The Comparison Effect between Albumin Infusion and Normal

Protein Diet on the Acceleration of Wound Healing: A Randomized

Control Trial

Arie Utariani

, Eddy Rahardjo

, David Sontani Perdanakusuma

, Nancy Margarita Rehatta

, Hamzah,

Kohar Hari Santoso

, Bambang Pujo Semedi

Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Indonesia

Department of Plastic Reconstructive and Aesthethic Surgery, Faculty of Medicine, Universitas Airlangga, Indonesia

Keywords: Hypoalbuminemia, albumin infusion, nutrition, wound healing.

Abstract: The aim of this study was to compare the role between albumin infusion or normal protein diet in the

process of wound healing during the state of hypoalbuminemia. The samples were fifteen Sprague Dawley

Rats that met inclusion criteria which were fed with casein for standardization and fed with casein 2% for

14 days to induce the state of hypoalbuminemia. Then the samples were divided into three groups: group

(A) preoperative albumin infusion, group (B) pre and postoperative 20% diet casein, and group (C) fed with

2% casein as control. The four incisions (2 cm each) were made on the back of the rat, kept in sterile

dressing, and evaluated on day 1, 3, 5, and 7. Measurement of the wound area using VisiTrak and statistical

analysis used ANOVA methods. The acceleration of wound healing in the hypoalbuminemia group starting

on the third day and maximal acceleration was achieved by feeding the protein on the fifth day sooner than

albumin infusion group.

1 INTRODUCTION

Wound is discontinue of the tissue or skin that may

be caused by trauma, surgical procedures,

neuropathic, vascular disorders, suppression and

malignancy (Baranoski, et al., 2003; Dipietro, Luisa,

Aime, Burns, 2003). The process of wound healing

on the damaged tissue begins increased cellular

activity and metabolic intensity. The wound healing

process occurs in 3 phases: (1) the inflammatory

phase, (2) the proliferative phase and (3) the

remodeling phase (Hess and Cathy, 2002; Dipietro,

Luisa, Aime, Burns, 2003; Enoch and Price, 2004).

In all phases of wound healing requires adequate

blood flow, tissue perfusion and oxygenation

(Jonsson, et al., 1991; Leaper, 2007). In patients

with malnutrition with less nutritional adequacy

would have a high risk of infection, wound healing

time, and length of stay in the hospital. One of the

proteins that are important in the wound healing

process is albumin (Haydock and Hill, 1986; Agung

and Hendro, 2005).

The study of pre operative albumin levels associated

with long-term complications of wound healing with

normal albumin levels was significantly associated

(p <0.05) with post operative wound healing, 23% -

52.46% in elective and 29% found in 44% of

patients with orthopedic surgery (Haydock and Hill,

1986; Agung and Hendro, 2005).

Protein is needed in every stage of wound

healing of the inflammatory phase, the proliferative

phase and the formation of granulation until the

remodeling phase. One of the roles of proteins is the

formation of collagen tissue to determine the

strength of the wound. Low protein intake even in a

short time can affect the speed of wound healing

significantly (Agung and Hendro, 2005).

So in this study we wanted to prove the role of

albumin either be given normal protein diet and

given preoperative albumin infusion to the

circumstances hypoalbuminemic prior to the

occurrence of an injury, so that it can be used as a

reference for the management of the use of albumin

in the state hypoalbuminemia who will do the

surgery planned or emergency, so as to help reduce

mortality and morbidity.

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312

Utariani, A., Rahardjo, E., Perdanakusuma, D., Rehatta, N., Hamzah, ., Santoso, K. and Semedi, B.

The Comparison Effect between Albumin Infusion and Normal Protein Diet on the Acceleration of Wound Healing: A Randomized Control Trial.

DOI: 10.5220/0008156403120315

In Proceedings of the 23rd Regional Conference of Dermatology (RCD 2018), pages 312-315

ISBN: 978-989-758-494-7

Figure 1: Sprague Dawley Rats : (A) kept in steril dressing; (B) incisions 2 cm each; and (C) healed wound.

2 MATERIAL AND METHODS

This research was an experimental research. The

design used in this research is randomize post test

only control group design. The samples were fifteen

Sprague Dawley Rats that met inclusion criteria

which were fed with casein for standardization and

fed with casein 2% for 14 days to induce the state of

hypoalbuminemia. Then the samples were divided

into three groups: group (A) preoperative albumin

infusion, group (B) pre and postoperative 20% diet

casein, and group (C) fed with 2% casein as control.

The four incisions (2 cm each) were made on the

back of the rat, kept in sterile dressing, and

evaluated on day 1, 3, 5, and 7 (Figure 1). Heal skin

tissue when fused with the tensile strength 2.62 N /

mm², was not found signs of inflammation, observed

7 days after injury (Forrest and Corter, 1995 ;

Gottrup, Melling, and Hollander, 2005).

Measurement of wound area used visitrak tool and

statistical analysis used ANOVA methods.

