Obesity Surgery

, Volume 21, Issue 12, pp 1937–1946 | Cite as

Impaired Laparotomy Wound Healing in Obese Rats

  • Liyu Xing
  • Eric J. Culbertson
  • Yuan Wen
  • Martin C. Robson
  • Michael George Franz
Animal Research

Abstract

Background

Obesity increases the risk of laparotomy dehiscence and incisional hernia. The aim of this study was to measure the biological effect of obesity on laparotomy wound healing and the formation of incisional hernias.

Methods

Normal-weight Sprague–Dawley (SD) and obese Zucker rats were used in an established laparotomy wound healing and incisional ventral hernia model. Mechanical testing was performed on abdominal wall strips collected from laparotomy wounds. Hernia size was measured by digital imaging. Picrosirius staining for collagen isoforms was observed with polarized microscopy. Abdominal wall fibroblasts were cultured to measure collagen matrix remodeling and proliferation.

Results

Laparotomy wound healing was significantly impaired in obese rats. Mechanical strength was lower than in normal-weight rats. Yield load was reduced in the obese group at all time points. Picrosirius red staining showed increased immature type III collagen content and disorganized type I collagen fibers within laparotomy wounds of obese rats. Wound size was significantly larger in the obese group. Collagen matrix remodeling was impaired with fibroblasts from obese rats, but there was no difference in fibroblast proliferation between the obese and normal-weight groups.

Conclusions

We observed for the first time that laparotomy wound healing is impaired in obese rats. The recovery of laparotomy wound strength is delayed due to abnormal collagen maturation and remodeling, possibly due to a defect in fibroblast function. Strategies to improve outcomes for laparotomy wound healing in obese patients should include correcting the wound healing defect, possibly with growth factor or cell therapy.

