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BG Control in Diabetic Patients Undergoing Surgical Wound Closure

Complications from surgical wound closure occur three times higher in diabetic patients with high blood glucose levels…. 

High blood glucose levels can have profound effects on the body. Such effects can include poor circulation and decreased immune response; which can lead to skin complications and risks of infections, as well as poor wound healing. With regards to the latter, poorly controlled blood glucose levels can cause wounds to heal more slowly and increase the risk of infections of a more serious nature. For these reasons, it is imperative for patients with diabetes to control their blood glucose levels.

This study retrospectively examined the effects and complications of high blood glucose levels in diabetic patients undergoing surgical wound closure. Each patient had their blood glucose levels checked five days prior to and five days after surgery as well as their HbA1c, which was collected two weeks prior to surgery. Researchers considered blood glucose levels greater than 200 mg/dL and HbA1c levels greater than 6.5% to be elevated and related this elevation to a significantly increased incidence of wound dehiscence.

Of those considered from databases from several wound care centers, 79 patients had blood glucose levels recorded perioperatively, and 64 patients had HbA1c levels recorded as required, which allowed for patient analysis. The results showed that 44% of patients who had high blood glucose levels prior to surgery had an occurrence of wound dehiscence; whereas 19% of patients without high blood glucose levels experienced the same. The risk was noted to be higher for patients who had high blood glucose levels after surgery or a high HbA1c. Overall, with adjustment for other factors, patients with high levels of blood glucose or an elevated HbA1c near the time of surgery were three times more likely to have wound dehiscence. It is therefore necessary to ensure every effort is made for tight control of blood glucose levels in diabetic patients who require surgical wound closure.

Practice Pearls:

  • Complications from surgical wound closure can occur when blood sugar is not controlled prior to and after surgery.
  • Consultation with a specialist to manage diabetes should be suggested in this patient population.
  • Tighter control of blood sugars should be taken in patients undergoing surgical wound closure.

Plastic and Reconstructive Surgery, October 2013