Post tonsillectomy wound healing

Over one million tonsillectomies are performed annually in the United States and Europe. Secondary post-tonsillectomy hemorrhage (PTH) is a significant burden to the health care system in terms of emergency department revisits, inpatient readmissions, and reoperation. 

 It has been previously theorized that secondary PTH is due to premature separation of an eschar or fibrin scab from the underlying wound, although this theory is not universally accepted and has not been demonstrated histologically in any prior studies.

Our research shows that the likely cause of secondary PTH is epithelial separation and wound contraction occurring concurrently with neovascularization. This exposes neovasculature to an uncovered and unprotected surface leaving new vessels at a higher risk of bleeding. This occurs most commonly from post-operative day six to nine.

Our lab developed a growth factor intervention that altered the timing of the wound healing events so that wound contraction and epithelial separation occurred prior to maximal neovascularization. Neovascularization therefore occurs at a time when there is a more mature epithelial covering of the wound, reducing the risk of exposed blood vessels in the wound bed.

Oral epithelialisation in wound healing

Post chemotherapy and radiotherapy mucositis of the oral cavity is often a dose limiting toxicity limiting optimal therapy for patients. Its incidence can be as high as 80% in head and neck radiation and 40% incidence in standard radiation. Annually, there are approximately 400,000 cases of treatment-induced damage to the oral cavity.

After radiation healing occurs by epithelial proliferation and migration. We are collaborating with the Knox lab at Stanford working with animal models of mucositis to develop preventative treatments.