David Herndon1,2,3, Karel D Capek1,2, Evan Ross1,2, Jayson W Jay2,3, Anesh Prasai1,2, Amina El Ayadi1,2, Guillermo Foncerrada-Ortega1,2, Elizabeth Blears1,2,3, Christian Sommerhalder1,2, Kara McMullen4, Dagmar Amtmann4, Robert Cox2,5, Gabriel Hundeshagen1,2,6, Kristofer Jennings7, Linda E Sousse1,2, Oscar E Suman1,2, Walter J Meyer8, Celeste C Finnerty1,2,3. 1. Department of Surgery, The University of Texas Medical Branch, Galveston, TX. 2. Shriners Hospitals for Children - Galveston, Galveston, TX. 3. Institute for Translational Sciences, The University of Texas Medical Branch, Galveston, TX. 4. Department of Rehabilitation Medicine, The University of Washington, Seattle, WA. 5. Department of Pathology, The University of Texas Medical Branch, Galveston, TX. 6. Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany. 7. Department of Preventative Medicine and Community Health, The University of Texas Medical Branch, Galveston, TX. 8. Department of Psychiatry and Behavioral Science, The University of Texas Medical Branch, Galveston, TX.
Abstract
BACKGROUND: Massive burns induce a hypermetabolic response that leads to total body wasting and impaired physical and psychosocial recovery. The administration of propranolol or oxandrolone positively affects postburn metabolism and growth. The combined administration of oxandrolone and propranolol (OxProp) for 1 year restores growth in children with large burns. Here, we investigated whether the combined administration of OxProp for 1 year would reduce scarring and improve quality of life compared with control. STUDY DESIGN:Children with large burns (n = 480) were enrolled into this institutional review board-approved study; patients were randomized to control (n = 226) oradministration of OxProp (n = 126) for 1 year postburn. Assessments were conducted at discharge and 6, 12, and 24 months postburn. Scar biopsies were obtained for histology. Physical scar assessments and patient reported outcome measures of physical and psychosocial function were obtained. RESULTS:Reductions in cellularity, vascular structures, inflammation, and abnormal collagen (P < 0.05) occurred in OxProp-treated scars. With OxProp, scar severity was attenuated and pliability increased (both P < 0.05). Analyses of patient-reported outcomes showed improved general and emotional health within the OxProp-treated group (P < 0.05). CONCLUSIONS: Here, we have shown improvements in objective and subjective measures of scarring and an increase in overall patient-reported physical function. The combined administration of OxProp for up to a year after burn injury should be considered for the reduction of postburn scarring and improvement of long-term psychosocial outcomes in children with massive burns.
RCT Entities:
BACKGROUND: Massive burns induce a hypermetabolic response that leads to total body wasting and impaired physical and psychosocial recovery. The administration of propranolol or oxandrolone positively affects postburn metabolism and growth. The combined administration of oxandrolone and propranolol (OxProp) for 1 year restores growth in children with large burns. Here, we investigated whether the combined administration of OxProp for 1 year would reduce scarring and improve quality of life compared with control. STUDY DESIGN:Children with large burns (n = 480) were enrolled into this institutional review board-approved study; patients were randomized to control (n = 226) or administration of OxProp (n = 126) for 1 year postburn. Assessments were conducted at discharge and 6, 12, and 24 months postburn. Scar biopsies were obtained for histology. Physical scar assessments and patient reported outcome measures of physical and psychosocial function were obtained. RESULTS: Reductions in cellularity, vascular structures, inflammation, and abnormal collagen (P < 0.05) occurred in OxProp-treated scars. With OxProp, scar severity was attenuated and pliability increased (both P < 0.05). Analyses of patient-reported outcomes showed improved general and emotional health within the OxProp-treated group (P < 0.05). CONCLUSIONS: Here, we have shown improvements in objective and subjective measures of scarring and an increase in overall patient-reported physical function. The combined administration of OxProp for up to a year after burn injury should be considered for the reduction of postburn scarring and improvement of long-term psychosocial outcomes in children with massive burns.
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