Objective. The correlation between obesity and deficient wound healing has long been established. This review examines the current literature on the mechanisms involved in obesity-related perioperative morbidity. Methods. A literature search was performed using Medline, PubMed, Cochrane Library, and Internet searches. Keywords used include obesity, wound healing, adipose healing, and bariatric and surgical complications. Results. Substantial evidence exists demonstrating that obesity is associated with a number of postoperative complications. Specifically in relation to wound healing, explanations include inherent anatomic features of adipose tissue, vascular insufficiencies, cellular and composition modifications, oxidative stress, alterations in immune mediators, and nutritional deficiencies. Most recently, advances made in the field of gene array have allowed researchers to determine a few plausible alterations and deficiencies in obese individuals that contribute to their increased risk of morbidity and mortality, especially wound complications. Conclusion. While the literature discusses how obesity may negatively affect health on various of medical fronts, there is yet to be a comprehensive study detailing all the mechanisms involved in obesity-related morbidities in their entirety. Improved knowledge and understanding of obesity-induced physiological, cellular, molecular, and chemical changes will facilitate better assessments of surgical risks and outcomes and create efficient treatment protocols for improved patient care of the obese patient population. 1. Introduction Obesity is a growing and significant healthcare issue [1–4]. In 1910, Dr. Kelly described obesity, stating “to be a storehouse for useless adipose tissue and to carry this handicap around, openly displayed wherever one goes, is one of the most distressing of life’s minor ailments [5].” While current viewpoints may be less extreme, obesity continues to carry a social stigma and is increasingly present in our society [2, 4, 6, 7]. According to recent figures, an average prevalence of 35 percent of adult Americans is classified as obese and 5 percent morbidly obese, with this trend continuing [2, 8]. Obesity is responsible for more than 25 percent of the increase in healthcare costs over the past 15 years [2, 4]. Body mass index (BMI) is one of the most objective methods in determining the presence and extent of obesity [9–11]. As BMI increases to obesity levels, morbidity and mortality rates rise dramatically [4, 12–20]. The clinical definition for obesity is a ？kg/m2, with severe
References
[1]
D. R. Cottam, S. G. Mattar, E. Barinas-Mitchell et al., “The chronic inflammatory hypothesis for the morbidity associated with morbid obesity: implications and effect of weight loss,” Obesity Surgery, vol. 14, no. 5, pp. 589–600, 2004.
[2]
W. E. Encinosa, D. M. Bernard, C.-C. Chen, and C. A. Steiner, “Healthcare utilization and outcomes after bariatric surgery,” Medical Care, vol. 44, no. 8, pp. 706–712, 2006.
[3]
S. G. Camden and J. Gates, “Obesity: changing the face of geriatric care,” Ostomy Wound Management, vol. 52, no. 10, pp. 36–44, 2006.
[4]
K. E. Thorpe, C. S. Florence, D. H. Howard, and P. Joski, “The impact of obesity on rising medical spending,” Health Affairs, Web Exclusives, pp. 480–486, 2004.
[5]
H. A. Kelly, “Excision of the fat of the abdominal wall lipectomy,” Surgery, Gynecology & Obstetrics, vol. 10, article 229, 1910.
[6]
J. A. Wilson and J. J. Clark, “Obesity: impediment to postsurgical wound healing,” Advances in Skin & Wound Care, vol. 17, no. 8, pp. 426–435, 2004.
[7]
P. R. Schauer and B. D. Schirmer, “The surgical management of obesity,” in Schwartz’s Principles of Surgery, pp. 997–1016, McGraw Hill Companies, New York, NY, USA, 8th edition, 2005.
[8]
K. M. Flegal, D. Carroll, B. K. Kit, and C. L. Ogden, “Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010,” Journal of the American Medical Association, vol. 307, no. 5, pp. 491–497, 2012.
[9]
W. Coutinho, “Latin America consensus on obesity,” Arquivos Brasileiros de Endocrinologia & Metabologia, vol. 43, pp. 21–67, 1999.
[10]
I. Pitanguy, N. F. G. de Amorim, and H. N. Radwanski, “Contour surgery in the patient with great weight loss,” Aesthetic Plastic Surgery, vol. 24, no. 6, pp. 406–411, 2000.
[11]
J. C. Rosen, P. Orosan, and J. Reiter, “Cognitive behavior therapy for negative body image in obese women,” Behavior Therapy, vol. 26, no. 1, pp. 25–42, 1995.
[12]
P. Benotti, G. C. Wood, C. Still, A. Petrick, and W. Strodel, “Obesity disease burden and surgical risk,” Surgery for Obesity and Related Diseases, vol. 2, no. 6, pp. 600–606, 2006.
[13]
M. P. Herman, J. D. Raman, S. Dong, D. Samadi, and D. S. Scherr, “Increasing body mass index negatively impacts outcomes following robotic radical prostatectomy,” Journal of the Society of Laparoendoscopic Surgeons, vol. 11, no. 4, pp. 438–442, 2007.
[14]
K. Jongnarangsin, A. Chugh, E. Good et al., “Body mass index, obstructive sleep apnea, and outcomes of catheter ablation of atrial fibrillation,” Journal of Cardiovascular Electrophysiology, vol. 19, no. 7, pp. 668–672, 2008.
[15]
A. Lübbeke, K. G. M. Moons, G. Garavaglia, and P. Hoffmeyer, “Outcomes of obese and nonobese patients undergoing revision total hip arthroplasty,” Arthritis Care and Research, vol. 59, no. 5, pp. 738–745, 2008.
[16]
J. Parikh, I. Yermilov, M. Mcgory, S. Jain, C. Y. Ko, and M. Maggard, “Is high BMI associated with specific complications after laparoscopic Roux-en-Y gastric bypass?” American Surgeon, vol. 73, no. 10, pp. 959–962, 2007.
