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 **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.