Plasma Vitamin C and Serum Protein Levels in Wound Disruption

Abstract

The problem of disruption and evisceration of abdominal wounds still remains unsolved, and the comparative importance of the various factors concerned with the production of this condition still remains in dispute. In a recent review of the literature, two of us 1 analyzed 1,458 collected cases, including 33 cases occurring in the surgical service of the City of Detroit Receiving Hospital. As a result of this study, we came to the following conclusions : The incidence of this catastrophe is probably about 1.5 per cent, with a mortality of about 35 per cent. The age, sex and race are unimportant factors. Seasonal variations may have some bearing as far as they predispose to respiratory infections. The period when disruption is most likely to occur is from the fifth to the tenth postoperative day, the eighth day being the average.Logically the causes for failure of a wound to heal normally lie in the conditions affecting and retarding wound healing. Locally, one must consider incisions placed without regard to injury of the nerve and blood supply, as well as the severance of the transversus abdominis muscle, frequently making for a weak closure of the deep layer of the abdominal wall. Faulty technic resulting in traumatization of tissue and poor hemostasis, injudicious choice of and method of using suture material and the presence of infection are considered to predispose to wound disruption. In addition, those conditions tending to increase intra-abdominal tension, such as undue coughing, vomiting and intestinal distention, are thought to be of importance. They not only make for increased strain on the suture line but also interfere with immobilization of the part. In addi¬ tion to the local factors pertaining to the wound itself, there are certain general factors which undoubtedly exert an influence on wound healing. The underlying disease or the presence of concurrent systemic disease resulting in a poor general condition of the patient must not be overlooked. Any condition of the patient result¬ ing in a nutritional deficiency sufficient to produce low levels of ascorbic acid in the plasma and of protein in the serum of the blood must be considered important. There is also the possibility of an allergic response to catgut.At the completion of this review, we felt more in doubt than ever regarding the relative importance of the various factors contributing to disruption of the abdominal wound. In reviewing the work of other writers and in summarizing our own case records, we were impressed that we were attempting to draw con¬ clusions from inaccurate and incomplete data. Too frequently it has been necessary to study records which lack sufficient information to afford a basis for forming Aided by a grant from Frederic satisfactory conclusions. The basic problem is one of wound healing, and it is difficult to evaluate its com¬ ponents even when a direct attempt is made in an indi¬ vidual case. If a study of a series of cases of wound disruption is to be of real value, it would seem logical to attempt analysis of e...

Einfluß eiweißreicher Ernährung auf die postoperative Stickstoffbilanz bei Magenresezierten

“…Diese bleiben unersetzt, wenn der Operierte kein Ei weiß aufnimmt. Bei Eiweißmangel kann es zu verzögerter Wundheilung (12), Wundruptur (2,7,12,19), Nahtinsuffizienz an Enteroanastomosen (18), Darmatonie (9,12), verminderter Infekt resistenz, Anfälligkeit für Kreislaufkollaps, Oedem (Operations gebiet, Lungen usw.) (8,12,20) und Körpergewichtsverlust kom men.…”

Συρραφή Του Τραύματος Της Χαμηλής Εγκαρσίας Καισαρικής Τομής Εις Εν Στρώμα Και Υστερογραφικός Έλεγχος Της Ουλής

“…Έπί πειραματόζωων δε ευρέθησαν χαμηλαί τιμαί άσκορβικοϋ οξέος εις τον όρόν τοΰ. πλάσματος είς περιπτώσεις διασπάσεως τοϋ τραύ ματος ( 44 , 46 ). Ή ενέργεια τής βιταμίνης Κ συνίσταται είς τον σχηματισμόν τής προ θρομβίνης.…”