CHAPTER 4: WOUND REPAIR

Factors Affecting Wound Healing

• Resist infection

• Provide essential nutrients for tissue repair

• Support reparative cellular processes

Medical Conditions That Impair Wound Healing

Catabolic metabolic states (breakdown > buildup)

Impaired oxygen or nutrient delivery

Drug- or therapy-induced interference

Catabolic metabolic states (breakdown > buildup)

• Poorly controlled type 1 diabetes mellitus

• End-stage renal or hepatic disease

• Malignant diseases

Effect: Body is breaking down tissues faster than it can repair them, impairing healing.

Impaired oxygen or nutrient delivery

• Severe chronic obstructive pulmonary disease (COPD)

• Poorly compensated congestive heart failure (CHF)

• Drug addictions (e.g., ethanolism)

Effect: Wounded tissue does not receive enough oxygen or nutrients to support healing.

Drug- or therapy-induced interference

• Long-term corticosteroids for autoimmune diseases

• Cytotoxic agents or irradiation for malignancies

Effect: These therapies suppress the immune system or directly inhibit wound-healing cells.

What Surgeons Can Do to Optimize Healing

Preoperative evaluation and optimization:

• Assess general health status before elective surgery.

• Correct malnutrition to achieve:

  • Positive nitrogen balance → body is in anabolic (building) state

  • Adequate protein and nutrient availability for repair

Goal: Ensure the patient has the metabolic and immunologic capacity to heal efficiently.