The effects of several antiseptic agents on granulation tissue were studied using rabbit ear chambers as models of the healing wound. This enabled us to study dynamically the action of these agents on the microcirculation of the wound. All the agents tested caused some adverse effect, but in the cases of hypochlorite antiseptics Eusol and Chloramine T, blood flow in the capillary circulation of the granulation tissue ceased and the process of repair was subsequently delayed. A laser Doppler flowmeter was used to measure these changes in local perfusion which reflected the toxic effects seen on microscopy of the ear chamber.

We randomly allocated 100 patients undergoing colonic or rectal resections to have their anastomoses made either by a single layer of braided polyester interrupted sutures, or by the SPTU circular stapling instrument. Twelve anastomoses leaked, 4 being detected only by contrast enema. There was no difference in leak rate between the two anastomotic methods, but patients in the stapled group had a significantly higher incidence of minor wound infection, and spent significantly more days in hospital after operation. The stapling instrument is no safer than sutures for colonic and rectal anastomoses, but considerably facilities the performance of a low anterior resection.

The leakage rate of colonic anastomoses may be as high as 13%. A good blood supply is of paramount importance. However tissue perfusion may be at risk in the elderly and in low colorectal anastomoses. We have tested the effect of isoxsuprine, an agent which reduces blood viscosity, and is an α-adrenergic antagonist and β-adrenergic agonist, on the healing process in normal and ischaemic rat colon. Both bursting pressure and hydroxyproline concentration were significantly improved in compromised ischaemic colon in animals treated with isoxsuprine. Isoxsuprine may improve healing in poorly perfused colonic anastomoses.

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In this study we report the effects of flurbiprofen and prostaglandin E2 on anastomotic tensile strength, collagen synthesis, and collagenolytic activity which are in a particularly fine balance in colonic healing. Colonic anastomoses were fashioned in 150 Sprague-Dawley rats which were allocated to receive either 20 mcg prostaglandin E2 in 1 ml saline, 1 ml saline alone (control) intraperitoneally for three days post-operatively, or oral 2.5 mg/kg flurbiprofen daily. Anastomotic bursting pressures, collagen content and collagenolytic activity were measured at three, six, and ten days. It was found that prostaglandin E2-treated animals had significantly weaker anastomoses at three days (102 +/- 6.1 mm Hg; m +/- SEM) compared with the control (126 +/- 7.3; P less than 0.02) or flurbiprofen group (128 +/- 4.6; P less than 0.01) with no differences at six and ten days. Collagen levels were higher in flurbiprofen-treated rats at three days (9.7 +/- 0.2 micrograms hydroxyproline/mg tissue) compared with the control (8.1 +/- 0.4 micrograms/mg; P 0.01) or prostaglandin E2 group (7.2 +/- 0.5 micrograms/mg; P 0.001). These differences were unchanged at six days but were not statistically different at ten days. Collagenolytic activity showed no differences in the three groups during the study. It is concluded that flurbiprofen enhances colonic healing with improved collagen synthesis without affecting collagenolytic activity.