Mucosal wound healing: The roles of age and sex

Hypothesis: It remains unclear whether aging delays wound healing, as past human studies have not adequately controlled for confounding factors such as morbidity and medications. Furthermore, although dermal wounds heal more quickly in women than in men, clinical observations suggest that the opposite may be true for mucosal healing. We assessed age and sex differences in mucosal wound healing, and we hypothesized that aging delays healing and sex modulates healing independent of age. Design and Setting: Clinical experimental study performed from June 2000 to August 2003 involving younger and older adult volunteers from the general community. Participants: Two hundred twelve male and female volunteers aged 18 to 35 years (n=119) or 50 to 88 years (n=93). Intervention: Standardized 3.5-mm circular wounds were placed on the oral hard palates of volunteers. Main Outcome Measure: Wound videographs were taken daily for 7 days after wounding to assess wound closure. Results: Wounds healed significantly more slowly in older adults compared with younger adults (P<.001) regardless of sex. This remained true even when individuals receiving medication and/or having a coexisting medical condition were excluded. Mucosal wounds healed more slowly in women than in men (P=.008) regardless of age. These effects were independent of demographic factors such as ethnicity, alcohol or nicotine use, or body mass index. Conclusions: Wound closure in older individuals was clearly delayed even when eliminating potential age-related confounds, indicating that aging does slow wound healing. Wound closure in women was also delayed, suggesting that wound healing is modulated by different mechanisms depending on tissue type. These findings may help target patients with increased surgical risks and greater need for postsurgical care.