Sharma Gaurav, Kulkarni Rohan, Shah Samir K, King William W, Longchamp Alban, Tao Ming, Ding Kui, Ozaki C Keith
Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
Surgery. 2016 Jul;160(1):204-210. doi: 10.1016/j.surg.2016.01.024. Epub 2016 Apr 14.
Wound complication rates after lower extremity vascular operative procedures stand as high as 40% and represent a major cause of morbidity, mortality, and cost. In view of increasing recognition of adipose tissue involvement in homeostasis and the response to injury, we hypothesized that adipose phenotype is linked to operative wound outcomes.
Clinical history, peripheral blood, and subcutaneous and perivascular adipose tissue were prospectively collected at the time of operation in patients undergoing lower extremity revascularization and lower extremity amputations. Nine biologic mediators (adiponectin; interleukin [IL]-1β, IL-6, and IL-8; leptin; monocyte chemoattractant protein-1; plasminogen activator inhibitor-1; resistin; and tumor necrosis factor) were assayed in the adipose tissues and plasma. The 30-day wound complications were captured in real time. Logarithmic transformation of mediator levels was performed based on positively skewed, non-Gaussian distribution, and data were compared using the Student t test. Bonferroni correction was used for multiple comparisons.
Sixty-six patients undergoing lower extremity revascularization or lower extremity amputations for severe peripheral arterial disease were enrolled. The 30-day follow-up was 92.4%. In total, 19 (29%) patients developed wound complications. Patients who developed wound complications had elevated perivascular adiponectin levels (mean ± standard error, 2,372.45 ± 648.64 ng/mL vs 832.53 ± 180.54 ng/mL, P = .004). Perivascular IL-1β levels were lower among patients with wound dehiscence (0.41 ± 0.004 pg/mL vs 0.73 ± 0.09 pg/mL, P = .001).
Local adipose tissue mediator levels at the time of operation demonstrate a previously undescribed compartment-specific relationship to wound outcomes in patients undergoing lower extremity vascular operative procedures. These associations provide fertile directives for defining the mechanisms underlying the pathogenesis of wound complications and their prevention.
下肢血管手术术后伤口并发症发生率高达40%，是发病、死亡及费用的主要原因。鉴于对脂肪组织参与体内稳态及损伤反应的认识不断增加，我们推测脂肪表型与手术伤口结局相关。
前瞻性收集接受下肢血管重建术和下肢截肢术患者手术时的临床病史、外周血以及皮下和血管周围脂肪组织。检测脂肪组织和血浆中的9种生物介质（脂联素；白细胞介素[IL]-1β、IL-6和IL-8；瘦素；单核细胞趋化蛋白-1；纤溶酶原激活物抑制剂-1；抵抗素；以及肿瘤坏死因子）。实时记录30天伤口并发症情况。基于正偏态、非高斯分布对介质水平进行对数转换，并使用学生t检验比较数据。采用Bonferroni校正进行多重比较。
纳入66例因严重外周动脉疾病接受下肢血管重建术或下肢截肢术的患者。30天随访率为92.4%。共有19例（29%）患者出现伤口并发症。出现伤口并发症的患者血管周围脂联素水平升高（平均±标准误，2372.45±648.64 ng/mL vs 832.53±180.54 ng/mL，P = .004）。伤口裂开患者的血管周围IL-1β水平较低（0.41±0.004 pg/mL vs 0.73±0.09 pg/mL，P = .001）。
手术时局部脂肪组织介质水平与接受下肢血管手术患者的伤口结局呈现出一种此前未被描述的特定部位关系。这些关联为明确伤口并发症发病机制及其预防机制提供了丰富的指导方向。
