对创面愈合微环境的比较分析和系统评价：对巨量体重减轻后身体塑形的影响。

A comparative analysis and systematic review of the wound-healing milieu: implications for body contouring after massive weight loss.

机构信息

Rochester, N.Y. From the Division of Plastic Surgery, University of Rochester Medical Center.

出版信息

Plast Reconstr Surg. 2009 Nov;124(5):1675-1682. doi: 10.1097/PRS.0b013e3181b98bb4.

DOI:10.1097/PRS.0b013e3181b98bb4

PMID:20009855

Abstract

BACKGROUND

Wound-healing complications following body contouring for massive weight loss patients are significant, with rates exceeding 40 percent. To better understand aberrant healing in this population, the authors have performed a comparative analysis of the wound milieu literature for patient populations with similar complication rates.

METHODS

PubMed and Ovid databases were reviewed from January of 1985 to January of 2009 for key terms, including wound healing, obesity, cancer, burn, transplant, and body contouring. Serum and wound levels of multiple factors, including matrix metalloproteinases (MMPs) and cytokines, were assessed.

RESULTS

Complication rates in body contouring surgery range from 31 to 66 percent. Sixty-five studies were reviewed, and wound-healing complication rates were identified for cancer (45.8 percent), burn (30.4 percent), posttransplant (36 percent), and obese (43 percent) populations. In these groups, matrix metalloproteinases and tissue inhibitors of metalloproteinase (TIMPs) help regulate wound repair. Matrix metalloproteinase levels were elevated in cancer (4-fold increase in MMP-2), burn (20- to 30-fold increase in MMP-9), transplant (1.4-fold increase in MMP-2), and obese/chronic (79-fold increase) populations. TIMPs were increased in cancer (1.9-fold increase in TIMP-2) and burn (1.4-fold increase in TIMP-1) patients but decreased in chronic wound (55-fold decrease in TIMP-1) populations. Alterations to these regulatory proteins lead to prolonged matrix degradation, up-regulation of inflammatory mediators, and decreased growth factors, delaying the wound-healing process.

CONCLUSIONS

Complications after body contouring surgery are likely multifactorial; however, molecular imbalances to the massive weight loss wound milieu may contribute to poor surgical outcomes. Examining wound regulatory proteins including transforming growth factor-beta, vascular endothelial growth factor, and matrix metalloproteinases could aid in understanding the healing difficulties observed clinically.

摘要

背景

大量减重患者进行身体塑形手术后的伤口愈合并发症发生率很高，超过 40%。为了更好地了解该人群中异常愈合的原因，作者对具有相似并发症发生率的患者群体的伤口环境文献进行了对比分析。

方法

从 1985 年 1 月至 2009 年 1 月，通过 PubMed 和 Ovid 数据库检索了与伤口愈合、肥胖、癌症、烧伤、移植和身体塑形相关的关键词。评估了包括基质金属蛋白酶（MMPs）和细胞因子在内的多种因子在血清和伤口中的水平。

结果

身体塑形手术的并发症发生率为 31%至 66%。共回顾了 65 项研究，确定了癌症（45.8%）、烧伤（30.4%）、移植后（36%）和肥胖（43%）患者的伤口愈合并发症发生率。在这些群体中，基质金属蛋白酶和金属蛋白酶组织抑制剂（TIMPs）有助于调节伤口修复。癌症患者的 MMP-2 水平升高了 4 倍，烧伤患者的 MMP-9 水平升高了 20-30 倍，移植患者的 MMP-2 水平升高了 1.4 倍，肥胖/慢性患者的 MMP-1 水平升高了 79 倍。癌症患者的 TIMP-2 水平升高了 1.9 倍，烧伤患者的 TIMP-1 水平升高了 1.4 倍，但慢性伤口患者的 TIMP-1 水平降低了 55 倍。这些调节蛋白的改变导致基质降解延长、炎症介质上调和生长因子减少，从而延迟伤口愈合过程。