Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Nancy McCain


Normal wound healing is a complex process that occurs in overlapping phases and depends upon interactions of the patient, environment and a large number of cells, growth factors, cytokines, chemokines, and other biochemical mediators. Psychological stress has been shown to adversely affect the normal wound healing process through its impact on cellular immunity. Cellular immunity impacts wound healing through the production and regulation of many of the above biochemical mediators of wound healing. The purpose of this pilot study was to examine the relationships among pre- and post-operative psychological stress experienced by women who were undergoing either immediate or delayed breast reconstruction following mastectomy for breast cancer and influence of that stress on wound healing, specifically the biochemical mediators of wound healing in the local wound environment. An integration of Lazarus and Folkman’s cognitive appraisal model of stress and coping and the psychoneuroimmunology model proposed by McCain, Gray, Walter and Robins (2005) served as the theoretical framework for the research. A descriptive non-experimental design was used, with samples collected over time to describe biochemical patterns in surgical wounds of women undergoing autologous breast reconstruction. Biochemical data were collected preoperatively, as well as at 24, 48, 72 and 96 hours postoperatively. Psychological stress instruments were administered pre-operatively and 48 hours post-operatively. Although subjects overall displayed low levels of psychological stress, meaningful wound fluid biochemical mediator patterns were detected. This study adds to our knowledge concerning wound fluid chemical mediators present in the local wound environment over time.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

December 2012

Included in

Nursing Commons