The effect of basic fibroblast growth factor on scarring.

Granulation-tissue myofibroblasts are important in wound contraction, disappearing in normal scars but persisting in hypertrophic scars. While transforming growth factor beta 1 (TGF-beta 1) is implicated in excessive scarring and induces the accumulation of myofibroblasts, the role of basic fibroblast growth factor (FGF-2) on scarring remains unreported. Four linear full-thickness incisions, each 20 mm long, were made dorsally on 25 adult male Hooded Lister rats. In each animal, one wound was unmanipulated (control), one was injected with TGF-beta 1 (positive control), one with vehicle alone and one with FGF-2 (test). The wounds were injected daily for 5 days. Animals were sacrificed in groups of five on days 5, 10, 15, 20 and 30 after wounding. Wounds were subjected to tensiometry. Sections were stained for collagen fibres, immunostained for myofibroblasts and studied under light microscopy and electron microscopy. Myofibroblasts were present in the granulation tissue on day 5, reached their maximum number on day 10 and disappeared from all wounds by day 30. Treatment with FGF-2 inhibited this transient phenotypic change of granulation-tissue fibroblasts into myofibroblasts, relative to controls (15.23% versus 58.71%, 15.23% versus 54.71% and 15.23% versus 53.15%; P<0.003 on day 10, paired t-test). Test collagen-fibre orientation resembled that of the normal dermis, in contrast to that of the control wounds. Test wound breaking strength was unreduced. These results suggest a possible anti-scarring effect of FGF-2 during wound healing.

The origin and mode of fibroblast migration and proliferation in granulation tissue.

The factors which regulate the properties of granulation tissue remain uncertain. The key cells in granulation tissue are fibroblasts and their role was investigated in rat skin excisional wounds. Full thickness wounds in 28 Hooded Lister rats were made and traced. On days 1 to 7, animals in groups of 4 received colchicine 1 mg/kg subcutaneously, 4 h before being killed. Wound sections were stained to locate and count mitotic cells. All wounds healed with a normal coefficient of contraction. The fibroblasts' mitotic indices (% of mitotic cells) were calculated. Dermis: 0.1% vs. 2.9% (control vs. test P < 0.001, paired t-test); fascia; 0.07% vs. 5.6% (control vs. test P < 0.001); granulation tissue: 9.7%. Granulation tissue fibroblasts come mainly from the adjacent fascia although the dermis may have an initial role. Once they are in the wound replication is extremely rapid. This study highlights for the first time the rapidity of fibroblastic migration and proliferation in excisional wounds, and suggests that future therapeutic interventions to control granulation tissue should consider these kinetics.

A survey of general surgeons' attitudes towards breast reconstruction after mastectomy.

Within the last 15-20 years there have been many changes in the management of breast cancer. Along with changes in treatment, possibilities for breast reconstruction have become increasingly sophisticated and commonplace. Despite the availability of breast reconstruction, we have noted large variations in referral patterns. Because the surgical treatment of breast cancer is largely undertaken by general surgeons, we investigated general surgeons' attitudes towards reconstruction using a postal questionnaire. In 1995, a questionnaire involving hypothetical criticisms was sent to general surgical members of the Association of Surgeons of Great Britain and Ireland. A total of 136 surgeons responded, 79 (58%) of whom had a specialist interest in breast cancer. Each surgeon saw an average of 68 new cases of breast cancer per year (range 0-400). The general surgeons were concerned about three areas: (1) 32.3% felt that breast reconstruction might adversely delay the detection of local recurrence; (2) 16.6% were worried that breast reconstruction has high morbidity; and (3) 17.4% said that patients did not want breast reconstruction despite being advised of its availability. To investigate these concern's further, an extensive literature search was undertaken. There is no evidence that breast reconstruction delays the detection of local recurrence. With appropriate patient selection, the morbidity of reconstructive options appears very acceptable. Finally, immediate breast reconstruction has psychological benefits when compared with delayed reconstruction.

Preventing seroma in the latissimus dorsi flap donor site.

A technique for preventing seroma in latissimus dorsi flap donor sites is presented. The procedure involves quilting the donor site skin flaps to the underlying tissues with absorbable sutures. In a single surgeon series, a retrospective group (n = 16) of non-quilted donor sites was compared to a prospective group of quilted donor sites (n = 11). The age range and indications for surgery were similar for each group. The incidence of donor site seroma was reduced from 56% to 0% after introduction of the new technique (P = 0.003). The mean volume of postoperative drainage was significantly less in the quilted group (320 ml vs. 608 ml; P < 0.05) and the drains were removed significantly earlier (mean 3.9 days vs. 7.3 days; P < 0.01). There was no significant difference in donor site drainage and time to drain removal between the non-quilted group that developed a seroma and those that did not. The procedure is easy to learn, straightforward to perform and requires no special instrumentation. We commend it to all surgeons who use latissimus dorsi flaps.