Theeffectsoflocallyappliedprocaineon

woundhealing
Detalles
" EscritoporArzuAkcal
C Publicado:28Noviembre2016

ArzuAkcal(1),SemraKarsidag(2),KemalettinY
ildiz(3),NebilYesiloglu(4),
MehmetAkifAkcal(5),FevziyeKabukcuoglu(6)

1.DepartmentofPlasticandReconstructiveSurgery ,AkdenizUniversity ,MedicalSchool,Antalya,Turkey

2.DepartmentofPlasticandReconstructiveSurgery ,SisliEtfalTrainingandResearchHospital,Istanbul,Turkey
3.DepartmentofPlasticandReconstructiveSurgery ,BezmiAlemUniversity,MedicalSchool,Istanbul,Turkey
4.DepartmentofPlasticandReconstructiveSurgery ,KartalLutfiKirdarTrainingandResearchHospital,Istanbul,
Turkey
5.DepartmentofOrthopedicsandT raumatology,Antalya AtatrkStateHospital,Antalya,T urkey,
6.DepartmentofPathology,SisliEtfalTrainingandResearchHospital,Istanbul,Turkey

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Objective:Thegoalsofthisstudywere:(1)T
odeterminetheefficacyof2%procaine(themostcommonlyusedconcentration)
odeterminetheproperopenwoundinjectionsite.
inwoundhealingand(2)T
MaterialsandMethods:ThirtyadultmaleSpragueDawleyratsweighingbetween250and350gwereused.T
wofullthickness
defectsweremadeontwosidesofthemidline1cmawayfrommidline.Theskinwoundareaswereapproximately1.5cm1.5
cm.Theanimalswererandomlydividedintothreegroups:Group1(controlgroup,n=8),Group2(injectiondirectlyintothe
baseofwound,n=8),andGroup3(injectionintohealthyskinaroundtheperipheralmarginsofthewound,n=8).Mechanical
analysesofwoundtensilestrengthofwereevaluatedinallgroups.
Results:WoundclosurewasfirstseeninGroup3onday14.Meanwoundhealingtimeswere18.25days,16.25days,and
15.62days,andmeantensilestrengthwas777.13cN,988.25cN,and1068.25cNintheGroups1,2,and3respectively
.
Conclusions:Procainedidnotcauseanynecrosisaroundthewound,didnotretardwoundhealing,didnotcausecirculation
deficiency,anddidnotreducethebreakingstrengthofthewound.Therefore,itcanbesafelyusedtoreducepainaroundthe
woundandtoacceleratethehealingprocessofslowtohealwounds.
Keywords:Procaine,slowtohealwounds,tensilestrength

Discussion
Recently,surgeonshavebeganplayinganac
tiveroleinmodulatingthehealingprocesswiththepharmologicaltreatmentof
openwounds.Procainehaswidespreadusageinclinicalpracticeandisalsoacomponentofmesotherapycocktailsduetoits
vasodilatatorandanalgesiceffectsinantiagingagents[13].However
,intheUnitedStates,someagentsthatcontaineprocaine
andareusedfordementiawerebannedbytheFoodandDrugAdministration[1].ProcainealsorelievesCTSbecauseithas
potentlocalanestheticproperties[3].Despitethisknowledgeaboutprocaine,theliteraturelacksinformationaboutitsef
fects
wheninjectedintoawoundorintohealthytissuesaroundthewound.
Afullthicknessexcisionalwoundmodelwasusedtodetecttheeffectsofprocaineonwoundhealing.Openwoundshealbythe
samebasicprocessesofinflammation,proliferation,andremodellingasdoclosedwounds.Themajordif
ferenceisthateach
sequenceismuchlongerinopenwounds[7].Ithasbeenstatedthatinjectionofsterilewaterintothewoundregiondelays
woundhealing,presumablybecausethevolumeofliquidinjectedintotheskinandsubcutaneoustissuescausestissuedamage
[7].Thus,sterilewaterwasnotusedinthecontrolgroup.Ithasbeenshownthatprocaineretardswoundhealingbyreducing
mucopolysaccharide,andconsequently,collagensynthesis[8].Manyhospitalsarenowusinglocalanestheticstorelievepost
operativepainandprolonganalgesia,althoughsomestudiesaboutlocalanestheticssuggestthattheseagentsshouldbe
avoidedinpatientswithslowtohealwounds,legulcers,orwhenfasthealingisessential[9,10].Studieshaveshownthat1%
and2%concentrationsofprocainedelayedwoundhealing,andtheuseof1:1,00,000epinephrinewasafactorthatexacerbated
thiseffectbyallowingprocainetoremainintheregionlonger.Thus,epinephrineinjectedaloneintheregionhadnonegative
effectonthehealingofwounds[5].Inthepre
sentstudy,procainethatwasinjectedintothebaseofthewoundandaroundthe
wounddidnotretardhealingtimesandrates.
Somereportshavestatedthatlocalanestheticspreserveendothelialbarrierfunctionduringacuteinflammation.Theef
fectsof
localanestheticagentsoncytokinereleaseandactivityaredosedependent[1
1]however,itisknownthatlocalanesthetics
inhibitbothcytokinereleaseandactivity.Nevertheless,whenoneconsidersthediversearrayofcytokinesandcytokineef
fects
involvedintheinflammatoryresponseandtheircomplexinteractions,itisclearthatourknowledgeoftheef
fectoflocal
anestheticagentsremainslimited.Esterandamidelocalanestheticsdecreaseleukocytemigration[12]andareassociated
withdecreasedendorgandamage.Inaddition,somestudieshavereportedthatlocalanestheticagentsdecreaseleukocyte
migration[13]andinhibitgenerationofhydrogenperoxide.Localanestheticsmayfunctionbyalteringthedistribution(rather
thanthemagnitudeofexpression)ofadhesionmolecules.Thelimitationofourstudywasthatwedidnotinvestigateleukocyte
migrationbymicroscopy,anddidnotperfomimmunohistochemistryforadhesionmolecularmarkers.However
,bothprocaine
treatmentgroupshealeduneventfully
,andhadashorterhealingtimethanthecontrolgroup.Also,collagenaccumulationsin
experimentalgroupsweremoreprominent.
Theinfiltrationoflocalanestheticsathighconcentrations(2%)decreasesthebreakingstrengthofskinwoundsinrats,butata
concentrationof0.5%,thedifferencesarenotsignificant[6].Inourstudy,2%procainedidnotdelaywoundhealinganddidnot
leadtosignificantdifferencescomparedtothecontrolgroup.Inaddition,therewerenostatisticallysignificantdif
ferences
betweenexperimentalgroups.
Inthefullthicknessexcisionalmodel,healingratesareoftenmonitoredbasedontheextentofreepithelization,histological
organizationofconnectivetissue,angiogenesis,andbiochemicalcontentofcollagenorproteoglycans[14].Inthisstudy
,we
foundthatprocainedidnotcauseanynecrosisaroundthewound,didnotretardwoundhealing,didnotcausecirculation
deficiency,anddidnotreducethebreakingstrengthofthewound.Thus,thisagentmayberecommendedforthehealingofboth
openwoundsandsurgicalwoundsduetoitsef
fectoncollagenaccumulation.Inaddition,procainecanbeusedsafelytoreduce
painaroundthewoundandtoacceleratethehealingofslowtohealwounds.

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