Wound Healing in Elderly and Frail Patients

Wound healing, including the surgical one, is a complex mechanism that follows specific physiological processes. In the elderly and frail patients, this process is altered by both the aging of the metabolic mechanisms and the presence of comorbidities. And it is even more difficult when that occurs following an emergency surgery for an acute pathology. In this context, laparoscopy, often considered unsuitable in this clinical subset, becomes the best healing change that is offered to these patients. The benefits of laparoscopy in terms of a better postoperative course are established, and the key role of laparoscopy is to reduce the impact of surgery on frail patient. The FRAILESEL study demonstrated a statistically significant reduction in both mortality and morbidity in patients undergoing laparoscopic surgery compared to those undergoing laparotomy (mortality 2.2% vs. 11.2%; morbidity 22.1% vs. 36.2%). At the same time, laparoscopy makes possible to avoid the large median laparotomies often burdened by infections and dehiscences in the elderly patients, which up to 38% of cases result in an incisional hernia. Another task is the use of appropriate service incisions and the adequate technique to suture them; one of the better incisions is the Pfannenstiel one which has 0.9% rate of the development of incisional hernia.