title: Severe postoperative wound healing disturbance in a patient with alpha-1-antitrypsin deficiency: the impact of augmentation therapy.
abstract: Wound healing disturbance is a common complication following surgery, but the underlying cause sometimes remains elusive. A 50-year-old Caucasian male developed an initially misunderstood severe wound healing disturbance following colon and abdominal wall surgery. An untreated alpha-1-antitrypsin (AAT) deficiency in the patient's medical history, known since 20 years and clinically apparent as a mild to moderate chronic obstructive pulmonary disease, was eventually found to be at its origin. Further clinical work-up showed AAT serum levels below 30% of the lower reference value; phenotype testing showed a ZZ phenotype and a biopsy taken from the wound area showed the characteristic, disease-related histological pattern of necrotising panniculitits. Augmentation therapy with plasma AAT was initiated and within a few weeks, rapid and adequate would healing was observed. AAT deficiency is an uncommon but clinically significant, possible cause of wound healing disturbances. An augmentation therapy ought to be considered in affected patients during the perioperative period.
authors.affiliation: Department of Visceral Surgery and Medicine, University Hospital of Bern, Bern, Switzerland.
authors.forename: Marionna
authors.initials: M
authors.lastname: Cathomas
authors.affiliation: Department of Visceral Surgery and Medicine, University Hospital of Bern, Bern, Switzerland.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Schüller
authors.affiliation: Department of Visceral Surgery and Medicine, University Hospital of Bern, Bern, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Candinas
authors.affiliation: Department of Visceral Surgery and Medicine, University Hospital of Bern, Bern, Switzerland.
authors.forename: Roman
authors.initials: R
authors.lastname: Inglin
mesh_terms: D006801:Humans; D007813:Laparotomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D015434:Panniculitis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D013529:Surgical Wound Dehiscence / Q000209:etiology* / Q000628:therapy; D014361:Trypsin Inhibitors / Q000627:therapeutic use*; D014945:Wound Healing / Q000502:physiology*; D000515:alpha 1-Antitrypsin / Q000627:therapeutic use*; D019896:alpha 1-Antitrypsin Deficiency / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D014361:Trypsin Inhibitors; D000515:alpha 1-Antitrypsin
keywords: Alpha-1-antitrypsin deficiency; Laparotomy; Panniculitis; Postoperative; Surgery; Wound healing disturbance
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