Influence of the initial state of the subcutaneous cell in overweight and obesity patients on the development of complications in the postoperative period

The World Obesity Federation published an atlas in 2023, which reports that if the current trend continues, in 2035 every second person in the World will be overweight or obese. Often, overweight or obese patients turn to a plastic surgeon for help, as the “easiest way” to solve this problem. Nevertheless, the initial state of the patient's health is fundamental to obtain a satisfying result for both the surgeon and the patient of the aesthetic intervention. Therefore, a thorough understanding of the pathomorphological processes occurring in the body of patients with overweight or obesity is necessary, which determines the relevance of this study.

Purpose of the study: to study the morphological picture of the subcutaneous tissue in patients with overweight or obesity.

Material and methods. A morphological and immunohistochemical assessment of the state of the subcutaneous tissue was carried out in 49 overweight women who, in the period from 2019 to 2020, underwent planned surgical interventions for aesthetic indications aimed at correcting body contours. After the operation, women were observed for 6 months, assessing the timing of wound healing, as well as the presence or absence of seromas, ligature fistulas, and wound infection. We carried out a comparative analysis of the morphological picture of the subcutaneous tissue in different course of the wound process, studied the prognostic significance of the identified subcutaneous tissue morphotypes in relation to the risk of delayed and complicated wound healing.

Results. Histological examination revealed two morphological types of subcutaneous adipose tissue structure: adipocyte and adipocyte-fibrous. The adipocyte type of structure of the subcutaneous adipose tissue is represented by the adipose tissue itself from typical mature adipocytes with interadipocyte small capillaries, which has a lobular structure with thin layers of interlobular connective tissue. This morphological type of structure was observed mainly in the group with a standard postoperative period. The mixed adipocyte-fibrous type of subcutaneous adipose tissue structure was characterized by a different ratio of two tissue components - fatty and fibrous. This morphological type of structure is typical for a group of patients with a delayed and complicated wound process in the postoperative period. The established changes in the histological structure, cell infiltration with an increase in the number of CD68+ positive macrophages and HLA-DR+ positive immune cells, perivascular CD20+ B-lymphocytes in the subcutaneous fat indicates that patients with a complicated healing process have already been admitted to the clinic in a state of local chronic inflammation of the subcutaneous tissue.

Conclusion. The morphological changes in the subcutaneous tissue revealed during our study can partially explain the prolongation of the wound process and the development of complications in the postoperative period in overweight and obese patients. However, in order to create a routine algorithm for the preoperative identification of patients at risk, it is necessary to identify correlations between biochemical changes in the blood and the development of changes in the subcutaneous tissue.

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