[17]
M. Rogliani, E. Silvi, L. Labardi, F. Maggiulli, and V. Cervelli, “Obese and nonobese patients: complications of abdominoplasty,” Annals of Plastic Surgery, vol. 57, no. 3, pp. 336–338, 2006.
[18]
L. Set？l？, A. Papp, S. Joukainen et al., “Obesity and complications in breast reduction surgery: are restrictions justified?” Journal of Plastic, Reconstructive and Aesthetic Surgery, vol. 62, no. 2, pp. 195–199, 2009.
[19]
E. J. Thomas, L. Goldman, C. M. Mangione et al., “Body mass index as a correlate of postoperative complications and resource utilization,” American Journal of Medicine, vol. 102, no. 3, pp. 277–283, 1997.
[20]
J. L. Mullen, G. P. Buzby, and D. C. Matthews, “Reduction of operative morbidity and mortality by combined preoperative and postoperative nutritional support,” Annals of Surgery, vol. 192, no. 5, pp. 604–613, 1980.
[21]
D. A. Anaya and E. P. Dellinger, “The obese surgical patient: a susceptible host for infection,” Surgical Infections, vol. 7, no. 5, pp. 473–480, 2006.
[22]
R. Bhatheja and D. L. Bhatt, “Clinical outcomes in metabolic syndrome,” Journal of Cardiovascular Nursing, vol. 21, no. 4, pp. 298–305, 2006.
[23]
J. Casey, W. R. Flinn, and J. S. T. Yao, “Correlation of immune and nutritional status with wound complications in patients undergoing vascular operations,” Surgery, vol. 93, no. 6, pp. 822–826, 1983.
[24]
U. Keller, “From obesity to diabetes,” International Journal for Vitamin and Nutrition Research, vol. 76, no. 4, pp. 172–177, 2006.
[25]
Surgery ASfMB, Bariatric Surgical Society Takes on New Name, New Mission, and New Surgery. Metabolic Surgery Expected to Play Bigger Role in Treating Type 2 Diabetes, 2013.
[26]
A. S. Aly, A. E. Cram, M. Chao, J. Pang, and M. McKeon, “Belt lipectomy for circumferential truncal excess: The University of Iowa experience,” Plastic and Reconstructive Surgery, vol. 111, no. 1, pp. 398–413, 2003.
[27]
D. J. Hurwitz, J. P. Rubin, M. Risin, A. Sajjadian, and S. Sereika, “Correcting the saddlebag deformity in the massive weight loss patient,” Plastic and Reconstructive Surgery, vol. 114, no. 5, pp. 1313–1325, 2004.
[28]
D. J. Hurwitz and T. E. Zewert, “Body contouring surgery in the bariatric surgical patient,” Operative Techniques in Plastic and Reconstructive Surgery, vol. 8, no. 2, pp. 87–95, 2002.
[29]
M. J. Kamper, D. V. Galloway, and F. Ashley, “Abdominal panniculectomy after massive weight loss,” Plastic and Reconstructive Surgery, vol. 50, no. 5, pp. 441–446, 1972.
[30]
R. W. Postlethwait and W. D. Johnson, “Complications following surgery for duodenal ulcer in obese patients,” Archives of Surgery, vol. 105, no. 3, pp. 438–440, 1972.
[31]
K. J. Printen, S. C. Paulk, and E. E. Mason, “Acute postoperative wound complications after gastric surgery for morbid obesity,” American Surgeon, vol. 41, no. 8, pp. 483–485, 1975.
[32]
W. E. Matory Jr., J. O'Sullivan, G. Fudem, and R. Dunn, “Abdominal surgery in patients with severe morbid obesity,” Plastic and Reconstructive Surgery, vol. 94, no. 7, pp. 976–987, 1994.
[33]
J. P. Rubin, “Plastic surgery after massive weight loss,” Contemporary Surgery, vol. 61, pp. 599–603, 2005.
[34]
R. I. Abdel-Moneim, “The hazards of surgery in the obese,” International Surgery, vol. 70, no. 2, pp. 101–103, 1985.
[35]
M. A. Carlson, “Acute wound failure,” Surgical Clinics of North America, vol. 77, no. 3, pp. 607–636, 1997.
[36]
C. E. Yale, “Gastric surgery for morbid obesity. Complications and long-term weight control,” Archives of Surgery, vol. 124, no. 8, pp. 941–946, 1989.
[37]
W. R. Thompson, J. F. Ameral, and M. D. Caldwell, “Complications and weight loss in 150 consecutive gastric exclusion patients. Critical review,” The American Journal of Surgery, vol. 146, no. 5, pp. 602–612, 1983.
[38]
F. M. Grazer and R. M. Goldwyn, “Abdominoplasty assessed by survey, with emphasis on complications,” Plastic and Reconstructive Surgery, vol. 59, no. 4, pp. 513–517, 1977.
[39]
I. Pitanguy, “Abdominal lipectomy,” Clinics in Plastic Surgery, vol. 2, no. 3, pp. 401–410, 1975.
[40]
Z. M. Arthurs, D. Cuadrado, V. Sohn et al., “Post-bariatric panniculectomy: pre-panniculectomy body mass index impacts the complication profile,” The American Journal of Surgery, vol. 193, no. 5, pp. 567–570, 2007.
[41]
M. A. Manahan and M. A. Shermak, “Massive panniculectomy after massive weight loss,” Plastic and Reconstructive Surgery, vol. 117, no. 7, pp. 2191–2199, 2006.
[42]
A. M. Wolf and H. W. Kuhlmann, “Reconstructive procedures after massive weight loss,” Obesity Surgery, vol. 17, no. 3, pp. 355–360, 2007.
