Acupuncture and Post-Surgical Wound Healing

• Transcutaneous tissue oxygen tension
  

• ASEPSIS score
  
• Subcutaneous tissue oxygen tension
  
• Transcutaneous tissue microperfusion
  
• Pain visual analogue scale (VAS)
  
• 24-hour narcotic usage
  
• Anxiety VAS
  
• State-Trait Anxiety Inventory (STAI)
  
• Serum epinephrine
  
• Serum cortisol
  
• Traditional Chinese Medicine pulse and tongue assessment
  
• Patient belief and expectancy survey
  

This is a prospective, randomized, controlled pilot study of the effects of acupuncture on surgical site complications in patients undergoing coronary artery bypass grafting. The past forty years of research in the UCSF Wound Healing Laboratory have solidified the following observations:

1. without adequate oxygen delivery, many processes of wound healing cannot proceed normally, particularly resistance to infection, collagen deposition, angiogenesis, and inflammation; and
2. hypoxic conditions, unfortunately, are common in chronic and acute wounds, and often result from subcutaneous vasoconstriction.

Sympathetic nervous system (SNS) activators and other vasoconstrictors have been shown to produce wound hypoxia. Activation of the SNS by any means, including pain and anxiety, causes vasoconstriction and impairs oxygen delivery. Simple means that limit SNS activity have been shown to increase perfusion and oxygen tension, and thereby facilitate wound healing. Many preliminary studies have shown that acupuncture decreases SNS activation, pain, and anxiety. In addition, there is evidence that acupuncture enhances circulation of blood. We therefore hypothesize that acupuncture will facilitate wound healing. We aim to quantify changes in anxiety, pain, stress hormones, and perfusion and oxygenation induced by these interventions, as well as wound healing outcomes, including infection and other wound complications.