Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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PEMF Modulates Cytokines in the Wound Milieu to Reduce Post-Operative Inflammation: Application to Autologous Breast Reconstruction
Naikhoba C. O. Munabi, B.A., June K. Wu, M.D., Erin M. Taylor, M.D., Jeffrey A. Ascherman, M.D., Arthur A. Pilla, Ph.D., Christine H. Rohde, M.D., M.P.H..
Columbia University, New York, NY, USA.

PURPOSE:
Non-thermal radio frequency pulsed electromagnetic fields (PEMF) have been reported to reduce pro-inflammatory cytokines and augment anti-inflammatory cytokines immediately after challenge in cellular and animal studies by enhancing calmodulin (CaM)-dependent nitric oxide (NO) signaling. We have reported that PEMF significantly reduces post-operative pain, narcotic requirements, and levels of a major pro-inflammatory cytokine, IL-1β, in wound exudates of breast reduction and autologous breast reconstruction patients. This study adds the effect of PEMF on a spectrum of inflammatory cytokines in the wound milieu of transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction patients.
METHODS:
In a double-blinded, placebo-controlled, randomized study, 32 patients underwent TRAM flap breast reconstruction followed by immediate application of an active PEMF or sham device to breast and abdominal surgical sites. The PEMF signal consisted of 2 msec bursts of a 27.12 MHz carrier repeating at 2 bursts/sec, and induced 5 V/m electric field. The sham PEMF device was outwardly indistinguishable from the active device, but did not deliver a signal. Wound exudates were collected beginning at 1 hour post-operatively and processed for cytokine analysis using a Millipore Multiplex Assay. IL-1α, IL-1β, IL-4, IL-6, IL-10, IL-13, TNFα, IFNg, MCP-1, G-CSF and GM-CSF levels were assayed through Luminex ELISA. Results from abdominal and breast wound exudates were combined for analysis.
RESULTS:
IL-4, IL-13, IFNg and GM-CSF were too low to detect. There were no significant differences between active and sham cohorts for G-CSF, IL-10, MCP-1 and TNFα at any time point. The pro-inflammatory cytokines IL-1α and IL-1β were about 2.2-fold higher in the sham cohort by 3 hours postoperatively, which persisted to 24 hours (P < 0.01, Figure 1A, 1B). The anti-inflammatory cytokine IL-6 was about 1.7-fold higher in the active cohort by 1 hour post-operatively, which persisted to 24 hours (P < 0.001, Figure 1C). Results at 12 hours post-operatively for all cytokines assayed are summarized in the Table.
CONCLUSION:
This study demonstrates that PEMF therapy rapidly lowers pro-inflammatory (IL-1α and IL-1β), and increases anti-inflammatory (IL-6) cytokines in the wound milieu of TRAM flap patients in the immediate post-operative period. To the authors’ knowledge, this is the first report of a PEMF effect on a panel of inflammatory mediators in a post surgical wound milieu. The dynamics of these cytokine responses are concurrent with PEMF enhanced post-operative pain reduction. These results are consistent with a mechanism involving a PEMF effect on CaM-dependent NO/cGMP signaling, which is known to down- and up-regulate inflammatory mediators in challenged biological systems. It is therefore proposed that PEMF acts through this signaling pathway to reduce post-operative pain, inflammation, narcotic use and morbidity in post surgical recovery.


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