[43]
J. F. Finks, K. L. Kole, P. R. Yenumula, et al., “Predicting risk for serious complications with bariatric surgery: results from the Michigan bariatric surgery collaborative,” Annals of Surgery, vol. 254, no. 4, pp. 633–640, 2011.
[44]
D. J. Ciesla, E. E. Moore, J. L. Johnson, J. M. Burch, C. C. Cothren, and A. Sauaia, “Obesity increases risk of organ failure after severe trauma,” Journal of the American College of Surgeons, vol. 203, no. 4, pp. 539–545, 2006.
[45]
L. Flancbaum and S. Belsley, “Factors affecting morbidity and mortality of Roux-en-Y gastric bypass for clinically severe obesity: an analysis of 1,000 consecutive open cases by a single surgeon,” Journal of Gastrointestinal Surgery, vol. 11, no. 4, pp. 500–507, 2007.
[46]
P. A. McCullough, M. J. Gallagher, A. T. DeJong et al., “Cardiorespiratory fitness and short-term complications after bariatric surgery,” Chest, vol. 130, no. 2, pp. 517–525, 2006.
[47]
J. Peter Rubin, V. Nguyen, and A. Schwentker, “Perioperative management of the post-gastric-bypass patient presenting for body contour surgery,” Clinics in Plastic Surgery, vol. 31, no. 4, pp. 601–610, 2004.
[48]
J. A. Greco, E. T. Castaldo, L. B. Nanney et al., “The effect of weight loss surgery and body mass index on wound complications after abdominal contouring operations,” Annals of Plastic Surgery, vol. 61, no. 3, pp. 235–242, 2008.
[49]
P. T. Campbell, C. C. Newton, A. N. Dehal, E. J. Jacobs, A. V. Patel, and S. M. Gapstur, “Impact of body mass index on survival after colorectal cancer diagnosis: the cancer prevention study-II nutrition cohort,” Journal of Clinical Oncology, vol. 30, no. 1, pp. 42–52, 2012.
[50]
M. Bombelli, R. Facchetti, D. Fodri, et al., “Impact of body mass index and waist circumference on the cardiovascular risk and all-cause death in a general population: data from the PAMELA study,” Nutrition, Metabolism & Cardiovascular Diseases, vol. 23, no. 7, pp. 650–656, 2013.
[51]
S. Y. Park, L. R. Wilkens, S. P. Murphy, et al., “Body mass index and mortality in an ethnically diverse population: the Multiethnic Cohort Study,” European Journal of Epidemiology, vol. 27, no. 7, pp. 489–497, 2012.
[52]
J. P. Reis, C. A. MacEra, M. R. Araneta, S. P. Lindsay, S. J. Marshall, and D. L. Wingard, “Comparison of overall obesity and body fat distribution in predicting risk of mortality,” Obesity, vol. 17, no. 6, pp. 1232–1239, 2009.
[53]
M. J. McNeely, J. B. Shofer, D. L. Leonetti, W. Y. Fujimoto, and E. J. Boyko, “Associations among visceral fat, all-cause mortality, and obesity-related mortality in Japanese Americans,” Diabetes Care, vol. 35, no. 2, pp. 296–298, 2012.
[54]
P. E. Serrano, S. A. Khuder, and J. J. Fath, “Obesity as a Risk Factor for Nosocomial Infections in Trauma Patients,” Journal of the American College of Surgeons, vol. 211, no. 1, pp. 61–67, 2010.
[55]
R. M. Pitkin, “Abdominal hysterectomy in obese women,” Surgery Gynecology and Obstetrics, vol. 142, no. 4, pp. 532–536, 1976.
[56]
L. B. Pemberton and W. G. Manax, “Relationship of obesity to postoperative complications after cholecystectomy,” The American Journal of Surgery, vol. 121, no. 1, pp. 87–90, 1971.
[57]
A. J. Derzie, F. Silvestri, E. Liriano, and P. Benotti, “Wound closure technique and acute wound complications in gastric surgery for morbid obesity: a prospective randomized trial,” Journal of the American College of Surgeons, vol. 191, no. 3, pp. 238–243, 2000.
[58]
V. L. Vastine, R. F. Morgan, G. S. Williams et al., “Wound complications of abdominoplasty in obese patients,” Annals of Plastic Surgery, vol. 42, no. 1, pp. 34–39, 1999.
[59]
M. A. Shermak, D. Chang, T. H. Magnuson, and M. A. Schweitzer, “An outcomes analysis of patients undergoing body contouring surgery after massive weight loss,” Plastic and Reconstructive Surgery, vol. 118, no. 4, pp. 1026–1031, 2006.
[60]
D. A. Dubay and M. G. Franz, “Acute wound healing: the biology of acute wound failure,” Surgical Clinics of North America, vol. 83, no. 3, pp. 463–481, 2003.
[61]
H. J. Sugerman, J. M. Kellum Jr., H. D. Reines, E. J. DeMaria, H. H. Newsome, and J. W. Lowry, “Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh,” The American Journal of Surgery, vol. 171, no. 1, pp. 80–84, 1996.
[62]
L. B. Salans, S. W. Cushman, and R. E. Weismann, “Studies of human adipose tissue. Adipose cell size and number in nonobese and obese patients,” Journal of Clinical Investigation, vol. 52, no. 4, pp. 929–941, 1973.
[63]
J. Smahel, “Adipose issue in plastic surgery,” Annals of Plastic Surgery, vol. 16, no. 5, pp. 444–453, 1986.
[64]
B. Markman, “Anatomy and physiology of adipose tissue,” Clinics in Plastic Surgery, vol. 16, no. 2, pp. 235–244, 1989.
[65]
F. Gottrup, R. Firmin, J. Rabkin, B. J. Halliday, and T. K. Hunt, “Directly measured tissue oxygen tension and arterial oxygen tension assess tissue perfusion,” Critical Care Medicine, vol. 15, no. 11, pp. 1030–1036, 1987.
