Which of the following factors can be associated with impaired wound healing?

a. Chemotherapy

b. Chronic steroid use

c. Peripheral vascular disease

d. Radiation therapy

e. Diabetes mellitus

Bone marrow suppression, a common consequence of chemotherapy, is detrimental to wound healing. Quantitative and qualitative lymphocyte and monocyte deficiency impairs cellular proliferation in the inflammatory phase of wound healing. Any chemotherapeutic agent that suppresses the bone marrow will impair healing. Glucocorticoids inhibit wound healing based on their anti-inflammatory and immunosuppressive effects. The anti-inflammatory effect of steroids is, in part, the result of inhibiting arachidonic acid metabolism by impairing macrophage migration, and by altering neutrophil function. Glucocorticoids also inhibit the synthesis of procollagen by fibroblasts, thus delaying wound contraction. Radiation injury leads to arteriolar fibrosis and impaired oxygen delivery. In addition, there is progressive obliteration of blood vessels in the radiated area over time. Radiation also causes intranuclear and cytoplasmic damage to fibroblasts, and this appears to limit their proliferative potential. Diabetes mellitus is often associated with decreased healing of open wounds and increased susceptibility of infection. Many factors contribute to poor healing in diabetic patients and most of them reflect local wound ischemia. However, healing is not impaired in a normally perfused area in a well-controlled diabetic. Peripheral arterial occlusive disease secondary to atherosclerosis can be a primary cause of impaired healing, and may be also a cofactor with other conditions.