Effect of nutrition, diet and suture material on long term wound healing.

Although it is known that malnutrition hinders early wound healing, it has not been determined whether this occurs because of formation of a poor scar or a slow rate of normal healing; the ultimate fate of the malnourished wound is unknown. Malnutrition was produced in rats by short gut syndrome. Elemental diet was compared to rat chow and silk was compared with polyglycolic acid suture. Nutritional deficiency was seen in short gut rats for two weeks postoperatively. Thereafter adaptation allowed partial recovery, but relative deficiency persisted. Morbidity and mortality of short gut rats doubled that of controls and all wound complications were limited to this group, occurring within the first two weeks. Malnourished animals surviving for 60 days had wound strength equal to the control rats as determined by gut anastomosis bursting strength, skin wound breaking strength and wound hydroxyproline content. Neither diet nor suture material altered ultimate wound strength. Improved nutrition allowed more animals and wound to survive, but ultimate healing survivors was indistinguishable from that of normal controls. Thus early weakness probably results from slow healing rather than formation of poor scar. Nutrition plays an important role in early strength and survival, but not in ultimate wound healing.

The ability of an elemental diet to support nutrition and adaptation in the short gut syndrome.

85% enterectomy or jejunal biopsy was randomly carried out on 80 male Sprague-Dawley rats, 300-350 gm. After recovery, rats in each group were randomly fed either elemental diet (ED) or rat chow. All rats were sacrificed 8 weeks postoperatively. Biopsied rats gained more weight with ED than chow (22% vs. 18%; p less than .01). Resection produced greater weight loss than biopsy (p less than .01) and slower gain (p less than .01). The failure to gain was most marked in ED rats, significantly less than in the chow group (p less than .05) by week two. A fall in hemoglobin, protein and albumin was seen: neither the fall nor difference between the groups was significant (p greater than .05). Enterectomized chow rats ate 22% more than their controls (p greater than .05). Increase in bowel length after resection, equally divided between jejunum and ileum, was 21% with ED and 26% with chow. Gut diameter after resection increased 104% and 98% with chow and ED, respectively. Villus height increased 65% in the jejunum of both enterectomized groups and 85% and 78% with chow and ED, respectively, in the ileum. Changes in gut length, diameter and villus height are significant in each group (p less than .01) but not between groups (p greater than .05).