[66]
K. Jonsson, J. A. Jensen, W. H. Goodson III et al., “Tissue oxygenation, anemia, and perfusion in relation to wound healing in surgical patients,” Annals of Surgery, vol. 214, no. 5, pp. 605–613, 1991.
[67]
K. Jonsson, T. K. Hunt, and S. J. Mathes, “Oxygen as an isolated variable influences resistance to infection,” Annals of Surgery, vol. 208, no. 6, pp. 783–787, 1988.
[68]
H. W. Hopf, T. K. Hunt, J. M. West et al., “Wound tissue oxygen tension predicts the risk of wound infection in surgical patients,” Archives of Surgery, vol. 132, no. 9, pp. 997–1005, 1997.
[69]
D. B. Allen, J. J. Maguire, M. Mahdavian et al., “Wound hypoxia and acidosis limit neutrophil bacterial killing mechanisms,” Archives of Surgery, vol. 132, no. 9, pp. 991–996, 1997.
[70]
T. K. Hunt, M. Linsey, M. Sonne, and E. Jawetz, “Oxygen tension and wound infection,” Surgical Forum, vol. 23, pp. 47–49, 1972.
[71]
J. Niinikoski, G. Grislis, and T. K. Hunt, “Respiratory gas tensions and collagen in infected wounds,” Annals of Surgery, vol. 175, no. 4, pp. 588–593, 1972.
[72]
T. K. Hunt and M. P. Pai, “The effect of varying ambient oxygen tensions on wound metabolism and collagen synthesis,” Surgery Gynecology and Obstetrics, vol. 135, no. 4, pp. 561–567, 1972.
[73]
F. X. Hausberger and M. M. Widelitz, “Distribution of labeled erythrocytes in adipose tissue and muscle in the rat,” The American Journal of Physiology, vol. 204, pp. 649–652, 1963.
[74]
D. M. Groszek, “Promoting wound healing in the obese patient,” AORN Journal, vol. 35, no. 6, pp. 1132–1138, 1982.
[75]
O. Gealekman, N. Guseva, C. Hartigan et al., “Depot-specific differences and insufficient subcutaneous adipose tissue angiogenesis in human obesity,” Circulation, vol. 123, no. 2, pp. 186–194, 2011.
[76]
T. Khan, E. S. Muise, P. Iyengar et al., “Metabolic dysregulation and adipose tissue fibrosis: Role of collagen VI,” Molecular and Cellular Biology, vol. 29, no. 6, pp. 1575–1591, 2009.
[77]
M. Spencer, R. Unal, B. Zhu et al., “Adipose tissue extracellular matrix and vascular abnormalities in obesity and insulin resistance,” Journal of Clinical Endocrinology and Metabolism, vol. 96, no. 12, pp. E1990–E1998, 2011.
[78]
J. Hirsch and J. L. Knittle, “Cellularity of obese and nonobese human adipose tissue,” Federation Proceedings, vol. 29, no. 4, pp. 1516–1521, 1970.
[79]
E. Billings Jr. and J. W. May Jr., “Historical review and present status of free fat graft autotransplantation in plastic and reconstructive surgery,” Plastic and Reconstructive Surgery, vol. 83, no. 2, pp. 368–381, 1989.
[80]
J. Ye, “Emerging role of adipose tissue hypoxia in obesity and insulin resistance,” International Journal of Obesity, vol. 33, no. 1, pp. 54–66, 2009.
[81]
M. C. Robson, D. P. Hill, M. E. Woodske, and D. L. Steed, “Wound healing trajectories as predictors of effectiveness of therapeutic agents,” Archives of Surgery, vol. 135, no. 7, pp. 773–777, 2000.
[82]
Z. Michailidou, M. D. Jensen, D. A. Dumesic et al., “Omental 11β-hydroxysteroid dehydrogenase 1 correlates with fat cell size independently of obesity,” Obesity, vol. 15, no. 5, pp. 1155–1163, 2007.
[83]
Z. Michailidou, S. Turban, E. Miller et al., “Increased angiogenesis protects against adipose hypoxia and fibrosis in metabolic disease-resistant 11β-hydroxysteroid dehydrogenase type 1 (HSD1)-deficient mice,” The Journal of Biological Chemistry, vol. 287, no. 6, pp. 4188–4197, 2012.
[84]
G. R. Small, P. W. F. Hadoke, I. Sharif et al., “Preventing local regeneration of qlucocorticoids by 11β-hydroxysteroid dehydrogenase type 1 enhances angiogenesis,” Proceedings of the National Academy of Sciences of the United States of America, vol. 102, no. 34, pp. 12165–12170, 2005.
[85]
N. Halberg, T. Khan, M. E. Trujillo et al., “Hypoxia-inducible factor 1α induces fibrosis and insulin resistance in white adipose tissue,” Molecular and Cellular Biology, vol. 29, no. 16, pp. 4467–4483, 2009.
[86]
R. T. De Jongh, E. H. Serné, R. G. Ijzerman, G. De Vries, and C. D. A. Stehouwer, “Impaired microvascular function in obesity: implications for obesity-associated microangiopathy, hypertension, and insulin resistance,” Circulation, vol. 109, no. 21, pp. 2529–2535, 2004.
[87]
B. I. Levy, E. L. Schiffrin, J.-J. Mourad et al., “Impaired tissue perfusion a pathology common to hypertension, obesity, and diabetes mellitus,” Circulation, vol. 118, no. 9, pp. 968–976, 2008.
