Clin Exp Otorhinolaryngol.  2015 Dec;8(4):390-395. 10.3342/ceo.2015.8.4.390.

Effectiveness of Recombinant Human Growth Hormone for Pharyngocutaneous Fistula Closure

• Kucuk N
• Sari M
• Midi A
• Yumusakhuylu AC
• Findik O
• Binnetoglu A

• KMID: 2128916
• DOI: http://doi.org/10.3342/ceo.2015.8.4.390

Abstract

OBJECTIVES
In laryngeal cancer, which comprises 25% of head and neck cancer, chemotherapy has come into prominence with the increase in organ-protective treatments. With such treatment, salvage surgery has increased following recurrence; the incidence of pharyngocutaneous fistula has also increased in both respiratory and digestive system surgery. We investigated the effects of recombinant human growth hormone on pharyngocutaneous fistula closure in Sprague-Dawley rats, based on an increase in amino acid uptake and protein synthesis for wound healing, an increase in mitogenesis, and enhancement of collagen formation by recombinant human growth hormone.
METHODS
This study was experimental animal study. Forty Sprague-Dawley rats were separated into two groups, and pharyngoesophagotomy was performed. The pharyngoesophagotomy was sutured with vicryl in both groups. Rats in group 1 (control group) received no treatment, while those in group 2 were administered a subcutaneous injection of recombinant human growth hormone daily. On day 14, the pharynx, larynx, and upper oesophagus were excised and examined microscopically.
RESULTS
Pharyngocutaneous fistula exhibited better closure macroscopically in the recombinant human growth hormone group. There was a significant difference in collagen formation and epithelisation in the recombinant human growth hormone group compared to the control group.
CONCLUSION
This study is believed to be the first in which the effect of recombinant human growth hormone on pharyngocutaneous fistula closure was evaluated, and the findings suggest the potential of use of growth hormone for treatment of pharyngocutaneous fistula.

Keyword

Pharyngocutaneous Fistula; Recombinant Human Growth Hormone; Postoperative Laryngectomy Complications

MeSH Terms

Animals
Collagen
Digestive System
Drug Therapy
Fistula*
Growth Hormone
Head and Neck Neoplasms
Human Growth Hormone*
Humans*
Incidence
Injections, Subcutaneous
Laryngeal Neoplasms
Larynx
Pharynx
Polyglactin 910
Rats
Rats, Sprague-Dawley
Recurrence
Wound Healing
Collagen
Growth Hormone
Human Growth Hormone
Polyglactin 910

Figure

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  Fig. 1 Following a 3-cm vertical incision in the neck midline, subcutaneous muscles were eradicated. Following sternohyoid muscle lateralisation, the oesophagus was located under the trachea. A 1.5-cm incision was then made between the floor of the mouth and the upper oesophagus and sutured with 8.0 vicryl. The skin was closed with 4.0 silk.

• 

  Fig. 2 Macroscopic image of a closed fistula in the neck and macroscopic image of abscess formation in the neck.

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  Fig. 3 Macroscopic fistula formation.

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  Fig. 4 Epithelised fistula tract; decreased inflammatory cells and dense fibroblasts are seen around the fistula tract (arrow) in the control group (H&E, ×100).

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  Fig. 5 Fibroblast concentration.

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  Fig. 6 (A) The fibroblasts significantly decreased and collagen tissue accumulation was seen (arrow) in the recombinant human growth hormone group. (B) The granulation tissue rich in small capillary vessels (star) show delayed recovery in the control group (H&E, ×100).

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  Fig. 7 Collagen formation.

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  Fig. 8 (A) In the recombinant human growth hormone group with no fistula formation, formation of scars rich in collagen (arrow) was seen. (B) A fistula tract was evident with rich fibroblast formation and low inflammatory cell count around the fistula (star) in the control group (H&E, ×100).

• 

  Fig. 9 Surface epithelium.

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