular gauze. Terminal biopsies were performed at 72 hours and day 28. Histology demonstrated significantly less inflammatory infiltrate, thicker neoepidermis, more pronounced rete ridge formation, and decreased scar tissue thickness in wet wounds. The mean macroscopic scar surface area was significantly decreased in full-thickness excisional wet wounds compared with dry wounds (61.2 mm² vs. 150.8 mm², p <0.01). Hydroxyproline content was decreased in full-thickness wet compared with dry groups (44.81 vs. 62.21 mg/g, p <0.01). Tensile strength was 90% greater in full-thickness wet compared with dry groups ( p <0.01). Healing in the liquid environment significantly reduced scar formation. This model will allow for future investigation of high-concentration topical scar-modulating agents in the liquid environment.     

颜面部小创面再生自愈疗法的美容效果

目的 探讨颜面部皮损切除后创面的美容修复新方法.方法 选择42例71个颜面部皮损,用环形刀将皮损完整切除,切除后创面喷碱性成纤维细胞生长因子（bFGF）和涂抹透明质酸软膏辅助创面组织再生和修复,每天3次,直至小创面愈合.观察创面再生自愈时间并评价其远期效果.结果 42例71个颜面部皮损创面均顺利治愈,仅遗留微小瘢痕.经统计分析,5 mm×5 mm面积的创面愈合时间平均为15d,15 mm× 15 mm面积的创面愈合时间平均为25 d.12个月后随访35例63个皮损治疗区,瘢痕面积比原皮损面积缩小50％左右,与正常皮肤颜色接近,基本与皮面相平.结论 颜面部皮损切除后小创面再生自愈疗法能减少瘢痕形成,方法简单,不增加额外手术损伤,是一种有效的面部皮损修复新方法.     

碱性成纤维细胞生长因子促进受创皮肤再生的实验研究

成纤维细胞生长因子（ｆｉｂｒｏｂｌｓｔｇｒｏｗｔｈｆａｃｔｏｒ，ＦＧＦ）有促进肉芽，组织生长作用，但对皮肤的修复与再生的作用研究尚少，为此设计了本实验研究。采用大鼠与小型猪背部创伤模型，在无菌条件下用手术刀在动物背部切割皮肤，形成面积约２．５ｃｍ２的圆形创面。分别用碱性成纤维细胞生长因子（ｂａｓｉｃｆｉｂｒｏｂｌａｓｔｇｒｏｗｔｈｆａｃｔｏｒ，ｂＦＧＦ），６０Ｕ／ｃｍ２创面以及相同剂量的生理盐水处理创面，隔天换药一次。结果表明，ｂＦＧＦ具有显著促进上皮细胞生长、加速创面上皮化速率以及增加愈合组织抗张力强度等作用。ｂＦＧＦ显著促进受创皮肤的再生效应可能与它能直接作用于皮肤基底细胞上特异性ｂＦＧＦ受体有关。     

The effect of macrophage depletion on delayed xenograft rejection: studies in the guinea pig-to-C6-deficient rat heart transplantation model

The purpose of this study was to investigate the effect of macrophage depletion, using liposome‐encapsulated dichloromethylene diphosphonate (Lip‐Cl₂MDP), on delayed xenograft rejection (DXR) in the guinea pig‐to‐C6‐deficient rat heart transplantation model. In this model, hyperacute rejection does not occur, but, in untreated recipient s, xenografts are still destroyed by DXR within 1–2 days. Graft survival was 68 ± 8.4 h in splenectomized control rats, 77 ± 16.3 h with Lip‐Cl₂MDP alone, 99 ± 10.4 h with deoxysperguarlin (DSG; P < 0.01 vs. controls), and 127 ± 19.4 h with Lip‐Cl₂MDP plus DSG (P < 0.01 vs. DSG alone). Treatment with DSG alone or in combination with Lip‐Cl₂MDP resulted in significant reductions in serum IgM levels at rejection. Immunohistological studies showed that Lip‐Cl₂MDP alone or in combination with DSG reduced infiltration of grafts by both ED1 + and ED2 + macrophages. These experiments support the concept that macrophages play an important role in DXR and suggest that strategies targeting macrophages may be useful in controlling DXR.     