[88]
Y. L. Chen, C. L. Chang, C. K. Sun, et al., “Impact of obesity control on circulating level of endothelial progenitor cells and angiogenesis in response to ischemic stimulation,” Journal of Translational Medicine, vol. 10, article 86, 2012.
[89]
H. Kiryu, W. Rikihisa, and M. Furue, “Encapsulated fat necrosis: a clinicopathological study of 8 cases and a literature review,” Journal of Cutaneous Pathology, vol. 27, no. 1, pp. 19–23, 2000.
[90]
S. S. Kroll, G. Gherardini, J. E. Martin et al., “Fat necrosis in free and pedicled TRAM flaps,” Plastic and Reconstructive Surgery, vol. 102, no. 5, pp. 1502–1507, 1998.
[91]
A. M. van Rij, C. S. De Alwis, P. Jiang et al., “Obesity and impaired venous function,” European Journal of Vascular and Endovascular Surgery, vol. 35, no. 6, pp. 739–744, 2008.
[92]
W. K. Stadelmann, A. G. Digenis, and G. R. Tobin, “Impediments to wound healing,” The American Journal of Surgery, vol. 176, no. 2, supplement 1, pp. 39S–47S, 1998.
[93]
J. L. Burns, J. S. Mancoll, and L. G. Phillips, “Impairments to wound healing,” Clinics in Plastic Surgery, vol. 30, no. 1, pp. 47–56, 2003.
[94]
G. Yosipovitch, A. DeVore, and A. Dawn, “Obesity and the skin: skin physiology and skin manifestations of obesity,” Journal of the American Academy of Dermatology, vol. 56, no. 6, pp. 901–916, 2007.
[95]
R. Cancello, C. Henegar, N. Viguerie et al., “Reduction of macrophage infiltration and chemoattractant gene expression changes in white adipose tissue of morbidly obese subjects after surgery-induced weight loss,” Diabetes, vol. 54, no. 8, pp. 2277–2286, 2005.
[96]
L. Wu, V. V. Parekh, C. L. Gabriel, et al., “Activation of invariant natural killer T cells by lipid excess promotes tissue inflammation, insulin resistance, and hepatic steatosis in obese mice,” Proceedings of the National Academy of Sciences of the United States of America, vol. 109, no. 19, pp. E1143–E1152, 2012.
[97]
F. X. Hausberger, “Pathological changes in adipose tissue of obese mice,” Anatomical Record, vol. 154, no. 3, pp. 651–660, 1966.
[98]
L. Cai, Z. Wang, A. Ji, et al., “Scavenger receptor CD36 expression contributes to adipose tissue inflammation and cell death in diet-induced obesity,” PLoS ONE, vol. 7, no. 5, Article ID e36785, 2012.
[99]
C. N. Lumeng, J. L. Bodzin, and A. R. Saltiel, “Obesity induces a phenotypic switch in adipose tissue macrophage polarization,” Journal of Clinical Investigation, vol. 117, no. 1, pp. 175–184, 2007.
[100]
A. Viardot, L. K. Heilbronn, D. Samocha-Bonet, et al., “Obesity is associated with activated and insulin resistant immune cells,” Diabetes/Metabolism Research and Reviews, vol. 28, no. 5, pp. 447–454, 2012.
[101]
K. A. Harford, C. M. Reynolds, F. C. McGillicuddy, and H. M. Roche, “Fats, inflammation and insulin resistance: Insights to the role of macrophage and T-cell accumulation in adipose tissue,” Proceedings of the Nutrition Society, vol. 70, no. 4, pp. 408–417, 2011.
[102]
K. R. Taylor, R. E. Mills, A. E. Costanzo, and J. M. Jameson, “γδ T cells are reduced and rendered unresponsive by hyperglycemia and chronic TNFα in mouse models of obesity and metabolic disease,” PLoS ONE, vol. 5, no. 7, Article ID e11422, 2010.
[103]
M. Sankhla, T. K. Sharma, K. Mathur, et al., “Relationship of oxidative stress with obesity and its role in obesity induced metabolic syndrome,” Clinical Laboratory, vol. 58, no. 5-6, pp. 385–392, 2012.
[104]
K. Kawai, A. Kageyama, T. Tsumano, et al., “Effects of adiponectin on growth and differentiation of human keratinocytes—implicaiton of impaired wound healing in diabetes,” Biochemical and Biophysical Research Communications, vol. 374, no. 2, pp. 269–273, 2008.
[105]
A. R. Shipman and G. W. M. Millington, “Obesity and the skin,” British Journal of Dermatology, vol. 165, no. 4, pp. 743–750, 2011.
[106]
R. Shibata, N. Ouchi, S. Kihara, K. Sato, T. Funahashi, and K. Walsh, “Adiponectin stimulates angiogenesis in response to tissue ischemia through stimulation of AMP-activated protein kinase signaling,” The Journal of Biological Chemistry, vol. 279, no. 27, pp. 28670–28674, 2004.
[107]
S. Shibata, Y. Tada, Y. Asano, et al., “Adiponectin regulates cutaneous wound healing by promoting keratinocyte proliferation and migration via the ERK signaling pathway,” The Journal of Immunology, vol. 189, no. 6, pp. 3231–3241, 2012.
[108]
W. B. Conolly, T. K. Hunt, M. Sonne, and J. E. Dunphy, “Influence of distant trauma on local wound infection,” Surgery Gynecology and Obstetrics, vol. 128, no. 4, pp. 713–718, 1969.
