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Mechanisms and prevention of decrease in wound margin strength in intestinal anastomoses and laparotomy wounds.

H Högström

    Acta Chirurgica Scandinavica. Supplementum
    |January 1, 1987
    PubMed
    Summary

    Wound healing strength decreases near incisions due to neutrophils. Serine proteinase inhibitors and free radical scavengers may prevent surgical complications like anastomotic dehiscence.

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    Area of Science:

    • Surgical pathology
    • Wound healing research
    • Biomaterials science

    Background:

    • Surgical incisions can experience a decrease in breaking strength post-operation.
    • This phenomenon is critical in preventing complications like anastomotic dehiscence and burst abdomen.
    • Understanding the underlying mechanisms is crucial for developing preventative strategies.

    Purpose of the Study:

    • To investigate the factors contributing to the early decrease in incisional wound breaking strength.
    • To identify the cellular and molecular mechanisms responsible for this strength reduction.
    • To evaluate the potential of therapeutic interventions in mitigating this effect.

    Main Methods:

    • Measurement of incisional wound breaking strength with sutures in situ at varying distances.

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  • Assessment of collagen content, solubility, and histological changes.
  • Induction of neutropenia using anti-neutrophil serum.
  • Administration of oxygen free radical scavengers and a serine proteinase inhibitor.
  • Measurement of myeloperoxidase activity and histological examination for neutrophil accumulation.

    • Main Results:

    • Breaking strength decreased markedly when sutures were placed close to the incision (1.5 mm) or in wounds under stretching.
    • Collagen content and histology showed insignificant early changes.
    • Neutropenia and serine proteinase inhibitors eliminated the strength decrease.
    • Oxygen free radical scavengers and collagenase inhibitors reduced, but did not eliminate, the decrease.
    • Neutrophil accumulation and myeloperoxidase activity were not reduced by the serine proteinase inhibitor.

    Conclusions:

    • A narrow zone of decreased tissue strength exists adjacent to incisional wounds.
    • Neutrophils appear to be the primary mediators of this early strength loss.
    • The mechanism likely involves a combination of neutral proteinases and oxygen free radicals.
    • Therapeutic strategies targeting neutrophil function may prevent surgical dehiscence.