Promoting healing with recombinant human platelet-derived growth factor--BB in a previously irradiated problem wound.

摘要

OBJECTIVES/HYPOTHESIS: Persistent, poorly healing wounds are a significant clinical problem in patients who have had previous irradiation. Despite current treatments, refractory nonhealing soft tissue wounds persist. The study described one of the earliest reported uses of recombinant human platelet-derived growth factor-BB (rhPDGF) gel to improve the healing of a previously irradiated refractory dermal wound to the neck that had been present for 12 years. STUDY DESIGN: Case report and literature review. METHODS: Review of local healing management of previously irradiated wounds and review of patients chart one year after follow-up treatment. RESULTS: A 47-year-old man had a 12-year history of a persistent, painful, nonhealing full-thickness dermal wound on the left side of his neck after radiation therapy and chemotherapy for a T2N2bM0 nasopharyngeal carcinoma. He had been tumor free for 12 years. Despite multiple modalities of therapy over a 1-year period (including moist hydrogel dressings, topical and oral antibiotics, serial debridement, and hyperbaric oxygen), the wound did not heal. After 6 months of topical rhPDGF gel treatment, sufficient granulation tissue developed within the dermal wound that a split-thickness skin graft was successfully performed. Symptomatically, the patient's continuous pain at the neck resolved after rhPDGF treatment. Serial histological biopsy specimens before and after rhPDGF treatment confirmed the wound transformation from a chronic state to a short-term healing state. CONCLUSION: In previously irradiated tissue, rhPDGF can be useful in helping refractory wounds to heal by inducing further granulation formation. If such treatment is planned, the patient should be informed of the possible theoretical risks of its use when it is in proximity to a previously treated neoplastic site.