Is there a rationale for the substitution of factor XIII in patients with wound healing problems after surgery for carcinoma of the head and neck?

Background: Factor XIII is known to play an important role in wound healing . In patients with head and neck carcinomas there is an accumulation of ris k factors for factor XIII deficiency such as chronic liver disease, extensi ve tissue lesions, and high intraoperative blood loss. Method: Serum levels of factor XIII in 22 patients who had undergone tumor surgery for head and neck carcinoma were measured preoperatively and daily up to 1 week followi ng surgery. Factor XIII was measured with the Berichrome assay as part of o ur routine laboratory studies. The results were correlated with preoperativ e pseudocholinesterase (PChe). Factor XIII was substituted for 3 days in 8 patients with persistent wound healing problems that did not improve after two weeks of conservative treatment. Results: We found that PChe levels are a predictor for the development of factor XIII levels during this period. In patients (n = 14) with normal PChe, factor XIII levels reached 86% of th e preoperative values 1 week after operation (group 1). In patients (n = 8) with low PChe, the levels reached only 65% (group 2). The rate of wound he aling problems was higher in group 2 (6/8) than in group 1 (2/14). In 6 pat ients treated with factor XIII, the wounds healed within 3 to 7 days. In tw o cases revision operation was necessary. Conclusion: We conclude that the therapy with factor XIII may be successful in patients with wound healing p roblems. Further studies will be necessary to find out whether prophylactic substitution of factor XIII in patients with low preoperative pseudocholin esterase levels is useful.