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Reduced collagen accumulation after major surgery
L N Jorgensen1, F Kallehave, T Karlsmark
1Department of Urology, Hvidovre Hospital, Denmark.
Insights
Major surgery impairs the body's ability to heal, as shown by reduced collagen in wound healing tests. This diminished capacity was more pronounced in patients who developed postoperative infections.
Area of Science:
- Surgical Research
- Wound Healing Biology
- Biomaterials Science
Background:
- Assessing wound-healing capacity is crucial for surgical patient outcomes.
- Major surgeries can impact systemic physiological functions, including tissue repair.
- Objective measurement of wound healing provides reliable clinical data.
Purpose of the Study:
- To objectively evaluate the impact of major surgery on wound-healing capacity.
- To compare preoperative and postoperative subcutaneous collagen accumulation.
- To identify correlations between surgical stress and impaired healing.
Main Methods:
- Utilized expanded polytetrafluoroethylene (ePTFE) tubes for subcutaneous implantation in 23 patients.
- Measured hydroxyproline and proline accumulation in ePTFE tubes at 5 and 10 days, both pre- and post-surgery.
- Analyzed differences in collagen accumulation between preoperative and postoperative periods.
Main Results:
- A significant decline in hydroxyproline accumulation was observed post-surgery compared to pre-surgery (P=0.01).
- The reduction in collagen accumulation was significantly greater in patients with postoperative infections (P=0.02).
- Median hydroxyproline levels decreased from 2.91 to 1.45 µg/cm post-surgery.
Conclusions:
- Major abdominal, thoracic, or urological surgery leads to impaired subcutaneous collagen synthesis.
- This suggests a systemic reduction in wound-healing capacity following major surgical procedures.
- Postoperative infections exacerbate the impairment of wound-healing capacity.
Abstract:
The preoperative and postoperative wound-healing capacity of 23 patients undergoing elective major abdominal, thoracic or urological surgery was tested objectively by the subcutaneous accumulation of hydroxyproline and proline in an expanded polytetrafluoroethylene (ePTFE) tube. Before scheduled surgery two ePTFE tubes were implanted for removal after 5 and 10 days. This was repeated for each patient immediately after surgery. After 10 days a higher amount of hydroxyproline was measured before than after operation (median 2.91 (range 0.37-14.45) versus 1.45 (range 0.26-6.94) micrograms/cm, P = 0.01)). This decline was significantly higher in the six patients who had a postoperative infection (median 3.02 (range -0.06 to 6.14) versus 0.36 (range -1.56 to 12.60) micrograms/cm, P = 0.02). This study shows that major surgery is associated with impairment of subcutaneous collagen accumulation in a test wound, suggesting diminished systemic wound-healing capacity in such patients.