In-vitro external fixation pin-site model proof of concept: A novel approach to studying wound healing in transcutaneous implants

Abstract

External fixation is an essential surgical technique for treating trauma, limb lengthening and deformity correction, however infection is common, with infection rates ranging from 4.5 to 100% of cases. Throughout the literature researchers and clinicians have highlighted a relationship between excessive movement of the pin and skin and an increase in the patient’s risk of infection, however, currently no studies have addressed this role of pin-movement on pin-site wounds. This preliminary study describes a novel in vitro pin-site model, developed using a full-thickness human skin equivalent (HSE) model in conjunction with a bespoke mechanical system which simulates pin-movement. The effect of pin-movement on the wound healing response of the skin equivalents was assessed by measuring the expression of pro-inflammatory cytokines. Six human skin equivalent models were divided into three test groups: no pin as the control, static pin-site wound and dynamic pin-site wound ( n = 3). On day 3 concentrations of IL-1α and IL-8 showed a significant increase compared to the control when a static fixation pin was implanted into the skin equivalent ( p < 0.05) and ( p < 0.005) respectively. Levels of IL-1α and IL-8 increased further in the dynamic sample compared to the static sample ( p < 0.05) and ( p < 0.0005). This study demonstrates for the first time the application of HSE model to study external-fixation pin-movement in vitro. The results of this study demonstrated pin-movement has a negative effect on soft-tissue wound-healing, supporting the anecdotal evidence reported in the literature, however further analysis of wound heading would be required to verify this hypothesis.