PERFUSION, MICROVASCULAR DISEASE, AND WOUND HEALING

Abstract

SUMMARY The common findings in these systemic diseases that can result in poor wound healing are anatomic and biochemical changes in the microvascular structure and function. The common outcome is tissue hypoxia in the wound microenvironment. Whereas the normal healing wound exhibits central hypoxia, and this is known to promote angiogenesis, oxygenation from the periphery must be adequate for normal healing to occur. It is clear that low tissue oxygen tensions impair healing.12 Whereas the typical wound-healing problems in diabetes, connective tissue diseases, and Buerger's disease are seen in the extremities, evidence suggests that the microvascular changes with resulting tissue inability to respond to the demands of healing occur in many or all tissues. Although we think of the blood supply to the head and neck region as generally adequate for healing, in these patients it is not basal supply, but the ability of the microvasculature to vasodilate and produce the hyperemic response to trauma that is crucial for wound healing. Consideration must be given to these findings in treating patients whose systemic disease may result in poor tissue oxygenation. Because inadequate tissue oxygenation predisposes to infection,22 antibiotic therapy or hyperbaric oxygen therapy or both may be indicated, based on clinical findings. Incisions should be designed to maximize postoperative blood supply to the wound.” Local treatment of the ischemic wound with topical oxygen-releasing compounds is an experimental technique that may increase perfusion and wound oxygenation.21 Recognition and management of the underlying systemic disease are clearly of major importance. As clearly has been shown in diabetes, microvascular complications are associated with long-term poor control of glucose levels.1 With understanding of the underlying disorder of wound healing in these conditions, therapy may be modified to maximize the desired clinical outcome.