[109]
T. Hunt, “A new method of determining tissue oxygen tension,” The Lancet, vol. 2, no. 7374, pp. 1370–1371, 1964.
[110]
M. Di Girolamo, N. S. Skinner Jr., H. G. Hanley, and R. G. Sachs, “Relationship of adipose tissue blood flow to fat cell size and number,” The American Journal of Physiology, vol. 220, no. 4, pp. 932–937, 1971.
[111]
D. C. Hohn and T. K. Hunt, “Oxidative metabolism and microbicidal activity of rabbit phagocytes: cells from wounds and from peripheral blood,” Surgical Forum, vol. 26, pp. 85–87, 1975.
[112]
D. A. Anaya and E. P. Dellinger, “The obese surgical patient: a susceptible host for infection,” Surgical Infections, vol. 7, no. 5, pp. 473–480, 2006.
[113]
D. C. Hohn, R. D. MacKay, B. Halliday, and T. K. Hunt, “Effect of O2 tension on microbicidal function of leukocytes in wounds and in vitro,” Surgical Forum, vol. 27, no. 62, pp. 18–20, 1976.
[114]
F. P. de Heredia, S. Gomez-Martinez, and A. Marcos, “Obesity, inflammation and the immune system,” Proceedings of the Nutrition Society, vol. 71, no. 2, pp. 332–338, 2012.
[115]
T. J. Krizek, M. C. Robson, and E. Kho, “Bacterial growth and skin graft survival,” Surgical Forum, vol. 18, article 518, 1967.
[116]
M. C. Robson, “Wound infection: a failure of wound healing caused by an imbalance of bacteria,” Surgical Clinics of North America, vol. 77, no. 3, pp. 637–650, 1997.
[117]
M. C. Robson, T. J. Krizek, and J. P. Heggers, “Biology of surgical infection,” Current Problems in Surgery, vol. 10, no. 3, pp. 1–62, 1973.
[118]
M. C. Robson, B. D. Stenberg, and J. P. Heggers, “Wound healing alterations caused by infection,” Clinics in Plastic Surgery, vol. 17, no. 3, pp. 485–492, 1990.
[119]
J. Panuncialman and V. Falanga, “The science of wound bed preparation,” Surgical Clinics of North America, vol. 89, no. 3, pp. 611–626, 2009.
[120]
S. Udenfriend, “Formation of hydroxyproline in collagen,” Science, vol. 152, no. 3727, pp. 1335–1340, 1966.
[121]
M. C. Robson, “Infection in the surgical patient: an imbalance in the normal equilibrium,” Clinics in Plastic Surgery, vol. 6, no. 4, pp. 493–503, 1979.
[122]
A. B. G. Lansdown, B. Sampson, and A. Rowe, “Sequential changes in trace metal, metallothionein and calmodulin concentrations in healing skin wounds,” Journal of Anatomy, vol. 195, no. 3, pp. 375–386, 1999.
[123]
A. Barbul, S. A. Lazarou, D. T. Efron, H. L. Wasserkrug, and G. Efron, “Arginine enhances wound healing and lymphocyte immune responses in humans,” Surgery, vol. 108, no. 2, pp. 331–337, 1990.
[124]
W. H. Goodson III and T. K. Hunt, “Development of a new miniature method for the study of wound healing in human subjects,” Journal of Surgical Research, vol. 33, no. 5, pp. 394–401, 1982.
[125]
J. W. Madden and E. E. Peacock Jr., “Studies on the biology of collagen during wound healing. I. Rate of collagen synthesis and deposition in cutaneous wounds of the rat,” Surgery, vol. 64, no. 1, pp. 288–294, 1968.
[126]
J. Viljanto, Biochemical Basis of Tensile Strength in Wound Healing: An Experimental Study with Viscose Cellulose Sponges on Rats, tr.: Kirjapaino Polytypos, Turku, Finland, 1964.
[127]
M. Ganeshkumar, T. Ponrasu, R. Krithika, K. Iyappan, V. S. Gayathri, and L. Suguna, “Topical application of Acalypha indica accelerates rat cutaneous wound healing by up-regulating the expression of Type I and III collagen,” Journal of Ethnopharmacology, vol. 142, no. 1, pp. 14–22, 2012.
[128]
L. Xing, E. J. Culbertson, Y. Wen, M. C. Robson, and M. G. Franz, “Impaired laparotomy wound healing in obese rats,” Obesity Surgery, vol. 21, no. 12, pp. 1937–1946, 2011.
[129]
J. P. Cai, B. Harris, V. Falanga, W. H. Eaglstein, P. M. Mertz, and Y. H. Chin, “Recruitment of mononuclear cells into wounded skin: mechanism and modulation,” Progress in Clinical and Biological Research, vol. 365, pp. 243–256, 1991.
[130]
S. A. Xanthakos, “Nutritional deficiencies in obesity and after bariatric surgery,” Pediatric Clinics of North America, vol. 56, no. 5, pp. 1105–1121, 2009.
[131]
B. Ernst, M. Thurnheer, S. M. Schmid, and B. Schultes, “Evidence for the necessity to systematically assess micronutrient status prior to bariatric surgery,” Obesity Surgery, vol. 19, no. 1, pp. 66–73, 2009.
[132]
C. Schweiger, R. Weiss, E. Berry, and A. Keidar, “Nutritional deficiencies in bariatric surgery candidates,” Obesity Surgery, vol. 20, no. 2, pp. 193–197, 2010.
[133]
V. Moizé, R. Deulofeu, F. Torres, J. M. De Osaba, and J. Vidal, “Nutritional intake and prevalence of nutritional deficiencies prior to surgery in a spanish morbidly obese population,” Obesity Surgery, vol. 21, no. 9, pp. 1382–1388, 2011.
