Tipos de heridas
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VOLUME: 22 PUBLICATION DATE: Feb 01 2010
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Issue: 2 February 2010
Start Page: 27
End Page: 31
author:
Erdinc Kamer, MD; Haluk Recai Unalp, MD; Omer Gundogan, MD; Gulden Diniz, MD; Ragip Ortac, MD; Murat Olukman, MD; Hayrullah Derici, MD; Mehmet Ali Onal, MDAbstract: Background. Abdominal wall repair after celiotomy is important because insufficient incisional wound strength results in wound failures such as fascial dehiscence and herniation. Ascorbic acid has been shown to play an important role in wound healing. The purpose of this study was to investigate whether ascorbic acid improves incisional wound healing in a diabetic rat. Methods. MaleWistar-Albino streptozosin-induced diabetic rats (n = 20) were divided into two groups: control group (CG; n = 10), and daily 200 mg/kg ascorbic acid (study group, [SG], n = 10) given orally. Ten animals from each group were euthanized on postoperative day (POD) 14 after wounding; breaking strength, histologic examination, and tissue hydroxyproline levels were analyzed. Results. The hydroxyprolinetissue content of the abdominal fascia in the ascorbic acid treatment group was superior to the control group, and the difference was statistically significant (P < 0.05). The tensiometric analyses revealed that tensile strength for the midline incision was significantly higher in the study group compared to the control group (P < 0.05). Significant differences were found in the results ofhistologic examination of tissue specimens between the two groups regarding acute inflammation, chronic inflammation, granulation tissue fibroblast maturation, collagen deposition, and neovascularization on POD 14 (P < 0.05). Conclusion. The present study demonstrates that administration of ascorbic acid prior to laparotomy expedites wound healing in a rat. On the contrary, we suggest that it couldconfer benefits to tissue healing by significantly enhancing tissue hydroxyproline levels, neovascularization, fibroblast maturation, and collagen deposition.
Address correspondence to:
Erdinc Kamer, MD Department of Surgery
Izmir Ataturk Training and Research Hospital
1834 sk. No:9/4, 35530 Karsiyaka Izmir, Turkey
Phone: +90 232 2444444/2546
E-mail: erdinc.kamer@gmail.com
Healingof the abdominal wall wound following celiotomy is important because insufficient incisional wound strength results in prolonged periods of disability for the patient secondary to fascial dehiscence and hernia formation.1 Wound healing is a natural restorative response to tissue injury. It is a complex and dynamic process with reconstitution and restoration of the tensile strength of injured skinor tissue.2 The normal healing process in healthy individuals takes place at an optimal rate but it is usually delayed or even impaired completely among patients with diabetes.3 This impaired wound healing in diabetes mellitus is a significant clinical problem. High blood glucose hinders proliferation of cells and decreases collagen production. Furthermore, decreased chemotaxis and phagocytosis,a reduction in the levels of growth factors, and the inhibition of fibroblast proliferation have all been suggested to contribute to the observed impairment in wound healing.3
Ascorbic acid (vitamin C) has been shown in earlier investigations to have an unparalleled stimulatory effect on collagen-type synthesis.4 Ascorbic acid is an important modulator of collagen production and acts as acofactor in hydroxylation of proline and lysine residues in procollagen.5 Ascorbic acid has been reported to increase collagen deposition and tensile strength in experimental models of wound repair. The role of ascorbic acid in the healing of injured tissues has been investigated in a variety of studies.6 However, effect of ascorbic acid on the incisional wound healing has not been studied in...
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