Wound Healing Process in Post-bariatric Patients: an Experimental Evaluation

Abstract

Bariatric surgery is the most effective treatment for morbid obesity. Despite this, side effects are recorded. One of them is redundant skin hanging from the patients' body causing both aesthetical and functional deformities. They can only be corrected with body contouring surgery, whose wound complication rate is very high in previously obese population. Despite several hypotheses, an adequate explanation is still awaited. The aim of our study was to evaluate the wound healing process in post-bariatric patients. Seven patients, six women and one man, were enrolled. They all were nonsmokers and nondiabetic. They all underwent biliopancreatic diversion (BPD). After 36 months, abdominoplasty was performed. Biochemical parameters before and after bariatric surgery were evaluated. The content of total protein and hydroxyproline was assessed in multiple scar biopsies before and after BPD. Abdominoplasty horizontal scar skin samples were subjected to histological evaluation with Weigert-Van Gieson stain for elastic fibers and connectivum. All biochemical parameters analyzed were reduced post-BPD compared to the preoperative period. Tissue proteins were significantly reduced after BPD both in their totality and as hydroxyproline and hydroxyproline/total tissue protein. Histological evaluation revealed abnormal dermal elastic and collagen fibers. The cause of aberrant healing in massive weight loss body contouring is likely multifactorial. A relationship between nutritional state, wound collagen accumulation, and elastic fiber content seems to be only partially involved. The high mechanical stress of tissues before BPD probably influences the wound healing process after BPD.

Predictors of vaginal mesh exposure after midurethral sling placement: a case–control study

“…However, despite preoperative nutrient replacement, increased rates of wound complications have been reported in this population [15]. Thus, it is possible that other mechanisms, such as high mechanical stress on tissues before bariatric surgery or weight loss, may also lead to poor healing because of decreased tissue elasticity and impaired microcirculation [15,16].…”

“…The impact of bariatric surgery on wound healing has been well studied in elective body-contouring surgery after weight loss [14][15][16]. One potential hypothesis is that poor wound healing in these patients is attributable to nutrient deficiencies, Fig.…”

“…One potential hypothesis is that poor wound healing in these patients is attributable to nutrient deficiencies, Fig. 1 Flow chart of study cohorts e.g., in protein, zinc, copper, vitamin B 12 , vitamin A, and vitamin C [14][15][16]. However, despite preoperative nutrient replacement, increased rates of wound complications have been reported in this population [15].…”

Impaired Abdominal Skin Sensory Function in Morbid Obesity and After Bariatric Surgery

“…In recent years, due to the worldwide growth of obesity [4] and of bariatric surgery [5], the number of ex-obese individuals who undergo plastic surgery has increased, thereby requiring special attention in the field of plastic surgery [6,7]. The number of post-operative complications tends to be higher in patients with a history of morbid obesity; although the true causes of these complications are still under investigation [8], health care professionals need to give post-bariatric patients special care [9].…”

“…Recent histological and molecular studies have confirmed that the abdominal dermis of the morbidly ex-obese shows lymphocytic infiltrations and destructuration of the collagen and elastic network [8,10,11], a lower quantity of heparan sulfate, and lower genetic expression of perlecan and type III collagen [12]. The destructuration of the fibrous extracellular matrix of the dermis is more intense in the infra-umbilical (IU) region [13].…”