[134]
C. F. Nicoletti, T. P. Lima, S. P. Donadelli, et al., “New look at nutritional care for obese patient candidates for bariatric surgery,” Surgery for Obesity and Related Diseases, vol. 9, no. 4, pp. 520–525, 2013.
[135]
C. A. Blume, C. C. Boni, D. S. Casagrande, et al., “Nutritional profile of patients before and after Roux-en-Y gastric bypass: 3-year follow-up,” Obesity Surgery, vol. 22, no. 11, pp. 1676–1685, 2012.
[136]
D. A. de Luis, D. Pacheco, O. Izaola, M. C. Terroba, L. Cuellar, and T. Martin, “Zinc and copper serum levels of morbidly obese patients before and after biliopancreatic diversion: 4 years of follow-up,” Journal of Gastrointestinal Surgery, vol. 15, no. 12, pp. 2178–2181, 2011.
[137]
A. Damms-Machado, A. Friedrich, K. M. Kramer et al., “Pre- and postoperative nutritional deficiencies in obese patients undergoing laparoscopic sleeve gastrectomy,” Obesity Surgery, vol. 22, no. 6, pp. 881–889, 2012.
[138]
A. B. G. Lansdown, “Calcium: a potential central regulator in wound healing in the skin,” Wound Repair and Regeneration, vol. 10, no. 5, pp. 271–285, 2002.
[139]
S. Balesaria, S. Sangha, and J. R. F. Walters, “Human duodenum responses to vitamin D metabolites of TRPV6 and other genes involved in calcium absorption,” The American Journal of Physiology: Gastrointestinal and Liver Physiology, vol. 297, no. 6, pp. G1193–G1197, 2009.
[140]
G. Tamer, B. Mesci, I. Tamer, D. Kilic, and S. Arik, “Is vitamin D deficiency an independent risk factor for obesity and abdominal obesity in women?” Endokrynologia Polska, vol. 63, no. 3, pp. 196–201, 2012.
[141]
R. Ghergherechi, N. Hazhir, and A. Tabrizi, “Comparison of vitamin D deficiency and secondary hyperparathyroidism in obese and non-obese children and adolescents,” Pakistan Journal of Biological Sciences, vol. 15, no. 3, pp. 147–151, 2012.
[142]
C. Ding, D. Gao, J. Wilding, P. Trayhurn, and C. Bing, “Vitamin D signaling in adipose tissue,” British Journal of Nutrition, vol. 108, no. 11, pp. 1915–1923, 2012.
[143]
R. B. Saper and R. Rash, “Zinc: an essential micronutrient,” American Family Physician, vol. 79, no. 9, pp. 768–772, 2009.
[144]
O. Kaidar-Person, B. Person, S. Szomstein, and R. J. Rosenthal, “Nutritional deficiencies in morbidly obese patients: a new form of malnutrition? Part A: vitamins,” Obesity Surgery, vol. 18, no. 7, pp. 870–876, 2008.
[145]
M. Iwata, T. Takebayashi, H. Ohta, R. E. Alcalde, Y. Itano, and T. Matsumura, “Zinc accumulation and metallothionein gene expression in the proliferating epidermis during wound healing in mouse skin,” Histochemistry and Cell Biology, vol. 112, no. 4, pp. 283–290, 1999.
[146]
L. Costarelli, E. Muti, M. Malavolta et al., “Distinctive modulation of inflammatory and metabolic parameters in relation to zinc nutritional status in adult overweight/obese subjects,” Journal of Nutritional Biochemistry, vol. 21, no. 5, pp. 432–437, 2010.
[147]
A. A. Al-Kaisy, S. A. Salih, and H. A. Al-Biati, “Effect of zinc supplement in the prognosis of burn patients in Iraq,” Annals of Burns and Fire Disasters, vol. 19, no. 3, pp. 115–122, 2006.
[148]
S. M. Levenson and E. Seifter, “Dysnutrition, wound healing, and resistance to infection,” Clinics in Plastic Surgery, vol. 4, no. 3, pp. 375–388, 1977.
[149]
M. Freiman, E. Seifter, C. Connerton, and S. M. Levenson, “Vitamin A deficiency and surgical stress,” Surgical Forum, vol. 21, pp. 81–82, 1970.
[150]
D. U. Talas, A. Nayci, S. Atis et al., “The effects of corticosteroids and vitamin A on the healing of tracheal anastomoses,” International Journal of Pediatric Otorhinolaryngology, vol. 67, no. 2, pp. 109–116, 2003.
[151]
S. V. Pollack, “Wound healing: a review. III. Nutritional factors affecting wound healing,” Journal of Enterostomal Therapy, vol. 9, no. 2, pp. 28–33, 1982.
[152]
M. Haws, R. E. Brown, H. Suchy, and A. Roth, “Vitamin A-soaked gelfoam sponges and wound healing in steroid-treated animals,” Annals of Plastic Surgery, vol. 32, no. 4, pp. 418–422, 1994.
[153]
M. F. Trevisani, M. A. Ricci, J. T. Tolland, and W. C. Beck, “Effect of vitamin A and zinc on wound healing in steroid-treated mice,” Current Surgery, vol. 44, no. 5, pp. 390–393, 1987.
[154]
T. K. Hunt, H. P. Ehrlich, J. A. Garcia, and J. E. Dunphy, “Effect of vitamin A on reversing the inhibitory effect of cortisone on healing of open wounds in animals and man,” Annals of Surgery, vol. 170, no. 4, pp. 633–641, 1969.
[155]
J. Z. Williams and A. Barbul, “Nutrition and wound healing,” Surgical Clinics of North America, vol. 83, no. 3, pp. 571–596, 2003.
[156]
R. F. Neiva, K. Al-Shammari, F. H. Nociti Jr., S. Soehren, and H.-L. Wang, “Effects of vitamin-B complex supplementation on periodontal wound healing,” Journal of Periodontology, vol. 76, no. 7, pp. 1084–1091, 2005.
