Surgical wound healing in bleeding disorders

Animal experiments have shown that a number of bleeding disorders may affect wound healing (WH), including haemophilia B, deficiency of factor XIII and abnormalities of fibrinogen. Therefore, normal healing requires adequate haemostatic function for the appropriate time frame (up to 4 weeks in the c...

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Bibliographic Details
Published in:Haemophilia : the official journal of the World Federation of Hemophilia 2012-07, Vol.18 (4), p.487-490
Main Author: RODRIGUEZ-MERCHAN, E. C.
Format: Article
Language:English
Subjects:
Afibrinogenemia - physiopathology
Animals
bleeding disorders
Blood Coagulation Disorders - physiopathology
Factor XIII Deficiency - physiopathology
haemophilia
Hemophilia B - physiopathology
Hemorrhage - prevention & control
Hemostasis - physiology
Humans
Models, Animal
Risk Factors
Surgical Procedures, Operative
surgical wounds
wound healing
Wound Healing - physiology
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Summary:Animal experiments have shown that a number of bleeding disorders may affect wound healing (WH), including haemophilia B, deficiency of factor XIII and abnormalities of fibrinogen. Therefore, normal healing requires adequate haemostatic function for the appropriate time frame (up to 4 weeks in the clean and uncontaminated wound). Many factors may affect WH, including impaired haemostasis, diabetes, poor nutrition, insufficient oxygenation, infection, smoking, alcoholism, old age, stress and obesity. The gold standard for the correct care of surgical wounds in patients with bleeding disorders includes wound dressing and comprehensive standard care (haemostasis, nutritional support, treatment of co‐morbidities, offloading, reperfusion therapy and compression). Although complications of surgical wounds healing in patients with bleeding disorders are uncommon, a low level of the deficient factor for an insufficient period of time could cause WH complications such as haematomas, infection, and skin necrosis and dehiscence. Clinical experience and animal experiments appear to indicate that, to get a satisfactory healing of surgical wounds and avoid potential complications of WH, a good level of haemostasis is necessary for 2–3 weeks after surgery. However, many treaters would regard this recommendation at odds with (i.e. more aggressive than) current standards. Unfortunately no additional clinical evidence for this recommendation can be provided.
ISSN:1351-8216
1365-2516
DOI:10.1111/j.1365-2516.2012.02760.x