*5.3.5 Septicaemia*

Excessive secretion of pro-inflammatory mediators due to endotoxins is a critical part of systemic inflammation that leads to sepsis or septicaemia. Systemic inflammation has a hypo-inflammatory state characterised by monocyte deactivation and immunosuppression that compromises leukocytic activity and has inhibitory effect on wound healing.

Septicaemia also causes plasma and endothelial-related inflammatory modifications that impact coagulation and has been implicated in micro circulatory thrombosis that affects tissue perfusion and may even lead to fatalities due to associated multiple-organ failure [49, 50].

### *5.3.6 Nutrition*

Wound healing is nutrition intensive as there is significant protein loss to maintain normoglycaemia, thus patients' bodies consume body stores of fats and protein during this process and it is essential to maintain proper nutrition to ensure proper wound remediation. While glucose is the main fuel for wound healing, protein malnutrition, especially deficiencies of specific amino acids such as arginine and methionine have been associated with compromised wound repair due to prolonged inflammation stage, disruption of matrix deposition, cellular proliferation, and angiogenesis. Decreased rates of collagen deposition during dermal wound healing have also been associated with malnutrition [51–53].
