Wound Repair and Body Contouring Surgery After Gastric Bypass
Condition: Obesity, Morbid
MeSH terms: Obesity, Morbid
Study type: Observational

Summary: 
      The primary aim of our study is to test the hypothesis that wound healing is impaired in the
      patient who has experienced massive weight reduction following gastric bypass for morbid
      obesity. Specifically we will document post-surgical local complications and evaluate
      multiple wound healing parameters in two patient populations in a prospective fashion. The
      test group will consist of patients who have undergone dramatic weight loss and are much in
      need of a panniculectomy due to excessive skin redundancy. The control group will consist of
      patients within normal weight ranges who are seeking an abdominoplasty.
    

Detailed description: 
      The morbidly obese patient after successful weight reduction surgery represents a poorly
      understood patient population that presents unique quandaries. Prior to gastric bypass
      surgery, many of these patients have Type II diabetes, frequent skin infections from poor
      hygiene, and multiple medical co-morbidities. Fortunately, numerous problems resolve during
      the period of the rapid weight loss. Typically the Type II diabetes comes under control
      without medication and patients experience improvement in mobility and psychosocial
      adjustment. Unfortunately new dilemmas can rise such as vitamin deficiencies due to many
      months of starvation, residual end glycosylation products in diabetic skin and massive skin
      redundancies in multiple locations. Excessive skin is prone to infection. Patients continue
      to be plagued with postural problems, functional problems (improper personal hygiene,
      continued difficulties in ambulation) and psychosocial problems associated with a poor body
      image. Body contouring can provide such patients with marked improvements in lifestyle. The
      post-bariatric patient population is rapidly increasing in number, yet their wound healing
      responses to accidental or surgical trauma are unreported in the literature.

      Recent studies have documented clinical suspicions that the post-bariatric patient is at an
      increased risk for wound healing complications following body contouring procedures. The most
      recent retrospective study of 30 patients

      assessed post-surgical outcomes following body contouring procedures in multiple body
      locations and noted a 20% incidence of wound breakdown and a 16% incidence of seroma (1). An
      earlier retrospective study comparing panniculectomy in post bariatric patients to those
      receiving a simultaneous panniculectomy plus gastric bypass documented wound infections
      (16%), dehiscence (13%) and skin necrosis (6%) in the post bariatric group (2). A prospective
      study of ten post-bariatric patients who were given a circumferential abdominoplasty likewise
      experienced wound complications: (33% seromas, 16.6% dehiscence, and infections 8.2%) (3). An
      11 patient dermalipectomy series for body contouring after bariatric surgery showed a 27%
      incidence of infection and seroma (4). To date, the highest rate of wound healing
      complications was reported in 46 out of 55 (86%) dermolipectomy patients (5). Taken together
      these reports provide clinical evidence that wound healing is impaired in the post-bariatric
      patient population. We are prepared to undertake a quantitative evaluation of wound repair
      characteristics in this select population.

      There are multiple reasons to suspect that the skin itself may be defective in these patients
      who have undergone massive weight reduction. A lifetime of stretched out skin can thin the
      density of epidermal appendages and peripheral nerve endings, alter the vascular network,
      diminish the elasticity and alter the weave of the collagen bundles in the reticular dermis.
      Such negative circumstances may impede the delivery of oxygen and nutrients and ultimately
      hinder tensile strength. Nutritional deficiencies from the forced starvation are thought to
      decrease anabolic processes and impair the inflammatory processes, factors that also govern
      the timing and quality of wound repair. Dehiscence rates could be negatively impacted by this
      synergy of alterations. While the post-bariatric patients can electively seek body contouring
      surgery, it is certain that the ever increasing number of post-bariatric patients will
      experience unexpected trauma or non-elective surgical procedures - all circumstances that
      also challenge the body to repair itself. We maintain that it will be important to document
      wound healing deficiencies so that optimal treatment plans can be implemented when the need
      arises.

      Disclaimer: Individuals who participate in this study are financially responsible for all
      costs relating to the surgery!
    

Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        All potential subjects presenting to the plastic surgery practice ages 18-65 will be
        approached for participation
      
Keywords: Gastric Bypass; Body contouring; Excessive weight loss