The role of chronic inflammation in pathogenesis of complications after contour-plastic surgeries

   Achieving optimal results in aesthetic surgery is impossible without a thorough understanding of the pathophysiological processes occurring in the patient’s body. This is especially important for overweight individuals, whose numbers are steadily increasing. This group of patients is most susceptible to local postoperative complications, such as wound dehiscence, persistent seromas, and flap necrosis.

   Purpose of a study: to identify the causes of local wound complications after plastic surgery associated with massive tissue detachment in overweight patients.

   Material and Methods. Morphological and immunohistochemical assessment of subcutaneous fat (SCF) was performed in 49 women aged 30–60 years with a body mass index (BMI) of 25.0–29.9 kg/m² who underwent abdominal contouring (Graser abdominoplasty) in 2019–2020. The structure of the subcutaneous fat and the course of the postoperative period were assessed, including the healing time of surgical wounds, the development of seromas, ligature fistulas, and necrosis.

   Results. The study identified two subcutaneous fat morphotypes: adipocytic (lobules of mature adipocytes with thin layers of connective tissue and interadipocyte capillaries) and adipocytic-fibrous (inflammatory) (variable ratios of adipose and fibrous tissue). The first type was detected in 3 (23.1 %) of 13 patients with uncomplicated wound healing (Group 1), while the second type was observed in 10 (76.9 %) patients in Group 1 and in all 36 patients (100 %) in Group 2. Women in Group 2 were statistically significantly more likely (43.5 % vs 15.4 %, p < 0.05) to have vascular abnormalities (hypervascularization up to 10–15 vessels/mm², changes in vascular morphology, plethora, perivascular fibrosis/edema) and an active local immune response: increased numbers of CD68⁺ macrophages, HLA-DR⁺ immune cells, and perivascular CD20⁺ B lymphocytes.

   Conclusion. Complicated and prolonged wound healing after contour plastic surgery in patients with a BMI greater than 24.9 kg/m² is directly related to subclinical chronic inflammation in the subcutaneous fat, manifested by fibrotic degeneration, vascular changes, and immune cell activation. Patients with excess body weight should be identified as a risk group with the development of preoperative assessment algorithms (morphology of the subcutaneous fat, blood biochemistry) and the use of modified abdominoplasty techniques.

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