Effects of chronic corticosteroids and vitamin A on the healing of intestinal anastomoses

Am J Surg. 1992 Jan;163(1):71-7. doi: 10.1016/0002-9610(92)90255-p.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anastomosis, Surgical
  • Animals
  • Dexamethasone / antagonists & inhibitors
  • Dexamethasone / pharmacology*
  • Intestines / surgery*
  • Male
  • Postoperative Care
  • Preoperative Care
  • Rabbits
  • Surgical Wound Dehiscence / physiopathology
  • Surgical Wound Dehiscence / prevention & control*
  • Vitamin A / pharmacology*
  • Wound Healing / drug effects*

Substances

  • Vitamin A
  • Dexamethasone