Background: Stress has been demonstrated as a factor that influences the rate of wound healing. Living kidney donors are an ideal group on which to assess the impact of stress on surgical wounds as they have little or no major physical or psychosocial co-morbidities. The aim of this study was to develop a technique with which to quantitatively assess wound healing and ascertain whether pre-operative stress was implicated in inferior wound healing.

Methods: 20 living kidney donors undergoing hand-assisted laparoscopic donor nephrectomy were included. Stress was assessed using the Perceived Stress Scale (PSS) and was measured 10-14 days pre-operatively. Two surgical wounds and an area of normal skin were scanned using the Episcan© High-Resolution Ultrasound machine with a 20MHz probe. Participants were scanned on days 1-3 and at their follow up appointment. Image analysis included change in wound size and median colour intensity; a value calculated by the ultrasound machine reflecting residual tissue oedema (lower median intensity indicating increased oedema). Images were analysed independently by two researchers and an average score used for the analysis.

Results: Median PSS score was 4.5 (range 0-10; sd 2.86). Stress did not correlate with age, gender, length of stay or the pre-operative day on which the questionnaire was completed (mean 13 days; sd 4.01). Increased stress correlated with higher median intensity in normal skin (r 0.62, p<0.01) indicating relatively reduced skin hydration. Increased stress correlated with poorer wound healing as demonstrated by lower median intensity scores (indicating increased tissue oedema) at follow up across two separate wounds (Hand port: r=-0.739, p=0.001; Lap port: r=-0.523, p<0.05). Stress was poorly correlated with net reduction in wound size and rate of reduction (r <0.2, p>0.05). Inferior wound healing was not associated with age, BMI or the number of post-operative days.

Conclusions: The results of this pilot study show high-resolution ultrasound is an effective way of quantitatively assessing wound healing in surgical patients. Pre-operative stress is strongly correlated with poor post-operative wound healing. A larger longitudinal study is necessary to assess the impact of ultrasound changes on immediate and long-term clinical outcomes.

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