A 52-year-old man undergoes elective abdominal wall closure after resection of a colonic mass. Regarding factors that impair wound healing, all of the following are true EXCEPT:

Question

Accepted Answer

D. Advanced age (>70 years) completely halts the proliferative phase and prevents epithelialization. ## Factors Impairing Wound Healing

### Systemic Factors That Delay Healing

**Key Point:** Wound healing can be impaired by local and systemic factors. Understanding which factors cause true cessation versus delayed healing is critical for exam success.

### Analysis of Each Option

| Factor | Mechanism | Clinical Impact |
|--------|-----------|------------------|
| Corticosteroids | Inhibit fibroblast proliferation, reduce collagen synthesis, suppress inflammation | Delayed healing, increased infection risk |
| Diabetes mellitus | Impaired neutrophil function (chemotaxis, phagocytosis), hyperglycemia-induced glycation, microvascular dysfunction | Delayed healing, higher infection rates |
| Malnutrition (protein) | Insufficient amino acids for collagen synthesis; reduced fibroblast proliferation | Reduced tensile strength, delayed epithelialization |
| Advanced age | Slower proliferative response, delayed angiogenesis, reduced collagen remodeling | **Delayed but not halted** |

### Why Option 3 is Wrong

**High-Yield:** Advanced age does NOT completely halt wound healing. While the proliferative and remodeling phases are slower in elderly patients, they still occur. Epithelialization and collagen deposition continue — just at a reduced rate. The wound will heal, but it takes longer.

**Clinical Pearl:** Elderly patients (>70 years) have:
- Delayed inflammatory response
- Slower fibroblast proliferation
- Reduced angiogenesis
- Prolonged remodeling phase

However, these are **delays, not cessation**. Healing still progresses, and primary intention wounds in elderly patients still achieve adequate tensile strength for suture removal at standard intervals (though infection risk is higher).

### Verification of Correct Options

**Option 0 (Corticosteroids):** TRUE — Corticosteroids suppress the inflammatory phase and inhibit fibroblast function, significantly impairing healing.

**Option 1 (Diabetes):** TRUE — Hyperglycemia impairs neutrophil chemotaxis and phagocytosis, reducing the inflammatory response and increasing infection risk.

**Option 2 (Malnutrition):** TRUE — Protein deficiency directly limits collagen synthesis (collagen is ~30% glycine, ~11% proline). Tensile strength is reduced.

**Warning:** Do not confuse "delayed healing" with "no healing." Advanced age is a risk factor for complications but does not prevent wound healing.

Answer

A. Diabetes mellitus delays wound healing primarily by impairing neutrophil chemotaxis and phagocytosis

Answer

B. Malnutrition (protein deficiency) reduces tensile strength because collagen cannot be synthesized without adequate amino acids

Answer

C. Systemic corticosteroid use impairs collagen synthesis and increases infection risk

A 52-year-old man undergoes elective abdominal wall closure after resection of a colonic mass. Regarding factors that impair wound healing, all of the following are true EXCEPT:

Explanation

Factors Impairing Wound Healing

Systemic Factors That Delay Healing

Analysis of Each Option

Why Option 3 is Wrong

Verification of Correct Options

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Factor	Mechanism	Clinical Impact
Corticosteroids	Inhibit fibroblast proliferation, reduce collagen synthesis, suppress inflammation	Delayed healing, increased infection risk
Diabetes mellitus	Impaired neutrophil function (chemotaxis, phagocytosis), hyperglycemia-induced glycation, microvascular dysfunction	Delayed healing, higher infection rates
Malnutrition (protein)	Insufficient amino acids for collagen synthesis; reduced fibroblast proliferation	Reduced tensile strength, delayed epithelialization
Advanced age	Slower proliferative response, delayed angiogenesis, reduced collagen remodeling	Delayed but not halted