Impaired wound healing as a result of systemic diseases

Wound complications after kidney transplantation in nondiabetic patients

INTRODUCTION

Impaired wound healing represents a common operative complication after kidney transplantation. This problem seems to be affected by factors related to surgical technique, drugs, and patient/graft peculiarities.

PATIENTS AND METHODS

From January 2000 to December 2007, 350 consecutive kidney transplantations were performed in a population of nondiabetic patients. We evaluated the influence of various factors on impaired wound healing.

RESULTS

Among 350 kidney transplantation patients, we observed 54 cases (15.43%) of impaired healing of the surgical incision: 36 (10.29%) with first level and 18 (5.14%) with second level wound complications. Factors related to complications were overweight and delayed graft function. Cyclosporine and tacrolimus had similar effects. However, all patients developing second level complications showed more risk factors. In our experience, postoperative lymphocele did not occur as an unique factor but became a significant risk factor when associated with another one. Patients who did not have reconstruction of the muscle layers showed a greater incidence of incisional complications.

CONCLUSION

Impaired healing of the surgical incision more or less seriously influenced outcomes of transplanted patients. This complication was common and usually related to the presence of more than one risk factor.

Cachexia - an intrinsic factor in wound healing

Systemic diseases are intrinsic factors that alter and may impair the wound healing process. Cachexia is a manifestation of systemic, often chronic, diseases and is characterised by systemic inflammation, appetite suppression and skeletal muscle wasting. Anorexia in cachectic states is commonly associated with malnutrition. Malnutrition may cause impaired healing. Therefore, it would follow that cachexia could influence wound healing because of reduced food intake. However, the lack of response to measures to reverse cachexia, such as supported nutrition, would suggest that a direct causal link between anorexia and weight loss in cachexia is too simple a model. To date, there is no published literature that examines the role of cachexia in human wound healing specifically. This article aims to demonstrate that cachexia is an intrinsic factor in wound healing. The role of the common mediators in wound healing and in cachexia are compared - specifically inflammation, including the nitric oxide synthase pathway, collagen deposition and reepithelialisation.

Healing of surgical incision in kidney transplantation: a single transplant center's experience

INTRODUCTION

Impaired healing of the surgical incision represents a common complication after kidney transplantation. We led a retrospective study seeking to understand the factors linked to these complications and reasons for their reduction during the last year.

PATIENTS AND METHODS

From January 2000 to April 2004, 170 consecutive kidney transplantations were performed in a homogenous patient population. We evaluated the influence of following factors to determine impaired healing of the incision: antirejection drugs, overweight/obesity, age, delayed graft function (DGF), diabetes, and abdominal wall reconstruction technique.

RESULTS

Among 165 patients we observed 26 (15.76%) cases of impaired healing of the surgical incision: 17 (65,38%) with first-level and nine with second-level wound complications.

CONCLUSIONS

Impaired healing of the surgical incision influences the outcome of kidney transplant patients. In our study we observed that cyclosporine and tacrolimus similary affected the incision's healing. It was not possible to evaluate the role of basiliximab. A univariate analysis of the factors related to complications revealed overweight and DGF. However, all patients developing second-level complications showed more risk factors. Patients who had not had reconstruction of the muscle layers showed a greater incidence of surgical complications, whereas patients who had skin sutured with an intradermic technique did not show an increased risk.