Effects of chronic corticosteroids and vitamin A on the healing of intestinal anastomoses.
The ability of vitamin A to reverse the inhibitory effects of chronic corticosteroids on cutaneous and fascial wound healing is well established. To investigate this in the unique low-collagen environment of the intestinal anastomosis, 35 rabbits received twice-daily injections of either saline (control), dexamethasone (0.1 mg/kg/day), dexamethasone plus low-dose vitamin A (1,000 IU/kg/day), or dexamethasone plus high-dose vitamin A (10,000 IU/kg/day) for a 2-week period. Animals then underwent creation of single-layer, inverting small and large intestine anastomoses. All injections were continued postoperatively. A fifth group received only dexamethasone preoperatively and dexamethasone plus high-dose vitamin A postoperatively. On postoperative day 7, animals underwent in situ assessment of anastomotic bursting pressure and subsequent histologic examination using a modified Ehrlich/Hunt scale. Corticosteroids significantly impaired the healing of small and large intestine anastomoses, with decreased bursting pressures and histologic parameters at 1 week. Only high-dose vitamin A significantly reversed this inhibitory effect, whether given preoperatively or only postoperatively.
Phillips
J D
JD
Department of Surgery, University of California, Los Angeles School of Medicine 90024.
Kim
C S
CS
Fonkalsrud
E W
EW
Zeng
H
H
Dindar
H
H
D000714:Anastomosis, Surgical; D000818:Animals; D003907:Dexamethasone / Q000037:antagonists & inhibitors / Q000494:pharmacology*; D007422:Intestines / Q000601:surgery*; D008297:Male; D011182:Postoperative Care; D011300:Preoperative Care; D011817:Rabbits; D013529:Surgical Wound Dehiscence / Q000503:physiopathology / Q000517:prevention & control*; D014801:Vitamin A / Q000494:pharmacology*; D014945:Wound Healing / Q000187:drug effects*
D014801:Vitamin A; D003907:Dexamethasone