Wound Repair and Body Contouring Surgery After Gastric Bypass
| Status: | Completed |
|---|---|
| Conditions: | Obesity Weight Loss |
| Therapuetic Areas: | Endocrinology |
| Healthy: | No |
| Age Range: | 18 - 65 |
| Updated: | 4/21/2016 |
| Start Date: | January 2006 |
| End Date: | March 2010 |
A Pilot/Feasibility Study on Wound Repair and Body Contouring Surgery After Gastric By-pass
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.
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.
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!
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!
Inclusion Criteria:
- Gastric Bypass or other weight reduction procedure requesting body contouring surgery
- Cosmetic abdominoplasty
- Be willing to complete study required bloodwork and collection of tissue and fluid
samples
Exclusion Criteria:
- Unable to comply with study requirements
We found this trial at
1
site
1211 Medical Center Dr
Nashville, Tennessee 37232
Nashville, Tennessee 37232
(615) 322-5000
Vanderbilt Univ Med Ctr Vanderbilt University Medical Center (VUMC) is a comprehensive healthcare facility dedicated...
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