Reduced collagen accumulation after major surgery.

The preoperative and postoperative wound-healing capacity of 23 patients undergoing elective major abdominal, thoracic or urological surgery was tested objectively by the subcutaneous accumulation of hydroxyproline and proline in an expanded polytetrafluoroethylene (ePTFE) tube. Before scheduled surgery two ePTFE tubes were implanted for removal after 5 and 10 days. This was repeated for each patient immediately after surgery. After 10 days a higher amount of hydroxyproline was measured before than after operation (median 2.91 (range 0.37-14.45) versus 1.45 (range 0.26-6.94) micrograms/cm, P = 0.01)). This decline was significantly higher in the six patients who had a postoperative infection (median 3.02 (range -0.06 to 6.14) versus 0.36 (range -1.56 to 12.60) micrograms/cm, P = 0.02). This study shows that major surgery is associated with impairment of subcutaneous collagen accumulation in a test wound, suggesting diminished systemic wound-healing capacity in such patients.