Epidermal Nerve Fiber Quantification And Wound Healing Outcomes In A Head And Neck Surgery Cohort
Amy Anne D. Lassig1, Bruce Lindgren2, Anna Wilson1, Bryan McAdams2, William Kennedy2.
1University of Minnesota, Hennepin Healthcare Research Institute, Minneapolis, MN, USA, 2University of Minnesota, Minneapolis, MN, USA.
Introduction: Neuropathy and denervation are known to be associated with impaired wound healing in animal models and clinical populations. We sought to evaluate the association between epidermal nerve fiber characteristics and wound healing outcomes after head and neck surgery. Methods: A prospective cohort study was performed at a tertiary care hospital. Patients undergoing head and neck surgery for benign and malignant disease were recruited and enrolled. Full thickness cutaneous specimens were obtained at surgery and evaluated with immunohistochemical staining via confocal microscopy with quantification of epidermal nerve fibers. Cutaneous evaluation included antibody driven staining for protein gene product 9.5 (pan-neuronal staining), substance P (SP), calcitonin gene-related peptide (CGRP), vasoactive intestinal peptide (VIP), and nerve growth factor beta. Other utilized tissue antigens included endothelial marker - CD31, basement membrane marker - type IV collagen, and mast cell marker - tryptase. Patient characteristics and clinical outcomes were recorded. Results: 17 patients were enrolled with complete data collection. In this small sample size, while none of our analyses reached statistical significance, lower epidermal nerve fiber counts were associated with increased overall post-operative complications (p = 0.09), other complications (p = 0.11), and need for long term wound care after surgery (p = 0.21). Conclusions: Cutaneous nerve fibers are postulated to play an important role in acute wound healing. We quantitatively and qualitatively evaluate epidermal nerve fibers via confocal microscopy in the setting of acute wound healing after head and neck surgery; we find associations between lower nerve fiber counts and poorer wound healing outcomes in this small clinical cohort.
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