Local and systemic concentrations of pro- and anti-inflammatory cytokines in human wounds.

OBJECTIVE: There is a lack of knowledge on the concentrations of cytokines and growth factors in wound healing. The objective was to characterize the pattern of local-tissue and systemic peri-and postoperative dynamics of cytokines and growth factors in a clinical model of a controlled and comparable operative plastic surgery trauma. DESIGN: Prospective clinical study. - SETTING: A University Department of Surgery. PATIENTS: 28 patients undergoing an elective reduction mammoplasty. MAIN OUTCOME MEASURES: IL-6, IL-8, sTNFR-1 and TGF-beta levels in plasma and wound fluid. RESULTS: Levels of cytokines increased only moderately in plasma. Cytokine levels in wound fluid were several fold higher. IL-6 in the wound fluid peaked at 7 hours after the operation (271 +/- 135.8 pg/ml); IL-8 after 4 hours (11 +/- 9.4 ng/ml); sTNFR-1 at the second postoperative day (11.1 +/- 3.4 ng/ml). TGF-beta decreased at the first (15.2 +/- 8.6 ng/ml) and second (11.7 +/- 5.0 ng/ml) postoperative day. CONCLUSION: Wound cytokine and growth factor levels are markedly higher than the systemic ones indicating a compartmentalization of the immune response. Cytokines peaked at different time points, probably reflecting the influx of inflammatory cells into the wound and the phase of wound healing. Further studies are necessary to clarify the mechanism of cytokine release in normal postoperative wounds before therapeutic use can be developed.