Effects of profound hemodilution on small-intestinal wound healing in rabbits

Background. Wound healing is influenced by tissue oxygen tension and blood perfusion, but not by moderate anemia or hemodilution. The effect of periop erative profound hemodilution on small-intestinal wound healing remains unc lear. Methods. We performed jejunectomy followed by end-to-end anastomosis in rab bits subjected to a variety of perioperative hemodilutions: HD(HES), hemodi luted with hydroxyethylstarch; HD(P+HES), hemodiluted with autologous plasm a and hydroxyethylstarch; HD(HES)/R, hemodiluted with hydroxyethylstarch an d retransfused afterward. Intraoperative hemoglobin levels were 5 g 100 ml( -1). On Postoperative Day 5, the tensile strength (TS) of the anastomosis w as measured and histological specimen was obtained. The time courses of hem oglobin, serum albumin (Alb), plasma fibrinogen (Fbg), and plasma activity of factor XIII (F XIII) were measured. Results. TS in HD(HES)/R (236.0 +/- 52.2 gf) was similar to that in control (266.5 +/- 41.6 gf); however, TS in HD(HES) (179.8 +/- 17.9 gf) and HD(P+H ES) (165.5 +/- 14.7 gf) decreased significantly, The histological findings in HD(HES)/R were similar to those of control, whereas they demonstrated a delayed healing process in HD(HES) and HD(P+HES). Hemoglobin levels were st ill lower on Postoperative Day 5 in HD(HES) and HD(P+HES), but increased to 10.0 g 100 ml(-1) after retransfusion in HD(HES)/R. Hemodilution caused si gnificant decreases in Alb, Fbg, and F XIII, but the values after retransfu sion in HD(HES)/R were similar to postoperative values in HD(P+HES). Conclusion. Intraoperative profound hemodilution does not interfere with sm all-intestinal wound healing as long as postoperative hemoglobin levels wer e maintained above 10 g 100 ml(-1). Postoperative levels of other plasma co nstituents may not influence wound healing. (C) 2001 Academic Press.