Page 38 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Implications for Healing 11

reduces cytokin levels and alters killer cell activity, subsequently
slowing skin barrier repair (Altemus et al. 2001 ).
Changes in behaviour such as smoking, alcohol consump-
tion, poor diet and lack of exercise are also thought to impact
on healing. Research has shown that surgical patients who
are considered regular smokers have significantly slower
healing periods that those classed as non-smokers (Silverstein
1992 ). This is thought to be because the toxins and nicotine
within cigarette smoke reduce oxygen levels in the blood
whilst also reducing macrophage function (Silverstein 1992 ).
Given the known link between hypoxia and reduced healing
(Gordillo and Sen 2003 ), this relationship is not suprsing. The
negative implications of smoking for wound healing are fur-
ther illustrated by research exploring smoking cessation pro-
grammes (Moller et al. 2002 ): implementation of such
programmes 6–8 weeks before scheduled surgery has been
found to reduce post-surgical wound complications. Similarly,
alcohol consumption has been linked to slower healing
(Benveniste and Thut 1981 ). Animal studies have highlighted
the effects of alcohol use, demonstrating the disruption to
numerous mechanisms which underpin the healing process.
For example, alcohol use before or after wounding can impair
the inflammatory response that is essential in the initial heal-
ing stages (Fitzgerald et al. 2007 ). Animal studies have also
shown that heavy alcohol use is associated with delays in cell
migration and collagen deposition at the wound site, which in
turn can impede the healing process (Benveniste and Thut
1981 ). A link between preoperative alcohol use and postop-
erative morbidity has also been shown in humans (Tønnesen
and Kehlet 1999 ). Finally diet and exercise have also been
linked to the rate of wound healing. For example, nutritional
deficits including, low protein, low glucose intake and vitamin
deficiencies, can all impede the wound healing process
(Russell 2001 ; Posthauer 2006 ; McDaniel et al. 2008 ). Lack of
regular physical activity has also been shown to slow wound
healing rate in animal models (Keylock et al. 2008 ).
Furthermore, studies with human patients have shown that
regular exercise can lead to reduced wound healing time