Overweight and imbalance of the intestinal microbiota are risk factors for disruption of reparative processes during the healing of postoperative wounds. Given the scale of the obesity epidemic in the modern world, the number of overweight patients undergoing surgery for various reasons is also increasing. Potentiation of the risk of a delayed and complicated course of the wound process with a combination of obesity and disturbances in the composition of the intestinal microbiota determines the relevance of this study.Purpose of the study: to study the composition of the intestinal microbiota in patients with overweight and obesity, who have a slowdown in the course of the wound process and the development of complications in the postoperative period.Material and methods. The composition of the intestinal parietal microbiota was studied by microbial markers in the blood using gas chromatography in 49 overweight women who underwent planned surgical interventions for aesthetic indications aimed at correcting body contours from 2019 to 2020. After surgery, women were followed up for 6 months, assessing the timing of wound healing. A comparative analysis of the composition of the intestinal microbiota was carried out in different courses of the wound process, the prognostic significance of individual indicators of the intestinal microbiota was studied in relation to the risk of delayed and complicated wound healing.Results. In the postoperative period, three groups were formed: 1st − complicated wound process (n = 21), 2nd − slow wound process 16 (n = 16), 3rd − standard wound process (n = 12). There were statistically significant differences between the 1st and 2nd groups in terms of “Peptostreptococcus anaerobius (Gr 1) ≥ 562.0 · 105 cells/g”, p = 0.025) and “Propionibacterium ≥3.2 · 105 cells/g”, p = 0.0136). Differences were found between the 1st and 3rd groups in terms of “Endotoxin ≥0.7 nmol/ml”, p = 0.051). The highest risk of complicated and delayed postoperative wound healing is observed when the value of the indicators «Propionibacterium ≥32.0 · 105 cells/g”, “Peptostreptococcus anaerobius (Gr 1) ≥7.0 · 105 cells/g” and “Endotoxin ≥0.7 nmol/ml”. On the basis of the decision tree method, 4 risk classes of a delayed and complicated course of the wound process were identified. The highest risk is in patients with a combination of factors “Propionibacterium ≥ 3.2 · 105 cells/g” and “Endotoxin ≥ 0.7 nmol/ml”.Conclusion. A number of indicators of intestinal microbiota have a high prognostic value in relation to the risk of developing a complicated and delayed course of the wound process in overweight individuals. The data obtained can be used to predict unfavorable healing of surgical wounds.
Introduction. Overweight and imbalance of the intestinal microbiota are risk factors for disruption of reparative processes during the postoperative wound healing. Given the scale of the obesity epidemic in the modern world, the number of overweight patients undergoing surgery for various reasons is also increasing. The potentiation of the risk of a delayed and complicated course of the wound process combined with obesity and violated composition of the intestinal microbiota determines the relevance of this study.The aim of the study was to investigate the composition of the intestinal microbiota in patients with increased body weight, with long-term non-healing and complicated surgical wounds.Methods. The composition of the parietal intestinal microbiota was studied by microbial markers in the blood using gas chromatography in 49 overweight women who underwent planned surgical interventions for aesthetic indications in the period from 2019 to 2020, aimed at correcting body contours. After the operation, women were observed for 6 months, with assessment of the timing of wound healing. We carried out a comparative analysis of the composition of the intestinal microbiota in the different course of the wound process, studied the prognostic significance of individual parameters of the intestinal microbiota in relation to the risk of delayed and complicated wound healing.Results. In the postoperative period, all patients were divided into three groups: group 1 - complicated wound process (n=21), group 2 - delayed wound process 16 (n=16), group 3 - conventional wound process (n=12). Statistically significant differences were found between groups 1 and 2 in terms of "Peptostreptococcus anaerobius (Gr 1) 562.0" (621.76962.03 versus 101.75371.90, respectively, p=0.025) and "Propionibacterium 3.2" (77.57 48.57 vs. 40.44 38.15, respectively, p=0.014). Differences were found between groups 1 and 3 in terms of Endotoxin 0.7 (0.730.58 nmol/ml versus 0.860.48 nmol/ml, respectively, p=0.051). The most risk of the complicated and delayed postoperative wound healing is observed when the values of the parameters were "Propionibacterium 32.0", "Peptostreptococcus anaerobius (Gr 1) 7.0" and "Endotoxin 0.7". Based on the decision tree analysis, 4 risk classes of delayed and complicated course of the wound process were identified. Patients with a combination of Propionibacterium 3.2 and Endotoxin 0.7 had the highest risk.Conclusion. A number of parameters of the intestinal microbiota have a high prognostic value regarding the risk of developing a complicated and delayed course of the wound process in overweight individuals. The data obtained can be used to predict unfavorable healing of surgical wounds. Further research is needed in this area on a larger sample of patients, including males.
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