Keywords

Wound healing Hernia Collagen Fibroblast Laparotomy Obesity 

References

  1. 1.
    Franz MG. The biology of hernia formation. Surg Clin North Am. 2008;88(1):1–15. vii.PubMedCrossRefGoogle Scholar
  2. 2.
    Pollock AV, Evans M. Early prediction of late incisional hernias. Br J Surg. 1989;76:953–4.PubMedCrossRefGoogle Scholar
  3. 3.
    Burger JW et al. Incisional hernia: early complication of abdominal surgery. World J Surg. 2005;29(12):1608–13.PubMedCrossRefGoogle Scholar
  4. 4.
    Hoer J et al. Factors influencing the development of incisional hernia. A retrospective study of 2, 983 laparotomy patients over a period of 10 years. Chirurg. 2002;73(5):474–80.PubMedCrossRefGoogle Scholar
  5. 5.
    Sugerman HJ et al. Greater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh. Am J Surg. 1996;171(1):80–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Riou JP, Cohen JR, Johnson Jr H. Factors influencing wound dehiscence. Am J Surg. 1992;163(3):324–30.PubMedCrossRefGoogle Scholar
  7. 7.
    Regnard JF et al. Ventral incisional hernias: incidence, date of recurrence, localization and risk factors. Ital J Surg Sci. 1988;18(3):259–65.PubMedGoogle Scholar
  8. 8.
    Merkow RP et al. Effect of body mass indes on short-term outcomes after colectomy for cancer. J Am Coll Surg. 2009;208:53–61.PubMedCrossRefGoogle Scholar
  9. 9.
    Grace RH, Cox SJ. Incidence of incisional hernia following dehiscence of the abdominal wound. Proc R Soc Med. 1973;66(11):1091–2.PubMedGoogle Scholar
  10. 10.
    Keill RH et al. Abdominal wound dehiscence. Arch Surg. 1973;106(4):573–7.PubMedGoogle Scholar
  11. 11.
    Alexander HC, Prudden JF. The causes of abdominal wound disruption. Surg Gynecol Obstet. 1966;122(6):1223–9.PubMedGoogle Scholar
  12. 12.
    Baggish MS, Lee WK. Abdominal wound disruption. Obstet Gynecol. 1975;46(5):530–4.PubMedGoogle Scholar
  13. 13.
    Pitkin RM. Abdominal hysterectomy in obese women. Surg Gynecol Obstet. 1976;142(4):532–6.PubMedGoogle Scholar
  14. 14.
    Bucknall TE, Cox PJ, Ellis H. Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. Br Med J (Clin Res Ed). 1982;284(6320):931–3.CrossRefGoogle Scholar
  15. 15.
    Lamont PM, Ellis H. Incisional hernia in re-opened abdominal incisions: an overlooked risk factor. Br J Surg. 1988;75(4):374–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Kupczyk-Joeris D et al. Incisional hernia. Causes and principles of repair. Zentralbl Chir. 1990;115(18):1161–7.PubMedGoogle Scholar
  17. 17.
    Hesselink VJ et al. An evaluation of risk factors in incisional hernia recurrence. Surg Gynecol Obstet. 1993;176(3):228–34.PubMedGoogle Scholar
  18. 18.
    da Silva AL, Petroianu A. Incisional hernias: factors influencing development. South Med J. 1991;84(12):1500. 1504.PubMedCrossRefGoogle Scholar
  19. 19.
    Cleveland RD, Zitsch 3rd RP, Laws HL. Incisional closure in morbidly obese patients. Am Surg. 1989;55(1):61–3.PubMedGoogle Scholar
  20. 20.
    Luijendijk RW et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 2000;343(6):392–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Carlson MA. Acute wound failure. Surg Clin North Am. 1997;77(3):607–36.PubMedCrossRefGoogle Scholar
  22. 22.
    Burger JW et al. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg. 2004;240(4):578–83.PubMedGoogle Scholar
  23. 23.
    Sauerland S et al. Obesity is a risk factor for recurrence after incisional hernia repair. Hernia. 2004;8(1):42–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Nascimento AP, Costa AM. Overweight induced by high-fat diet delays rat cutaneous wound healing. Br J Nutr. 2006;96(6):1069–77.PubMedCrossRefGoogle Scholar
  25. 25.
    Goodson 3rd WH, Hunt TK. Wound collagen accumulation in obese hyperglycemic mice. Diabetes. 1986;35(4):491–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Biondo-Simoes Mde L, et al. Obesity and abdominal wound healing in rats. Acta Cir Bras. 25(1):86–92.Google Scholar
  27. 27.
    DuBay DA et al. Progressive fascial wound failure impairs subsequent abdominal wall repairs: a new animal model of incisional hernia formation. Surgery. 2005;137(4):463–71.PubMedCrossRefGoogle Scholar
  28. 28.
    DuBay DA et al. Incisional herniation induces decreased abdominal wall compliance via oblique muscle atrophy and fibrosis. Ann Surg. 2007;245(1):140–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Franz MG et al. Fascial incisions heal faster than skin: a new model of abdominal wall repair. Surgery. 2001;129(2):203–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Puchtler H, Waldrop FS, Valentine LS. Polarization microscopic studies of connective tissue stained with picro-sirius red FBA. Beitr Pathol. 1973;150(2):174–87.PubMedGoogle Scholar
  31. 31.
    Junqueira LC et al. Differential histologic diagnosis of osteoid. A study on human osteosarcoma collagen by the histochemical picrosirius-polarization method. J Pathol. 1986;148(2):189–96.PubMedCrossRefGoogle Scholar
  32. 32.
    Montes GS et al. Histochemical and morphological characterization of reticular fibers. Histochemistry. 1980;65(2):131–41.PubMedCrossRefGoogle Scholar
  33. 33.
    Dubay DA et al. Fascial fibroblast kinetic activity is increased during abdominal wall repair compared to dermal fibroblasts. Wound Repair Regen. 2004;12(5):539–45.PubMedCrossRefGoogle Scholar
  34. 34.
    Baum CL, Arpey CJ. Normal cutaneous wound healing: clinical correlation with cellular and molecular events. Dermatol Surg. 2005;31(6):674–86. discussion 686.PubMedCrossRefGoogle Scholar
  35. 35.
    Goodson 3rd WH, Hunt TK. Deficient collagen formation by obese mice in a standard wound model. Am J Surg. 1979;138(5):692–4.PubMedCrossRefGoogle Scholar
  36. 36.
    Vrabec JT. Tympanic membrane perforations in the diabetic rat: a model of impaired wound healing. Otolaryngol Head Neck Surg. 1998;118(3 Pt 1):304–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Kurtz TW, Morris RC, Pershadsingh HA. The Zucker fatty rat as a genetic model of obesity and hypertension. Hypertension. 1989;13(6 Pt 2):896–901.PubMedGoogle Scholar
  38. 38.
    Bray GA. The Zucker-fatty rat: a review. Fed Proc. 1977;36(2):148–53.PubMedGoogle Scholar
  39. 39.
    Metz CN. Fibrocytes: a unique cell population implicated in wound healing. Cell Mol Life Sci. 2003;60(7):1342–50.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2011

Authors and Affiliations

  • Liyu Xing
    • 1
  • Eric J. Culbertson
    • 1
  • Yuan Wen
    • 1
  • Martin C. Robson
    • 2
  • Michael George Franz
    • 1
  1. 1.Department of SurgeryUniversity of MichiganAnn ArborUSA
  2. 2.University of South FloridaTampaUSA

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