Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1991 Nov;214(5):605–613. doi: 10.1097/00000658-199111000-00011

Tissue oxygenation, anemia, and perfusion in relation to wound healing in surgical patients.

K Jonsson 1, J A Jensen 1, W H Goodson 3rd 1, H Scheuenstuhl 1, J West 1, H W Hopf 1, T K Hunt 1
PMCID: PMC1358617  PMID: 1953114

Abstract

Oxygen tension and collagen deposition were measured in standardized, subcutaneous wounds in 33 postoperative surgical patients. Pertinent clinical and wound parameters were analyzed by Pearson's correlation test and sequential linear regression analysis. Collagen deposition was directly and significantly proportional to wound oxygen tension and measures of perfusion. There were no significant correlations with hematocrit, estimated blood loss, length of operation, smoking, age, weight, sex, or urine output. This study in humans confirms animal experiments showing that collagen deposition and tensile strength in wounds are limited by perfusion and tissue oxygen tension. It appears unnecessary to maintain hemoglobin at normal levels to support repair, provided that peripheral perfusion can be maintained at a high level in compensation for anemia. These circumstances reflect the fact that although oxygen is essential to many aspects of healing, and must be delivered at adequate partial pressures, reparative tissue consumes relatively little of it.

Full text

PDF
613

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bains J. W., Crawford D. T., Ketcham A. S. Effect of chronic anemia on wound tensile strength: correlation with blood volume, total red blood cell volume and proteins. Ann Surg. 1966 Aug;164(2):243–246. doi: 10.1097/00000658-196608000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Barbul A., Lazarou S. A., Efron D. T., Wasserkrug H. L., Efron G. Arginine enhances wound healing and lymphocyte immune responses in humans. Surgery. 1990 Aug;108(2):331–337. [PubMed] [Google Scholar]
  3. Chang N., Goodson W. H., 3rd, Gottrup F., Hunt T. K. Direct measurement of wound and tissue oxygen tension in postoperative patients. Ann Surg. 1983 Apr;197(4):470–478. doi: 10.1097/00000658-198304000-00017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chvapil M., Hurych J., Ehrlichová E. The influence of various oxygen tensions upon proline hydroxylation and the metabolism of collagenous and non-collagenous proteins in skin slices. Hoppe Seylers Z Physiol Chem. 1968 Feb;349(2):211–217. doi: 10.1515/bchm2.1968.349.1.211. [DOI] [PubMed] [Google Scholar]
  5. Chvapil M., Peng Y. M. Oxygen and lung fibrosis. Arch Environ Health. 1975 Nov;30(11):528–532. doi: 10.1080/00039896.1975.10666770. [DOI] [PubMed] [Google Scholar]
  6. De Jong L., Kemp A. Stoicheiometry and kinetics of the prolyl 4-hydroxylase partial reaction. Biochim Biophys Acta. 1984 May 31;787(1):105–111. doi: 10.1016/0167-4838(84)90113-4. [DOI] [PubMed] [Google Scholar]
  7. Evans N. T., Naylor P. F. Steady states of oxygen tension in human dermis. Respir Physiol. 1966 Dec;2(1):46–60. doi: 10.1016/0034-5687(66)90037-5. [DOI] [PubMed] [Google Scholar]
  8. Fong T. P., Ko S. T., Streczyn M., Westerman M. P. Chronic anemia, wound healing, and red cell 2,3-diphosphoglycerate. Surgery. 1976 Feb;79(02):218–223. [PubMed] [Google Scholar]
  9. GRANT R. A. ESTIMATION OF HYDROXYPROLINE BY THE AUTOANALYSER. J Clin Pathol. 1964 Nov;17:685–686. doi: 10.1136/jcp.17.6.685. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Goodson W. H., 3rd, Andrews W. S., Thakral K. K., Hunt T. K. Wound oxygen tension of large vs small wounds in man. Surg Forum. 1979;30:92–95. [PubMed] [Google Scholar]
  11. Goodson W. H., 3rd, Hunt T. K. Development of a new miniature method for the study of wound healing in human subjects. J Surg Res. 1982 Nov;33(5):394–401. doi: 10.1016/0022-4804(82)90054-3. [DOI] [PubMed] [Google Scholar]
  12. Goodson W. H., 3rd, Lopez-Sarmiento A., Jensen J. A., West J., Granja-Mena L., Chavez-Estrella J. The influence of a brief preoperative illness on postoperative healing. Ann Surg. 1987 Mar;205(3):250–255. doi: 10.1097/00000658-198703000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Gottrup F., Firmin R., Chang N., Goodson W. H., 3rd, Hunt T. K. Continuous direct tissue oxygen tension measurement by a new method using an implantable silastic tonometer and oxygen polarography. Am J Surg. 1983 Sep;146(3):399–403. doi: 10.1016/0002-9610(83)90427-0. [DOI] [PubMed] [Google Scholar]
