Immunotherapies, Anti-Neoplastic Agents, and Wound Healing

Background: For patients receiving immunotherapies and anti-neoplastic agents, understanding the implications of medication effects on wound healing is critical for surgical planning. With the advent of new oncologic and immune therapies, plastic surgeons are faced with unfamiliar therapies among patients seeking reconstructive or aesthetic surgery. The of this study is to provide an evidence-based, structured narrative review of the effects of common anti-neoplastic and immune modulatory medications on wound healing to elucidate key clinical considerations for surgical planning. Methods: Searches utilizing various indexing terms and key words surrounding wound healing, antineoplastic agents, and immunotherapies was conducted with PubMed and Embase by Elsevier. The search was limited to full text, non-review articles in English published between 2002 and 2023. Articles were screened independently by five investigators. Case reports, randomized control trials, prospective cohort studies, or retrospective cohort studies that investigated an antineoplastic agent and reported on outcomes related to wound healing were included. Articles were excluded if they reported on animals, analgesics, steroids, or did not investigate outcomes related to wound healing. Results: Screening yielded 45 articles for analysis. Drug categories included checkpoint inhibitors, mammalian target of rapamycin inhibitors, alkylating agents, antimetabolites, monoclonal antibodies, and tyrosine kinase inhibitors, and receptor tyrosine kinase inhibitors. Many postoperative surgical wound healing complications were documented across classes. Conclusion: Our study provides a review of wound healing complications associated with anti-neoplastic agents and immunotherapies. Application of this review in the context of expanding medical treatment for cancer, has high importance to wound healing in plastic surgery.