[libribook.com] Traumatic Scar Tissue Management 1st Edition

Psychological Stress and Wound Healing
Studies over the last 30 years have shown that the effects of psychological stress
on healing are moderate to large, resulting in poor surgical outcomes and poor
wound healing associated with other forms of trauma (Padgett & Glaser 2003,
Lusk & Lash 2005, Starkweather 2007, Von Ah & Kang 2007, Rosenberger et al.
2009, Lucas 2011, Broadbent & Koschwanez 2012).
Substantial data suggest that psychological stress and the subsequent immune
system disruption can negatively impact wound healing, both directly and
indirectly, with the most prominent impact occurring due to the effects of stress
on cellular immunity.
Cellular immunity plays an important role in wound healing through the
production and regulation of pro- and anti-inflammatory cytokines, which
mediate many of the complex intricacies of wound healing. Dysregulation of
various cytokines disrupts normal wound healing leading to delayed or improper
healing, increased healing time, increased risk of infection, prolonged edema and
wound complications, such as pathophysiological scars (Glaser et al. 1999,
Broadbent et al. 2003, Ebrecht et al. 2003, Lucas 2011).
Psychological considerations, such as distress, depression and anxiety, have also
been shown to slow wound healing. Patients reporting greater than average
symptoms of depression or anxiety were four times more likely to be categorized
as slow healers compared with patients reporting less distress. Heightened
distress, associated with unhealthy behaviors, such as smoking, substance abuse,
poor nutrition and alteration of normal sleep patterns, can impact wound healing
in a variety of ways. The impact of smoking on wound healing was discussed in
Chapter 5, most notably reduced proliferation of macrophages and a decrease in
the levels of oxygen capable of reaching the periphery. Increased alcohol use can
reduce angiogenesis, delay deposition of collagen at the wound site and slow
wound healing by adversely impacting cardiac and immune function. Poor
nutrition, such as protein deficiency, can impact capillary formation, collagen
synthesis and wound remodelling. Alteration in sleep patterns impacts growth
hormone (GH) release, which may down-regulate wound healing processes such
as immune response. Even relatively mild sleep disruption can alter
proinflammatory cytokines and GH secretion (Benveniste & Thut 1981,