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[Biochemical wound monitoring. PMN elastase in different healing stages after trauma surgery-orthopedic
H P Hofer1, E Kukovetz, W Petek
1Universitätsklinik für Chirurgie, Karl-Franzens-Universität Graz.
Abstract:
Laboratory parameters are of proven value in the diagnosis of early postsurgical infections, since clinical aspects cannot always be clearly defined. Neutrophil granulocytes (PMN) are major inflammatory cells taking effect following ingestion and degradation of foreign material, such as bacteria and cell debris, for example after mechanical trauma. In patients who had undergone surgery we monitored the course of plasma PMN elastase in uncomplicated wound healing (n = 22), in uncomplicated wound healing associated with secondary infections (n = 6), and in defective wound healing (manifestation of a bacterial wound infection: n = 3; wound infection already manifest at the time of entry on study: n = 11). Surgical trauma was accompanied by an increase in PMN elastase and C-reactive protein (CRP) in all patients studied, reaching a maximum within the first 3 postsurgical days. When a bacterial wound infection became manifest during the course of healing there was a highly significant difference on the 4th postsurgical day (p < 0.01) compared with the group with uncomplicated healing. Since PMN elastase can now be determined automatically with an autoanalyser and a commercial kit and its discriminatory time point is as soon as 4-5 days after surgery, it is suggested that this marker should be determined routinely together with CRP in traumatology.
Insights
Plasma neutrophil elastase (PMN elastase) and C-reactive protein (CRP) can help diagnose early postsurgical infections. Elevated PMN elastase levels by day 4-5 post-surgery indicate bacterial infection, aiding timely treatment.
Area of Science:
- Biochemistry
- Immunology
- Surgical Pathology
Context:
- Early detection of postsurgical infections is crucial for effective patient management.
- Clinical signs of infection can be ambiguous in the early postsurgical period.
- Neutrophil granulocytes (PMN) play a key role in the inflammatory response to surgical trauma and infection.
Purpose:
- To evaluate plasma PMN elastase as an early diagnostic marker for postsurgical infections.
- To compare PMN elastase levels in uncomplicated wound healing versus infected or defective healing.
- To assess the utility of PMN elastase alongside C-reactive protein (CRP) in traumatology.
Summary:
- Surgical trauma elevated PMN elastase and CRP in all patients, peaking within 3 days.
- A significant difference in PMN elastase was observed by the 4th postsurgical day in patients with bacterial wound infections compared to those with uncomplicated healing (p < 0.01).
- Plasma PMN elastase levels, measurable via automated analysis, show discriminatory potential as early as 4-5 days after surgery.
Impact:
- Routine determination of PMN elastase with CRP can improve early diagnosis of postsurgical infections.
- This diagnostic approach aids in timely intervention for bacterial wound infections.
- Enhanced monitoring of inflammatory markers can lead to better patient outcomes in traumatology.