Abstract
To compare aspects of wound healing after cleft lip surgery performed within one week of age and wound healing after surgery performed within 2 - 4 months of age, especially concentrations of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinases-1 (TIMP-1) in tissue removed during surgery. 34 tissue samples (26 boys and 8 girls) were removed during surgery within one week of age (n=19) or within 2 - 4 months of age (n=15). Tissue samples were separated into epidermis, dermis and mucous membrane. Proteins were extracted in cacodylic buffer for 24 h at a temperature 2 - 8 ºC. Total protein concentrations were examined using a modification of the Lowry method. Samples were examined using ELISA kit Amersham Biotrak Activity Assay (GE Healthcare UK) for detection of MMP-9 and TIMP-1 concentrations. MMP-9: early surgery - epidermis 2.168 ± 3.303 μg/g of protein (mean ± SD), dermis 1.251 ± 1.848 µg/g, 2 - 4 months surgery - epidermis 0.347 ± 0.212 μg/g, dermis 0.555 ± 0.276 µg/g. TIMP-1: early surgery - epidermis 1.762 ± 2.162 μg/g, dermis 1.628 ± 0.822 µg/g, mucous membrane 2.066 ± 1.717 µg/g, 2 - 4 months surgery - epidermis 1.881 ± 2.810 μg/g, dermis 3.117 ± 1.540 µg/g, mucous membrane 4.833 ± 6.550 µg/g. There were no significant differences in concentrations of protein MMP-9 in epidermis and dermis and TIMP-1 in epidermis and mucous membrane according to time of surgery. Significantly decreased levels of TIMP-1 in dermis were found in samples obtained from early surgery compared to levels in samples obtained from 2 - 4 months surgery.
Highlights
Cleft lip is one of most common congenital malformations in humans
Table 1. shows concentration of matrix metalloproteinase-9 (MMP-9) isolated from the lip tissue related to the age of children in the time of surgery. (Results expressed as mean ± SD)
While concentrations of Matrix metalloproteinases (MMPs)-9 were increased in tissue samples removed during surgery performed within 1 week, no significant differences in concentrations of protein MMP-9 between the two groups according to the time of the surgery were found
Summary
Labioplasty performed on infants to repair such defects often results in severe scar formation[1]. Wounds in fetuses heal rapidly and generally without scar formation until late gestation. Adult skin wounds heal by scar formation, while fetal skin wounds heal without scar formation by a process resembling regeneration rather than repair[2]. Relative to that in adults, fetal wound repair is characterized by more epithelization, fibroblast migration, extracellular matrix (ECM) deposition, and ultimate restoration of normal tissue architecture[3]. The amount and organization of ECM may be associated with scarless repair of fetal skin wounds[2]. The amount and organization of normal wound ECM are determined by a dynamic balance among overall matrix synthesis, deposition, and degradation[4]
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