Abstract
Background
Our knowledge of afferent nerve fiber reinnervation of grafted skin following third-degree
burn is limited by a lack of quantitative histological and psychophysical assessment
from the same cutaneous area. The current study compares fiber profile and functional
recovery measurements in injured and control skin from the same subject.
Materials and methods
Nerve regeneration and modality-specific sensory thresholds were compared using immunocytochemical
labeling with protein gene product 9.5 antibody to stain all axons and anti-substance
P to label substance P axons (which are predominantly unmyelinated), as well as computerized
instrumentation to obtain psychophysical estimates.
Results
Compared to control skin, threshold measures of pinprick (P < 0.001), warming (P < 0.001), touch (P < 0.001), and vibration (P < 0.01) were significantly elevated in burn-graft skin and correlated with histological
analysis of skin biopsies obtained from the same site. Immunohistochemical staining
of all axons innervating the dermis and epidermis revealed a significant reduction
in burn-graft relative to control skin (54% decrease, P < 0.0001). In contrast, the incidence of substance P nerve fibers was significantly
elevated in burn-graft (177% increase, P < 0.05) and appeared to correlate with patient reports of pruritus and pain.
Conclusions
Observations support the hypothesis that sensory regeneration is fiber-size-dependent
in burn-graft skin. The findings that substance P fiber growth increased while total
fiber count decreased and that thermal threshold showed the greatest degree of functional
recovery suggest that unmyelinated neurons have the greater ability to transverse
scar tissue and reinnervate grafted skin following third-degree burn injury.
Keywords
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Article info
Publication history
Received:
July 16,
2003
Identification
Copyright
© 2004 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
