Albumin Uptake by Skin, Skeletal Muscle and Lung in Living and Dying Patients

Quantitative changes in albumin and water content which occur in skin and muscle tissue obtained by biopsy from clean surgical incisions at the time of skin incision and at the time of wound closure were assessed in seven patients who had major abdominal and vascular operations. Biopsies from skin, muscle and pulmonary tissue were obtained in a second group of nine patients who had thoracotomy for suspected bronchogenic carcinoma. The intravascular albumin mass decreased linearly with the duration of the operation (r = 0.69, p <0.01) and was correlated significantly with a linear increase of extravascular albumin content in muscle (r = 0.63, p < 0.01). A significant increase of extravascular albumin occurred from the time of incision to the time of wound closure in the skin and muscle samples from both groups (p < 0.05-p < 0.001). Extravascular albumin and water content were assessed in a third group of three postoperative patients who died with acute respiratory failure. Although the concentration of extravascular albumin in pulmonary tissue taken from this group was not different from the thoracotomy group, calculations based on the mean combined post mortem lung weights showed two to three times more extravascular albumin content. The histopathological findings are consistent with these changes. Thoracotomy was not associated with an abnormal increase in pulmonary extravascular albumin and water content, possibly because albumin does not gain access to the pulmonary extravascular space in increased amounts during operation in this clinical setting.