Effects of Perioperative Antiinflammatory and Immunomodulating Therapy on Surgical Wound Healing

Abstract

Patients with various rheumatologic and inflammatory disease states commonly require drugs known to decrease the inflammatory or autoimmune response for adequate control of their condition. Such drugs include nonsteroidal antiinflammatory drugs (NSAIDs), cyclooxygenase (COX)-2 inhibitors, corticosteroids, disease-modifying antirheumatic drugs (DMARDs), and biologic response modifiers. These drugs affect inflammation and local immune responses, which are necessary for proper wound healing in the perioperative setting, thereby potentially resulting in undesirable postoperative complications. Such complications include wound dehiscence, infection, and impaired collagen synthesis. The end result is delayed healing of soft tissue and bone wounds. The current literature provides insight into the effect of some of these drugs on wound healing. For certain drugs, such as methotrexate, trials have been conducted in humans and direct us on what to do during the perioperative period. Whereas with other drugs, we must rely on either small-animal studies or extrapolation of data from human studies that did not specifically look at wound healing. Unfortunately, no clear consensus exists on the need and optimum time for withholding therapy before surgery. Likewise, clinicians are often uncertain of the appropriate time to resume therapy after the procedure. For those drugs with limited or no data in this setting, the use of pharmacokinetic properties and biologic effects of each drug should be considered individually. In some cases, discontinuation of therapy may be required up to 4 weeks before surgery because of the long half-lives of the drugs. In doing so, patients may experience an exacerbation or worsening of disease. Clinicians must carefully evaluate individual patient risk factors, disease severity, and the pharmacokinetics of available therapies when weighing the risks and benefits of discontinuing therapy in the perioperative setting.

Physical, antibacterial and antioxidant properties of chitosan films incorporated with thyme oil for potential wound healing applications

“…In addition, Braga et al pointed that thymol can have helpful effects in controlling the inflammatory process present in many infections, which is necessary for proper wound healing [19]. Since inflammation causes many complications including wound dehiscence, infection and impaired collagen synthesis, anti-inflammatory effects of thymol would be promising when thyme essential incorporated wound healing material is used [20]. The antimicrobial activity mechanism is commonly considered as resulted by disturbing the function of the cytoplasmic membrance, disrupting the active transport of nutrients to the cell membrane, and coagulation of bacteria cell contents [12,21].…”

Perioperative Surgical Site Infections and Complications in Elective Orthopedic Surgery in Patients with Rheumatoid Arthritis Treated with Anti-Tumor Necrosis Factor-Alpha Agents − Discontinue or Not, Clinical Dilemma

“…TNF blockers (IFX; 35 The Committee on Arthritis of the Japanese Orthopedic Association [29] investigated the prevalence of postoperative complications in patients with RA in teaching hospitals in Japan. The number of surgical procedures under treatment with biologic agent was 3,468 (IFX; 1,616, ETN; 1686, ADA; 41, TCZ; 102, abatacept; 23) and the prevalence of infection was 1.3% (46 procedures).…”

“…Patients with RA are already predisposed to impaired wound healing as a result of reduction in skin thickness [2,35]. Thus, many orthopaedic surgeons consider the risk of wound healing complication to be high in RA patients, especially treated with TNF blockers [36].…”

Rheumoorthopedy: actual questions of preoperational period

“…A.Busty с соавт. [8] провели клинико-эксперимен тальное исследование в отношении влияния таких антиревматических средств, как нестероидные про тивовоспалительные препараты (НПВП), глюко-кортикоиды (ГК), базисные противовоспалитель ные препараты (БПВП),биологические агенты, на различные фазы раневого процесса в послеопера ционном периоде. Оказалось , что все эти препа раты, назначаемые больным РЗ с целью сниже ния активности воспалительного процесса и кон тролирования ее на низком уровне, одновременно подавляют физиологические процессы воспаления и иммунного ответа на разных этапах раневого про цесса.…”