The Relationship between Proliferative Scars and Endothelial Function in Surgically Revascularized Patients

Abstract

Background: Proliferative scars are benign fibrotic proliferationswhichdemonstrateabnormalwoundhealing in response to skin injuries. As postulated in the "response to injury hypothesis", atherosclerosis is also triggered by an endothelial injury. Keloid and ath-erosclerotic processes have many pathophysiological and cytological features in common.Aims: In this study, we investigated the relationship between proliferative scars and endothelial function in surgically revascularized patients. We aimed to test the hypothesis that atherosclerosis is a wound healing ab-normality.Study Design: Cross-sectional study.Methods: Consecutive patients who were admitted to the cardiology outpatient clinic with a history of coro-nary artery bypass grafting operation were evaluated. Thirty-three patients with proliferative scars at the me-dian sternotomy site formed the keloid group, and 36 age- and sex-matched patients with no proliferative scar at the median sternotomy site formed the control group. Endothelial function was evaluated by flow-mediated vasodilatation of the brachial artery via ul-trasonograhic examination.Results: There is no signicant difference according to the demographic data, biochemical parameters, clini-cal parameters and number of grafts between keloid and control groups. Endothelial-dependent vasodila-tory response was lower in the keloid group than the control group (9.30±3.5 and 18.68±8.2, respectively; p=0.001).Conclusion: This study showed that endothalial dys-function, which is strongly correlated with atheroscle-rosis, was more prominent in patients with prolifera-tive scars. As proliferative scars and atherosclerosis have many features in common, we might conclude that atherosclerosis is a wound healing abnormality