[157]
C. W. Findlay Jr., “Effect of vitamin B12 on wound healing,” Proceedings of the Royal Society Experimental Biology and Medicine, vol. 82, no. 3, pp. 492–495, 1953.
[158]
J. L. Monaco and W. T. Lawrence, “Acute wound healing: an overview,” Clinics in Plastic Surgery, vol. 30, no. 1, pp. 1–12, 2003.
[159]
E. G. Brunson, J. F. Smith, and R. Dixon, “Vitamin B12: an aid to oral mucous membrane healing,” Oral Surgery, Oral Medicine, Oral Pathology, vol. 24, no. 1, pp. 102–112, 1967.
[160]
S. Agha-Mohammadi and D. J. Hurwitz, “Potential impacts of nutritional deficiency of postbariatric patients on body contouring surgery,” Plastic and Reconstructive Surgery, vol. 122, no. 6, pp. 1901–1914, 2008.
[161]
A. C. Cepeda-Lopez, S. J. M. Osendarp, A. Melse-Boonstra et al., “Sharply higher rates of iron deficiency in obese Mexican women and children are predicted by obesity-related inflammation rather than by differences in dietary iron intake,” The American Journal of Clinical Nutrition, vol. 93, no. 5, pp. 975–983, 2011.
[162]
J. P. McClung and J. P. Karl, “Iron deficiency and obesity: the contribution of inflammation and diminished iron absorption,” Nutrition Reviews, vol. 67, no. 2, pp. 100–104, 2009.
[163]
E. M. del Giudice, N. Santoro, A. Amato et al., “Hepcidin in obese children as a potential mediator of the association between obesity and iron deficiency,” Journal of Clinical Endocrinology and Metabolism, vol. 94, no. 12, pp. 5102–5107, 2009.
[164]
A. Amato, N. Santoro, P. Calabrò et al., “Effect of body mass index reduction on serum hepcidin levels and iron status in obese children,” International Journal of Obesity, vol. 34, no. 12, pp. 1772–1774, 2010.
[165]
M. J. Jacobson and J. Van Prohaska, “The healing of wounds in iron deficiency,” Surgery, vol. 57, no. 2, pp. 254–258, 1965.
[166]
W. L. Macon and W. J. Pories, “The effect of iron deficiency anemia on wound healing,” Surgery, vol. 69, no. 5, pp. 792–796, 1971.
[167]
H. W. Trueblood, T. S. Nelsen, and H. A. Oberhelman Jr., “The effect of acute anemia and iron deficiency anemia on wound healing,” Archives of Surgery, vol. 99, no. 1, pp. 113–116, 1969.
[168]
P. Kulapongs, R. Suskind, V. Vithayasai, and R. E. Olson, “Cell mediated immunity and phagocytosis and killing function in children with severe iron deficiency anemia,” The Lancet, vol. 2, no. 7882, pp. 689–691, 1974.
[169]
E. L. Howes, H. Briggs, R. Shea, and S. C. Harvey, “Effect of complete and partial starvation on the rate of fibroplasia in the healing wound,” Archives of Surgery, vol. 26, pp. 846–858, 1933.
[170]
S. A. Localio, M. E. Morgan, and J. W. Hinton, “The biological chemistry of wound healing: the effect of di-methionine on healing of wounds in protein depleted animals,” Surgery, Gynecology & Obstetrics, vol. 86, no. 5, pp. 582–590, 1948.
[171]
J. E. Rhoads, M. T. Fliegelman, and L. M. Panzer, “The mechanism of delayed wound healing in the presence of hypoproteinemia,” The Journal of the American Medical Association, vol. 118, pp. 21–23, 1942.
[172]
M. B. Williamson and H. J. Fromm, “The incorporation of sulfur amino acids into the proteins of regenerating wound tissue,” Journal of Biological Chemistry, vol. 212, no. 2, pp. 705–712, 1955.
[173]
S. S. Malinowski, “Nutritional and metabolic complications of bariatric surgery,” American Journal of the Medical Sciences, vol. 331, no. 4, pp. 219–225, 2006.
[174]
S. L. Doyle, C. L. Donohoe, J. Lysaght, and J. V. Reynolds, “Visceral obesity, metabolic syndrome, insulin resistance and cancer,” Proceedings of the Nutrition Society, vol. 71, no. 1, pp. 181–189, 2012.
[175]
S. L. Doyle, J. Lysaght, and J. V. Reynolds, “Obesity and post-operative complications in patients undergoing non-bariatric surgery,” Obesity Reviews, vol. 11, no. 12, pp. 875–886, 2010.
[176]
S. Agha-Mohammadi and D. J. Hurwitz, “Nutritional deficiency of post-bariatric surgery body contouring patients: What every plastic surgeon should know,” Plastic and Reconstructive Surgery, vol. 122, no. 2, pp. 604–613, 2008.
[177]
S. Agha-Mohammadi and D. J. Hurwitz, “Enhanced recovery after body-contouring surgery: reducing surgical complication rates by optimizing nutrition,” Aesthetic Plastic Surgery, vol. 34, no. 5, pp. 617–627, 2010.
[178]
D. ’Ettorre M, D. Gniuli, A. Iaconelli, et al., “Wound healing process in post-bariatric patients: an experimental evaluation,” Obesity Surgery, vol. 20, no. 11, pp. 1552–1558, 2010.
[179]
M. H. Shuster and J. A. Vazquez, “Nutritional concerns related to roux-en-y gastric bypass: what every clinician needs to know,” Critical Care Nursing Quarterly, vol. 28, no. 3, pp. 227–262, 2005.
