Background: Obese patients experience dramatic physical and metabolic changes in the skin and its collagen. Bariatric surgery is known to result in significant improvement in obesity-associated comorbid conditions and metabolic disturbances. The aim of this study was to evaluate skin quality following weight loss surgery and its suitability to produce an extracellular matrix for use in reconstructive procedures.
Methods: During circumferential lipectomy, skin tissue was obtained from 10 patients following bariatric surgery. The samples were subjected to histologic examination and to study by differential scanning calorimetry. A retrospective review of patient records was used to determine time between bariatric and body lift procedures and to identify subject demographic and clinical data, including body mass index, excess weight loss, and comorbid conditions.
Results: Plastic surgery followed bariatric surgery by 20.5 ± 11 months, and patients experienced an average weight loss of 132.1 ± 61.0 lb. Histologic evaluation of post-bariatric surgery skin samples showed a poorly organized collagen structure, elastin degradation, and regions of scar formation within macroscopically normal areas. Differential scanning calorimetry showed increased enthalpy of phase transition and decreased onset temperature for collagen denaturation in striae distensae samples compared with bulk bariatric skin samples, consistent with tissue matrix degradation in striae.
Conclusion: Skin tissue in this patient population exhibited significant signs of damage to extracellular matrix components despite the duration of time since the bariatric procedure.
New York, N.Y.; and Ewing, N.J.
From the Department of Surgery and the Division of Plastic Surgery, Department of Surgery, Lenox Hill Hospital; the Department of Chemistry, College of New Jersey; and private practice.
Received for publication April 20, 2009; accepted July 28, 2009.
Disclosure: Scot B. Glasberg, M.D., and Georgia M. Arvanitis, Ph.D., work as consultants to LifeCell Corporation. Neither of the other authors has any financial interests to disclose.
Scot B. Glasberg, M.D., 42A East 74th Street, New York, N.Y. 10021, firstname.lastname@example.org