The inflammatory reaction in healing wounds: the role of polymorphonuclear leucocytes

The inflammatory process in granulation tissue in full-thickness skin wounds was studied and the role of polymorphonuclear leucocytes (PMNLs) in this process evaluated in an experimental model in the rat. The number of PMNLs in the wound, assessed by determination of the PMNL-specific enzyme myeloperoxidase (MPO) activity in wound exudate, increased from 0.45 U/ml on day 1 after wounding to 0.8 U/ml on day 2, and then remained constant throughout the five days of observation. The concentration of prostaglandin E2 (PGE2) in wound exudate increased progressively from 70 ng/ml on day 1 to 290 ng/ml on day 5. The lack of correlation between these two variables indicated that PMNLs were not the major source of PGE2. Blood flow and albumin extravasation in the granulation tissue were measured, and the relation between these two variables and PMNL accumulation was studied. Rats were rendered neutropenic with an antineutrophil serum, resulting in an 83% decrease in circulating PMNLs and a 61% decrease in granulation tissue MPO activity on day 5, as compared with rats treated with normal rabbit serum. These reductions did not, however, affect either blood flow or albumin extravasation, and no correlation was observed; but when inter-individual variations in the absolute levels of the variables measured were eliminated by calculating in each rat a left-to-right wound ratio, PMNL accumulation correlated well to both blood flow (R = 0.81) and albumin extravasation (R = 0.65). It is suggested that blood flow and albumin extravasation in the granulation tissue are influenced by local PMNL accumulation and, further, that the inflammatory response varies considerably between one animal and another.