  14. Gottrup F., Firmin R., Rabkin J., Halliday B. J., Hunt T. K. Directly measured tissue oxygen tension and arterial oxygen tension assess tissue perfusion. Crit Care Med. 1987 Nov;15(11):1030–1036. doi: 10.1097/00003246-198711000-00008. [DOI] [PubMed] [Google Scholar]
  15. Guiney D. J., Morris P. J., Donaldson G. A. Wound dehiscence. A continuing problem in abdominal surgery. Arch Surg. 1966 Jan;92(1):47–51. doi: 10.1001/archsurg.1966.01320190049011. [DOI] [PubMed] [Google Scholar]
  16. Haydock D. A., Hill G. L. Improved wound healing response in surgical patients receiving intravenous nutrition. Br J Surg. 1987 Apr;74(4):320–323. doi: 10.1002/bjs.1800740432. [DOI] [PubMed] [Google Scholar]
  17. Hunt T. K., Pai M. P. The effect of varying ambient oxygen tensions on wound metabolism and collagen synthesis. Surg Gynecol Obstet. 1972 Oct;135(4):561–567. [PubMed] [Google Scholar]
  18. Jensen J. A., Goodson W. H., 3rd, Omachi R. S., Lindenfeld S. M., Hunt T. K. Subcutaneous tissue oxygen tension falls during hemodialysis. Surgery. 1987 Apr;101(4):416–421. [PubMed] [Google Scholar]
  19. Jensen J. A., Goodson W. H., 3rd, Vasconez L. O., Hunt T. K. Wound healing in anemia. West J Med. 1986 Apr;144(4):465–467. [PMC free article] [PubMed] [Google Scholar]
  20. Jonsson K., Jensen J. A., Goodson W. H., 3rd, West J. M., Hunt T. K. Assessment of perfusion in postoperative patients using tissue oxygen measurements. Br J Surg. 1987 Apr;74(4):263–267. doi: 10.1002/bjs.1800740413. [DOI] [PubMed] [Google Scholar]
  21. Knighton D. R., Silver I. A., Hunt T. K. Regulation of wound-healing angiogenesis-effect of oxygen gradients and inspired oxygen concentration. Surgery. 1981 Aug;90(2):262–270. [PubMed] [Google Scholar]
  22. Madden J. W., Peacock E. E., Jr Studies on the biology of collagen during wound healing. I. Rate of collagen synthesis and deposition in cutaneous wounds of the rat. Surgery. 1968 Jul;64(1):288–294. [PubMed] [Google Scholar]
  23. Myllylä R., Tuderman L., Kivirikko K. I. Mechanism of the prolyl hydroxylase reaction. 2. Kinetic analysis of the reaction sequence. Eur J Biochem. 1977 Nov 1;80(2):349–357. doi: 10.1111/j.1432-1033.1977.tb11889.x. [DOI] [PubMed] [Google Scholar]
  24. Niinikoski J. Effect of oxygen supply on wound healing and formation of experimental granulation tissue. Acta Physiol Scand Suppl. 1969;334:1–72. [PubMed] [Google Scholar]
  25. Ninikoski J. Oxygen and wound healing. Clin Plast Surg. 1977 Jul;4(3):361–374. [PubMed] [Google Scholar]
  26. Pietilä K., Jaakkola O. Effect of hypoxia on the synthesis of glycosaminoglycans and collagen by rabbit aortic smooth muscle cells in culture. Atherosclerosis. 1984 Feb;50(2):183–190. doi: 10.1016/0021-9150(84)90021-2. [DOI] [PubMed] [Google Scholar]
  27. Prockop D. J., Kivirikko K. I., Tuderman L., Guzman N. A. The biosynthesis of collagen and its disorders (first of two parts). N Engl J Med. 1979 Jul 5;301(1):13–23. doi: 10.1056/NEJM197907053010104. [DOI] [PubMed] [Google Scholar]
  28. SANDBERG N., ZEDERFELDT B. Influence of acute hemorrhage on wound healing in the rabbit. Acta Chir Scand. 1960 Apr 14;118:367–371. [PubMed] [Google Scholar]
  29. Shandall A., Lowndes R., Young H. L. Colonic anastomotic healing and oxygen tension. Br J Surg. 1985 Aug;72(8):606–609. doi: 10.1002/bjs.1800720808. [DOI] [PubMed] [Google Scholar]
  30. Stephens F. O., Hunt T. K. Effect of changes in inspired oxygen and carbon dioxide tensions on wound tensile strength: an experimental study. Ann Surg. 1971 Apr;173(4):515–519. doi: 10.1097/00000658-197104000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Trueblood H. W., Nelsen T. S., Oberhelman H. A., Jr The effect of acute anemia and iron deficiency anemia on wound healing. Arch Surg. 1969 Jul;99(1):113–116. doi: 10.1001/archsurg.1969.01340130115023. [DOI] [PubMed] [Google Scholar]
  32. Uitto J., Prockop D. J. Synthesis and secretion of under-hydroxylated procollagen at various temperatures by cells subject to temporary anoxia. Biochem Biophys Res Commun. 1974 Sep 9;60(1):414–423. doi: 10.1016/0006-291x(74)90220-4. [DOI] [PubMed] [Google Scholar]
  33. WATERMAN D. F., BIRKHILL F. R., PIRANI C. L., LEVENSON S. M. The healing of wounds in the presence of anemia. Surgery. 1952 Jun;31(6):821–828. [PubMed] [Google Scholar]
  34. ZEDERFELDT B. Studies on wound healing and trauma; with special reference to intravascular aggregation of erythrocytes. Acta Chir Scand Suppl. 1957;224:1–85. [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES