Effect of jaundice and its resolution on wound re-epithelization, skin collagen synthesis, and serum collagen propeptide levels in patients with neoplastic pancreaticobiliary obstruction.
BACKGROUND
Wound and anastomotic healing is considered to be delayed in patients with obstructive jaundice. The study was designed to find out whether the healing of experimental suction blister wounds, skin collagen synthesis, and serum procollagen levels are affected by obstructive jaundice, and if biliary drainage may cause any alterations in these processes.


METHODS
Suction blisters were induced on 24 patients with obstructive jaundice caused by neoplastic pancreaticobiliary obstruction and 17 control patients with the corresponding condition without jaundice, to compare healing parameters and collagen synthesis between the groups. A second set of suction blisters were induced on 13 formerly jaundiced patients after the resolution of jaundice and on 14 control patients, to find out whether drainage or time modifies healing or collagen synthesis. By using this model, it is possible to evaluate the re-epithelization and inflammation on wound healing and to assess the baseline skin collagen synthesis. The healing of suction blisters was followed up by measuring water evaporation and blood flow in the wound. Blister fluids and serum samples were collected to study collagen propeptides.


RESULTS
Healing of the blister wound was unaffected by obstructive jaundice. Drainage had no effect on healing. The baseline synthesis of type I and type III collagen in the skin was decreased in jaundiced patients. Biliary drainage improved the synthesis. Serum type III procollagen propeptide levels were elevated in jaundiced patients, but began to normalize after drainage.


CONCLUSIONS
Healing of an experimental blister wound is not disturbed by obstructive jaundice. The decreased baseline skin collagen synthesis is partly restored by the resolution of jaundice. The results indicate that cell protein synthesis is disturbed earlier than cell dynamics in obstructive jaundice. The elevated serum PIIINP levels, which are most likely to be related to early fibrosis in liver, decreased after drainage.
Koivukangas
V
V
Department of Surgery, Oulu University Hospital, University of Oulu, Oulu, Finland. vesa.koivukangas@oulu.fi
Oikarinen
A
A
Risteli
J
J
Haukipuro
K
K
D000230:Adenocarcinoma / Q000150:complications; D000328:Adult; D000368:Aged; D015415:Biomarkers; D001768:Blister / Q000378:metabolism / Q000503:physiopathology*; D018281:Cholangiocarcinoma / Q000150:complications; D003094:Collagen / Q000096:biosynthesis*; D004322:Drainage; D004847:Epithelial Cells / Q000378:metabolism; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology*; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications; D010446:Peptide Fragments / Q000097:blood*; D011347:Procollagen / Q000097:blood*; D013396:Suction; D014867:Water / Q000378:metabolism; D014945:Wound Healing / Q000502:physiology*
D015415:Biomarkers; D010446:Peptide Fragments; D011347:Procollagen; C047202:procollagen Type I N-terminal peptide; D014867:Water; D003094:Collagen