The physiology of wound healing.

Many of the biochemical events of wound healing are prisoners of the victim's physiologic state. Although the initial local events of inflammation occur normally in any viable tissue, the subsequent reparative capacities of macrophages, fibroblasts, and endothelial cells are seriously impaired by any compromise of local perfusion and oxygenation. In particular, the bacteriocidal capacities of granulocytes are heavily dependent on local oxygenation/perfusion, nutrition, and endocrine status. This article depicts the local mechanisms of repair with special attention to the means by which physiologic and nutritional support at the clinical level influence repair, even to a point at which wound healing may exceed contemporary expectations. Without appropriate physiologic, nutritional, and endocrine support, wound healing often fails totally. It is now possible, although not always easy, to achieve optimal physiologic support.