The Effects of Nitrofurazone on Wound Healing in Thoracoabdominal Full-Thickness Skin Defects

Sami Karapolat, MD; Banu Karapolat, MD; Alaaddin Buran, MD; Burcu Kemal Okatan, MD; AtilaTurkyilmaz, MD; Turan Set, MD; CelalTekinbas, MD

Disclosures

Wounds. 2020;32(5):134-141. 

In This Article

Results

The healing rate values at day 3 were 28.4% ± 2.8% for group A and 25.9% ± 4.9% for group B. At day 3, the statistical comparison of these parameters did not produce any significant difference (P = .276). The healing rate values at day 7 were 49.4% ± 1.6% in group A and 57.0 ± 2.8% in group B. The healing rate values at day 10 were 59.4% ± 3.1% in group A and 78.1% ± 2.4% in group B. The values obtained at days 7 and 10 for each group were compared statistically and a fairly significant difference was found in favor of group B (P < .001 for both).

The resected specimens were histologically evaluated and scored for inflammatory cells, collagen accumulation, granulation tissue formation, reepithelization, and features of skin defect in line with the scoring system (Table 1). All scores obtained for the above parameters in both groups and the average values of the scores are reported in Table 2. All of the histopathological results were statistically analyzed for significance.

The number of inflammatory cells was found to remain relatively constant throughout the experiment in group A (P = 1.000), whereas it decreased day by day in group B. In group B, the most significant statistical result was obtained between days 3 and 10 (P =.024). The scores relating to collagen accumulation tended to remain constant for the first 7 days in group A, showing an increase afterwards between days 7 and 10 (P = .038). Collagen accumulation increased day by day in group B; statistically significant results occurred between days 3 and 7 and between days 3 and 10 (P = .038 and P = .024, respectively).

The scores relating to granulation tissue formation went up in group A from day 7 and remained constant on the average through day 10; statistically significant differences were found between days 3 and 7 and between days 3 and 10 (P = .016 for both). The granulation tissue also increased in group B until day 7, but scores averaging close to 0 were observed at day 10; statistically significant differences were found between days 3 and 7 (P = .024), between days 3 and 10 (P = .020), and between days 7 and 10 (P = .011).

Reepithelization remained constant, with low scores throughout the experiment in group A (P >.05). Similar low scores were obtained on the average in group B until day 7, but there was a considerable increase in the scores between days 7 and 10 (P =.011).

For the features of the skin defect, high scores were obtained in group A from days 3 to 10 (P >.05), while the high scores seen at day 3 gradually decreased in group B averaging to 0 at day 10. Statistically significant differences were found in group B in terms of skin defect between days 3 and 10 and between days 7 and 10 (P =.014 and P =.026, respectively) (Figure 2 and Figure 3).

Figure 2.

(A) Group A, day 3: deep and wide ulcer formation in the middle parts, extensive inflammation, and granulation tissue (hematoxylin and eosin [H&E], magnification x4); (B) group A, day 7: deep and wide ulcer formation in the middle parts, extensive inflammation, and increased granulation tissue (H&E, magnification x4); (C) group A, day 10: deep and wide ulcer formation in the middle parts, extensive inflammation, and marked granulation tissue as well as slightly increased collagen tissue formation (H&E, magnification x4); and (D) group A, day 7: moderate collagen increase and marked granulation tissue (Masson's trichrome, magnification x4).

Figure 3.

(A) Group B, day 3: deep and wide ulcer formation, extensive inflammation, and granulation tissue (hematoxylin and eosin [H&E], magnification x4); (B) group B, day 7: surface ulcer formation, partial reepithelization, decrease in inflammatory cells, and granulation tissue becoming more apparent (H&E, magnification x4); (C) group B, day 10: healed ulcer areas, complete mature reepithelization, mild inflammation, and marked collagen accumulation (H&E, magnification x4); and (D) group B, day 10: marked collagen accumulation and complete surface epithelium formation (Masson's trichrome, magnification x4).

A comparison of the scores between groups A and B with respect to inflammatory cells, collagen accumulation, reepithelization, and features of skin defect showed there were statistically significant differences in favor of group B. No statistically significant difference was found between the 2 groups with respect to granulation tissue formation. All results obtained are shown in Table 2 and Figure 4 and Figure 5.

Figure 4.

Healing rates of group A (SF; control) and group B (nitrofurazone) during the study.

Figure 5.

The scores obtained for the 2 groups using the histopathological scoring system described in Table 1 for the categories of inflammatory cells, collagen accumulation, granulation tissue, reepithelization, and features of skin defect and the mean values of these at days 3, 7, and 10 of the experiment. SF: control group

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