Improved wound healing response in surgical patients receiving intravenous nutrition

The wound healing response was assessed in 90 surgical patients by measuring the accumulation of hydroxypyroline that occurred over a 7 day period, in fine tubes of thin walled GORE-TEX placed in the subcutaneous layers of the arm. In 47 patients presenting for intravenous nutrition, the wound healing response was less (0.34 +/- 0.23 microgram hydroxyproline/cm of tubing) than that of 36 normally nourished patients (0.49 +/- 0.30 microgram/cm; P less than 0.01). However, it was higher when measured after intravenous feeding had commenced (0.88 +/- 0.62 microgram/cm; P less than 0.005). In 29 patients two sequential studies of wound healing were conducted over a 14-day period of intravenous nutrition. The mean accumulation of hydroxyproline during the first week of intravenous nutrition was 0.36 +/- 0.24 microgram/cm and this was increased significantly over the second week of feeding to 0.78 +/- 0.67 microgram/cm; P less than 0.005. The wound healing response that occurred in wounds made after a period of pre-operative nutrition was better than that which occurred when only postoperative nutrition had been given (P less than 0.02). These results show that the wound healing response in surgical patients requiring intravenous nutrition is improved by this treatment. This improvement is seen after only one week of therapy and before there is an obvious change in nutritional status. It also appears that the improved wound healing response is more marked when intravenous nutrition is given before, rather than after the surgical procedure.