Controlled delivery of bFGF to recipient bed enhances the vascularization and viability of an ischemic skin flap

Therapeutic angiogenesis is a promising approach to treat ischemic skin flaps. We delivered basic fibroblast growth factor (bFGF) to the recipient bed of a rat dorsal skin flap by a drug delivery system with acidic gelatin hydrogel microspheres (AGHMs), and assessed augmentation of neovascularization and flap viability. An axial skin flap was elevated on the back of male Sprague–Dawley rats, and bFGF solution or bFGF-impregnated AGHMs were injected into the recipient bed. The dose of bFGF in the bFGF solution was set to 15 (Sol-15 group), 50 (Sol-50 group), or 150 μg (Sol-150 group). Correspondingly, 2 mg AGHMs were impregnated with 15 (AGHM-15 group), 50 (AGHM-50 group), or 150 μg (AGHM-150 group) bFGF. Other groups of animals received phosphate-buffered saline (Sol-Cont group) or phosphate-buffered saline-impregnated AGHMs (AGHM-Cont group) as controls. Seven days later, analyses of the area of necrosis, microangiographic findings, and histological findings in the flap were carried out. The area of necrosis in the AGHM-150 group was significantly smaller than that in the other groups. Microangiographic and histological analyses showed that neovascularization of the ischemic skin flap significantly increased in the AGHM-150 group as compared with the Sol-150 group and the AGHM-Cont group. These findings suggest that continuous delivery of bFGF to the recipient bed by bFGF-impregnated AGHMs enhances the viability of an ischemic skin flap.     

008 The Effect of the Gelatin Sheet Containing bFGF on Wound Healing

Aim: It is well recognized that bFGF accelerates proliferation of almost all cells concerned with wound healing and there is a report that bFGF was well sorbed with time to the acidic gelatin hydrogel with isoelectric points of 5.0. We investigated the effect of the acidic gelatin sheet containg bFGF. Methods: Full thickness defects of skin (1.5 × 1.5 cm) were created on the backs of mice.1) The wounds were covered with gelatin sheets (2 × 2 cm)containg bFGF(100 ìg/site), (A), and without bFGF(B). The concentration of bFGF in plasma was estimated by ELISA. 2) The wounds were covered with A, B and hydrogel dressing(control group, C) and wound area was measured with computer planimeter and neoepithelium was observed using the light microscope. Results: 1) The concentration of bFGF in plasma in (A) was statistically greater than (B) by the 7^th day. 2) Statistically smaller wound area was found 2 weeks postoperatively in (A) than in (C) and (D). Neoepithelium from edge of the wound was statistically longer in (A) than in (C). Conclusions: Controlled release of bFGF from the acidic gelatin sheet was fouhd and acidic gelatin sheet containg bFGF promoted neoepithelization and wound closure. The acidic gelatin sheet containg bFGF was thought to be effective on wound healing.     

Hepatitis C Virus Infection is Highly Correlated with Hepatocellular Apoptosis and Transforming Growth Factor‐β1 MRNA Expression in Patients with Chronic Hepatitis C

Introduction:  The cellular phases (granulation, reepithelialization, and dermal remodelling) of the healing process involve many cell types. Fibroblasts and myofibroblasts are the key cells in granulation tissue formation and wound contraction.
Objective:  To compare the effects on cultured human fibroblasts of a new nonadhesive lipidocolloid wound dressing, Urgotul^®, with five other wound dressings including impregnated gauzes and some other modern wound dressings.
Method:  Cultures in monolayer were used to study the morphology and growth of fibroblasts. The Bell model of cultured dermis equivalents was used to investigate myofibroblast differentiation. These cultures were labelled α‐SM actin and F‐actin.
Results:  Two of the tested dressings induced cytotoxic effects on the fibroblasts. They were found to inhibit cell growth (greater than 60%) and to disturb cell shape and cytoskeletal differentiation. Urgotul^® and the remaining three dressings showed no effect on proliferation. However some of them modified fibroblast morphology and affected F‐actin distribution.
Conclusion:  Depending on their nature and components, wound dressings may respect or affect in vitro fibroblast behaviour (proliferation, morphology, and α‐SM actin and F‐actin distribution). The observed in vitro findings require further investigations.     

