title: Effect of postoperative diclofenac on anastomotic healing, skin wounds and subcutaneous collagen accumulation: a randomized, blinded, placebo-controlled, experimental study.
abstract: BACKGROUND
  Retrospective studies have drawn attention to possible detrimental effects of non-steroidal anti-inflammatory drugs (NSAIDs) on the anastomotic leakage rate after colorectal resection. In this study, we examined the effects of the NSAID diclofenac on the breaking strength of an experimental colonic anastomosis and a skin incision as well as subcutaneous collagen accumulation.
  
  
  METHODS
  This was a randomized, blinded, placebo-controlled experimental study in 60 male Wistar rats treated with diclofenac 4 mg/kg/day or placebo. In each rat, a colonic anastomosis was performed and an expanded polytetrafluoroethylene (ePTFE) tube was placed subcutaneously. Incisional and anastomotic wound breaking strength and hydroxyproline content in the ePTFE tubes were measured 7 days after the operation.
  
  
  RESULTS
  We found no significant differences in any of the breaking strength measurements, but showed a median 38% reduction in hydroxyproline deposition as a result of diclofenac treatment (p = 0.03). In the placebo group, subcutaneous collagen deposition tended to correlate positively with skin incisional but negatively with anastomotic bio-mechanical strength.
  
  
  CONCLUSIONS
  Postoperative diclofenac treatment significantly inhibited collagen deposition in subcutaneous granulation tissue. Anastomotic strength and skin wound strength were not significantly affected. The ePTFE model is suitable for assessing the effect of various drugs on collagen formation and thus on wound healing.
authors.affiliation: Department of Surgical Gastroenterology D, Herlev Hospital, University of Copenhagen, Herlev, Denmark. madsklein1@gmail.com
authors.forename: M
authors.initials: M
authors.lastname: Klein
authors.forename: P-M
authors.initials: PM
authors.lastname: Krarup
authors.forename: M B
authors.initials: MB
authors.lastname: Kongsbak
authors.forename: M S
authors.initials: MS
authors.lastname: Agren
authors.forename: I
authors.initials: I
authors.lastname: Gögenur
authors.forename: L N
authors.initials: LN
authors.lastname: Jorgensen
authors.forename: J
authors.initials: J
authors.lastname: Rosenberg
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000139:chemically induced*; D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D003094:Collagen / Q000096:biosynthesis*; D003106:Colon / Q000601:surgery; D004008:Diclofenac / Q000009:adverse effects*; D008297:Male; D011184:Postoperative Period; D011897:Random Allocation; D051381:Rats; D017208:Rats, Wistar; D040521:Subcutaneous Tissue / Q000378:metabolism; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D003094:Collagen