Here - EWMA 2013

ORAL PRESENTATIONS
116
EWMA UCM Lecture
THE PATHOPHYSIOLOGICAL IMPACT OF SMOKING, SMOKING CESSATION AND
NICOTINE REPLACEMENT THERAPY ON WOUND HEALING
Lars Tue Sørensen 1
1 Copenhagen Wound Healing Center & Department of Surgery K, Bispebjerg Hospital;
University of Copenhagen (Copenhagen, Denmark).
Objective: To clarify how smoking and nicotine affects wound healing processes and to
establish if smoking cessation and nicotine replacement therapy reverse the
mechanisms involved.
Summary background data: Smoking is a recognized risk factor for healing
complications after surgery, but the pathophysiological mechanisms remain largely
unknown.
Methods: Pathophysiological studies addressing smoking and wound healing were
identified through electronic databases (PubMed, EMBASE) and by hand-search of
articles’ bibliography. Of the 1460 citations identified, 325 articles were retained following
title and abstract reviews. In total, 177 articles were included and systematically
reviewed.
Results: Smoking decreases tissue oxygenation and aerobe metabolism temporarily.
The inflammatory healing response is attenuated by a reduced inflammatory cell
chemotactic responsiveness, migratory function, and oxidative bactericidal mechanisms.
In addition¸ the release of proteolytic enzymes and inhibitors is imbalanced. The
proliferative response is impaired by a reduced fibroblast migration and proliferation in
addition to a down regulated collagen synthesis and deposition. Smoking cessation
restores tissue oxygenation and metabolism rapidly. Inflammatory cell response is
reversed in part within 4 weeks, whereas the proliferative response remains impaired.
Nicotine does not affect tissue microenvironment, but appear to impair inflammation and
stimulate proliferation.
Conclusion: Smoking has a transient effect on the tissue microenvironment and a
prolonged effect on inflammatory and reparative cell functions leading to delayed healing
and complications. Smoking cessation restores the tissue microenvironment rapidly and
the inflammatory cellular functions within four weeks, but the proliferative response
remain impaired. Nicotine and nicotine replacement drugs seem to attenuate
inflammation and enhance proliferation but the effect appear to be marginal.
FREE PAPER SESSION: ANTIMICROBAL AND OTHERS
117
Free Paper Session: Antimicrobal and Others
Sterile and bacterial burdened acute wound: parameters of
luminol-dependent chemiluminescence of wound fluid
Yuliya Yarets 1 , Tatjana Petrenko 1
1 Gomel State Medical University (Gomel, Belarus).
Aim: To evaluate the parameters of the luminol-dependent chemiluminescence (CL) of
the wound fluid.
Methods: The object of the study were the patients (n=38) with acute wounds. In the
wound fluid, which was received at the time of the patient’s admission, the parameters of
CL were estimated: the luminescence intensity (I) and its maximum (Imax) and the time
of its achievement t (min), the area under the curve (S), the speed of the luminescence
increase (V0). The bacteriological examination of all the wounds was also carried out.
Results: Bacterial isolates were found in 23 samples from acute wounds (60%), but 15
wounds swabs (40%) were sterile. Herewith the expressed clinical signs of the wound
infection were absent. It was revealed that the values of Imax like V0 and t of its
achievement did not differ at the patients with different result of bacteriological
examination. However, for the patients with sterile wounds swabs the reduction of I and
its transition to the stationary luminescence came earlier – by 1.49-1.55 minutes
(p