Healing effect of acellular fish skin with plasma rich in growth factor on full‐thickness skin defects

Acellular skin as a scaffold has a good potential to regenerate or repair damaged tissues. Growth factors such as Plasma Rich in Growth Factor (PRGF) as a rich source of active proteins can accelerate tissue regeneration. In this study, an acellular scaffold derived from fish skin with growth factors was used to repair full‐thickness skin defects in a rat model. Cellular results demonstrated that epithelial cells adhere well to acellular scaffolds. The results of animal studies showed that the groups treated with acellular scaffold and growth factor have a high ability to close and heal wounds on the 28th day after surgery. Histological and staining results showed that in the treated groups with scaffold and growth factor, an epidermal layer was formed with some skin appendages similar to normal skin. Overall, such scaffolds with biological agents can cause an acceptable synergistic effect on skin regeneration and wound healing.     

The usefulness of basic fibroblast growth factor for radiation‐exposed tissue

A high dose of ionizing external radiation damage to the skin and soft tissue results in changes in function as well as in the general body condition. Once radiation surpasses the tissue safety or survival level, progressive alteration in the damaged tissue results in tissue loss and then flap loss. Local expression and action of stem cells or local growth factors in the irradiated tissue is mitigated, and external administration is sought to investigate the possibility of skin and soft tissue survival after an elevating flap. Basic fibroblast growth factor (bFGF) is primarily considered as a potent angiogenic growth factor. In burns, resurfacing with a dermal component is required, and bFGF stimulates wound healing and enhances human skin‐derived mesenchymal stem cells under serum‐free conditions in a dose‐dependent manner. Thirty‐five male, 4‐ to 8‐week‐old CLAWN miniature pigs received radiation exposure to assess the effectiveness of bFGF in terms of the progressive clinical course relevant to human skin and soft tissue. At 2 weeks following 10‐Gy irradiation, tissue was preserved in the group receiving subcutaneous placement of a round‐type tissue expander and bFGF. The expander plus bFGF group demonstrated significantly greater dermo‐epidermal proliferation than the radiation alone, radiation plus bFGF, or expander plus radiation plus vehicle‐solution groups, and new blood vessel formation was significantly increased in the expander tissue with bFGF after irradiation (p < 0.01). Electron microscopy revealed that tissue with expander and bFGF maintained more stable skin adnexae with preserved intact epidermis and dermis. Thus, bFGF improved and maintained the tissue viability after immediate irradiation in the skin and soft tissue.     

Temporal and quantitative profiles of growth factors and metalloproteinases in acute wound fluid after mastectomy

Seventy-three samples of acute wound fluid were collected from 47 patients during the first 3 postoperative days (POD) following mastectomy for cancer ( n =47 on POD-1, n =19 on POD-2, and n =7 POD-3). Samples were analyzed by enzyme-linked immunosorbent assay for growth factor levels (epidermal [EGF], platelet-derived [PDGF], basic fibroblast [bFGF], transforming growth factor-β1 [TGF-β1], vascular endothelial [VEGF]), interleukin-6 (IL-6), matrix metalloproteinases (MMPs-2, -3, -9), and the tissue inhibitor of metalloproteinase 1 (TIMP-1). The levels of EGF, bFGF, PDGF, and interleukin-6 peaked on POD-1, with a significant decrease by POD-3, while total and active MMP-2, MMP-3, and tissue inhibitor of metalloproteinase 1 showed a progressive and significant increase from days 1 to 3. The wounds that later developed an infection (11%) were found to have a significantly lower PDGF and EGF on day 1 (PDGF, median 169 pg/mL [range, 86–2,595]) than the noninfected wounds (2,098 [17–66,506] p <0.05, Mann–Whitney U -test). Sixty-two percent patients developed a seroma and the levels of bFGF were significantly less in these patients (441 pg/mL [45–4,108]) than in those patients where there was no seroma (807 [245–3,133] p <0.05). The levels of certain growth factors in acute wound fluid may be important markers for wound outcomes.