Inflammation in surgical wound healing: Friend or foe?

Abstract

In 1922, Dr Alexis Carrel1 Carrel A. Growth-promoting function of leucocytes. J Exp Med. 1922; 36: 385-391 Crossref PubMed Scopus (57) Google Scholar demonstrated that leukocytes were capable of producing factors that stimulated cellular proliferation. Since that time, the appropriate function of inflammatory cells has been generally considered indispensable for successful wound healing. Landmark studies in the early 1970s and 1980s demonstrated that immune cells, particularly macrophages, are critical to wound healing, and the role of macrophages as mediators of angiogenesis and fibroplasia has been established firmly. 2 Leibovich S.J. Ross R. The role of the macrophage in wound repair: a study with hydrocortisone and antimacrophage serum. Am J Pathol. 1975; 78: 71-100 PubMed Google Scholar , 3 Hunt T.K. Knighton D.R. Thakral K.K. et al. Studies on inflammation and wound healing: angiogenesis and collagen synthesis stimulated in vivo by resident and activated wound macrophages. Surgery. 1984; 96: 48-54 PubMed Google Scholar The study of wound inflammation continues to receive intense attention, with more than 1000 articles on the topic published within the past five years. There is little argument that proper leukocyte activity assists in microbial decontamination of wounds. In addition, there are several logical arguments in support of a role for leukocytes in healing, even for sterile wounds. First, phagocytic leukocytes, as well as lymphocytes, produce multiple growth factors that promote the repair process. Second, the cellular death and tissue remodeling that occur during injury and repair would seem to require phagocytic clearance for complete resolution. Finally, studies in a variety of model systems suggest that key inflammatory cytokines are critical to wound healing. 4 Gillitzer R. Goebeler M. Chemokines in cutaneous wound healing. J Leukoc Biol. 2001; 69: 513-521 PubMed Google Scholar Despite these previous findings, other recent studies challenge the established paradigm and suggest that the role of leukocytes in the repair of sterile or minimally contaminated wounds requires reevaluation.