Many inflammatory cells secrete cytokines such as TGF-1 and IL-13, which are fibrinogenic20.
The inflammatory phase comprises the influx of neutrophils, macrophages, and lymphocytes to the lesion site, as well as vasoconstriction, platelet aggregation, and increase in vascular permeability; the proliferative phase involves granulation, the influx of fibroblasts and keratinocytes, re-epithelialization, capillary formation, and extracellular matrix production; and the final stage (or remodeling) is dependent on the balance between the synthesis and degradation of collagen27.
Thus, age, nutritional status, chronic diseases, caloric intake, cortisol release, stress, pain, and anesthesia affect the body's immune function, and can negatively interfere in the defense mechanism of the patient.
Preoperative malnutrition and especially protein deficiency and DNA dysfunctions interfere with collagen synthesis, fibroblast proliferation, decrease in angiogenesis, and reduction in proteoglycans.
Treatment needs to be initiated early in collagen synthesis, which increases between the 6th and 17th day; after the 42nd day, this process ceases and remodeling of the accumulated collagen occurs21.
In view of the possible causes of seroma and fibrosis, which include healing, collagen formation, inflammation, immune dysfunction, oxidative stress, and edema, it becomes necessary to understand the reactions involved in the above conditions and correlate them with functional nutrition.
From the third day up to weeks after, the phase known as proliferative, granulation, or fibroplasia phase occurs, where the requirements for carbohydrates, protein, lipids, vitamins A, C, and B complex, iron, zinc, and magnesium increase to promote cell proliferation, collagen synthesis, and neovascularization.