3 RESULTS

At the beginning of albumin analysis with

homogeneity between groups using the Tukey HSD

(p = 0129) obtained a homogeneous variance. And

the Kolmogorove-Smirnov normality test of Z

obtained the normal distribution (p = 0.490). To

know the difference between the initial albumin

group used one-way analysis of variance (one-way

ANOVA) obtained the value of F = 2.200 and p =

0.016. Initial albumin difference between groups did

not show any significant difference, and this group

has a homogeneous distribution.

Measurement of wound area using visitrak tool

and with statistical analysis seen in table 1, on day 3

of wound on preoperative albumin infusion (A) were

almost the same as normal protein diet (B), but on

day 5 in normal protein diet (B) an acceleration of

wound closure were faster than preoperative

albumin infusion (A) and on the seventh day of

normal protein diet (B) showed faster wound healing

compared to preoperative albumin infusion (A).

Table 1: Comparison of mean and standard deviation of wound days to 1,3,5,7 after surgery between groups: group (A)

preoperative albumin infusion, group (B) pre and postoperative 20% diet casein, and group (C) fed with 2% casein

(hypoalbumin) as control.

Group

Wound’s Width

Mean ± SD

1 3 5 7

A 5,40 ± 1,81 3,40 ± 1,14 2,40 ± 0,89 2,60 ± 1,52 5

B 5,40 ± 0,89 3,40 ± 1,14 1,80 ± 0,84 1,80 ± 0,84 5

C 6,00 ± 1,58 6,20 ± 1,92 5,80 ± 1,48 5.60 ± 0,90 5

In the state of hypoalbuminemia (C) widened the

wound area still same until the seventh day, but we

got a slowing of wound closure in preoperative

albumin infusion (A) and normal protein diet (B)

(Figure 2).

The Comparison Effect between Albumin Infusion and Normal Protein Diet on the Acceleration of Wound Healing: A Randomized Control

Trial

313

Figure 2: Wound’s Width.

4 DISCUSSION

This study described the role of albumin on wound

healing in hypoalbuminemia state. Improving the

hypoalbuminemia state by using an preoperative

albumin infusion or normal protein diet was a

solution to this problem, since albumin was one of

the important proteins in the wound healing process

(Haydock and Hill, 1986; Agung and Hendro, 2005).

To obtain an optimal wound healing was needed

nutritional adequacy. In people with malnutrition

will had a high risk of infection, prolong wound

healing, prolong hospitality, and increased risk of

death (Pedersen, 1992). This situation can be due to

decreased synthesis of proteins needed for growth

and repair of cells, which may affect metabolic

function and decrease the body's immune response,

duration of the inflammatory phase, a decrease of

fibroblasts, the synthesis of proteoglycans, collagen,

neoangiogenesis and improved form of injury

(Stadelmann, Digenis, and Tobin, 1998; Hunt, Hopf,

and Hussain, 2000). Patients with serum

albumin levels above 3 gm/dl were much more

likely to have uncomplicated wound healing (Casey

et al., 1983).

Measurement of wound area using visitrak tool

and with statistical analysis seen in table 1, on day 3

of wound on preoperative albumin infusion (A) were

almost the same as normal protein diet (B), but on

day 5 in normal protein diet (B) an acceleration of

wound closure were faster than preoperative

albumin infusion (A) and on the seventh day of

normal protein diet (B) showed faster wound healing

compared to preoperative albumin infusion (A). This

is according to research Repertinger (2004) occurred

after the fifth full reepitelialisasi EGFR wild-animal

in mice, whereas the increase in epithelial

proliferation has begun on day three (Repertinger et

al., 2004).

In the state of hypoalbuminemia (C) widened the

wound area still same until the seventh day, but we

got a slowing of wound closure in preoperative

albumin infusion (A) and normal protein diet (B)

(Figure 2).

In this study the contribution to normal protein

diet did not differ significantly with preoperative

albumin infusion to help repair damaged tissue. So

we argued for giving nutritional and or albumin

infusion on hypoalbuminemia state may affected

directly or indirectly the target tissue, particularly

affect cytokine production and inflammation and

affect the expression of proteins and growth factors

required in the wound healing process.

5 CONCLUSION

The acceleration of wound healing in the

hypoalbuminemia group starting on the third day

and maximal acceleration was achieved by feeding

the protein on the fifth day sooner than albumin

infusion group.

ACKNOWLEDGEMENT

I would like to give thanks to Prof. Dr. H. R. Eddy

Rahardjo, dr., SpAn., KIC. as promoter and Prof.

Dr. David S. Perdanakusuma, dr., SpBP(K). as co-

promoter for their support in overcoming numerous

obstacles I have been facing through my research. I

would like to thank my friends for accepting nothing

less than excellence from me. Last but not the least,

I would like to thank my family: my husband and to

my sons for supporting me spiritually throughout

writing this thesis and my life in general.

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