Nutritional Module 2 -- Page 12

BURNSURGERY.COM RESEARCH ABSTRACT SERIES

THE ANTI CATABOLIC AND WOUND HEALING EFFECTS OF THE TESTOSTERONE
ANALOG OXANDROLONE AFTER SEVERE BURN INJURY

By Demling Md., and DeSanti R.N. and Orgill Md., PhD

ABSTRACT

Purpose: Severe burn injury leads to marked catabolism and decreased lean mass which can impair healing. Anabolic agents can attenuate net catabolism. Our purpose was to determine whether the testosterone analog, oxandrolone, given during the acute post burn period decreased the degree of nitrogen loss and loss of body weight while also increasing the healing rate of a skin donor site.

Methods: Patients with burns between 40 and 70% of body surface were studied. A randomized double blinded placebo controlled study design was used. Patients were given oxandrolone 20 mg/day (n=11) or a placebo 20 mg/day (n=9) beginning between days 2-3 post burn. Net nitrogen balance and the healing time of a standardized donor site were measured. Patients were monitored until transferred to a burn rehabilitation facility, an average time period of 33 + 9 days.

Results: Mean burn size was 49 ± 8% for placebo and 53 ± 9% of TBS for the oxandrolone group. Smoke inhalation was present in approximately 50% of patients in both groups. All patients survived the burn injury. Net weight loss was 8 ± 3.1 kg in the placebo group compared with 3 ± 1.9 kg in the oxandrolone group, a statistically significant decrease. Net daily nitrogen loss over a 3 week period (day 7-28) was 13 ± 4 g in placebo treated compared to 4 ± 1.9 g for the oxandrolone group, a statistically significant decrease. The healing time of a standardized donor site, decreased from the placebo group value of 13 ± 3 days to 9 ± 2 days for oxandrolone treated patients, a significant improvement. No major liver dysfunction, or other complication attributable to an anabolic steroid was seen in either group.

Conclusion: We found, the anabolic agent, oxandrolone significantly decreased weight loss and net nitrogen loss and increased donor site wound healing compared to placebo controls. We noted no complications with the use of oxandrolone.

TABLE ONE ( PART A )

PATIENT AGE % TBS BURN %TBS GRAFTED INHALATION INJURY

LA 38 40 41 NO

DG 43 58 40 YES

AS 55 45 31 NO

RG 35 42 28 YES

KR 39 48 37 YES

DK 37 65 51 YES

TK 72 44 32 NO

RH 35 51 35 NO

Mean 44± 6 49± 7 39± 4 50 %

TABLE ONE ( PART B )

PATIENT AGE % TBS BURN % TBS GRAFTED INHALATION INJURY

WD 46 55 40 No

WL 43 41 25 No

AS 46 54 39 No

RC 44 51 40 Yes

DM 44 64 28 No

AZ 75 42 36 Yes

WZ 45 51 38 Yes

PM 38 48 32 No

AB 39 45 26 Yes

RS 49 59 40 Yes

AS 52 65 45 Yes

Mean± SD 49± 13 54± 9 36± 8 52%

TABLE TWO

Anabolic And Wound Healing Effects
Of Oxandrolone vs. Placebo After Burn Injury

MEAN ± SD

PLACEBO
(N = 8)

OXANDROLONE
(N = 11)

Donor Site
Healing/Days

13 ± 3

9 ± 2*

Net Wt Loss
(Kg)

8 ± 3

3 ± 2*

Net Nitrogen loss grams/ day #

13 ± 4

4 ± 2*

Metabolic Rate +
(% increase)

65 ± 13

63 ± 14

Mild Liver Changes
(% total)

57

50

Progressive Liver Dysfunction

0

0

# mean loss between days 7-28

* significantly different from placebo p< 0.05

+ normal metabolic rate as predicted by age, size, sex and a mild activity level

PATIENT	AGE	% TBS BURN	%TBS GRAFTED	INHALATION INJURY

LA	38	40	41	NO
DG	43	58	40	YES
AS	55	45	31	NO
RG	35	42	28	YES
KR	39	48	37	YES
DK	37	65	51	YES
TK	72	44	32	NO
RH	35	51	35	NO
Mean	44± 6	49± 7	39± 4	50 %

PATIENT	AGE	% TBS BURN	% TBS GRAFTED	INHALATION INJURY

WD	46	55	40	No
WL	43	41	25	No
AS	46	54	39	No
RC	44	51	40	Yes
DM	44	64	28	No
AZ	75	42	36	Yes
WZ	45	51	38	Yes
PM	38	48	32	No
AB	39	45	26	Yes
RS	49	59	40	Yes
AS	52	65	45	Yes
Mean± SD	49± 13	54± 9	36± 8	52%

Anabolic And Wound Healing Effects Of Oxandrolone vs. Placebo After Burn Injury
MEAN ± SD	PLACEBO (N = 8)	OXANDROLONE (N = 11)
Donor Site Healing/Days	13 ± 3	9 ± 2*
Net Wt Loss (Kg)	8 ± 3	3 ± 2*
Net Nitrogen loss grams/ day #	13 ± 4	4 ± 2*
Metabolic Rate + (% increase)	65 ± 13	63 ± 14
Mild Liver Changes (% total)	57	50
Progressive Liver Dysfunction	0	0