Plastic Surgery
doi: 10.25005/2074-0581-2023-25-1-36-46
A MODEL FOR ASSESSING THE RISK OF A DELAYED WOUND HEALING IN OBESE PATIENTS

E.P. Sukhoparova1, I.E. Khrustalyova1, E.V. Zinoviev2, E.S. Knyazeva2

1Department of Plastic Surgery, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation
2Saint Petersburg Research Institute for Emergency Medicine named after I.I. Dzhanelidze, Saint Petersburg, Russian Federation

Objective: Develop a model for predicting the risk of a delayed and complicated course of wound healing in obese patients

Methods: The study included 49 patients above 30 years of age (mean age 46.98±7.10 years) with a body mass index (BMI) above 25 kg/m2 (mean value 31.64±5.04 kg/m2 ), who underwent augmentation mammaplasty and aesthetic anterior abdominal wall reconstruction in the period from 2016 to 2018. In the postoperative period, the patients were divided into three groups depending on the wound healing pattern: Group I – complicated wound healing (n=21; 42.86%); Group II – delayed wound healing (n=16; 32.65%); Group III – standard wound healing (n=12; 24.49%). The assessment of the prognostic risk of developing a delayed and complicated wound healing was carried out using a new mathematical model, taking into account the insulin level (mIU/l) and spontaneous secretion of interleukin-1β (pg/ml). Logistic regression analysis was used to determine the significance of prognostic factors. The decision tree model was used to stratify risk groups. A receiver operating characteristic (ROC) analysis was used to assess the quality of the constructed model.

Results: Using the decision tree, three risk classes of delayed and complicated wound healing were identified. The highest risk of developing postoperative wound complications (risk=95.0%, n=20) was observed in patients with insulin levels ≥14.0 mIU/l. The average level of risk was determined at the value of insulin <14.0 mIU/l and spontaneous production of interleukin-1β ≥51.0 pg/ml (risk=50.0%, n=2). The lowest risk level of complications (risk=3.7%, n=27) was found with a combination of factors: insulin <14.0 mIU/l and interleukin-1β spontaneous production <51.0 pg/ml. The predictive quality of the constructed model is high (the area under the ROC curve is 0.98).

Conclusion: The proposed prognostic model will allow the identification of patients with a high risk of delayed or complicated wound healing in the preoperative period and timely adjust the treatment tactics.

Keywords: Overweight, wound healing, prognosis, non-healing wounds.

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Authors' information:

Sukhoparova Elena Petrovna,
Candidate of Medical Sciences, Associate Professor of the Department of Plastic Surgery, Pavlov First Saint Petersburg State Medical University
ORCID ID: 0000-0002-7133-0440
SPIN-код: 8755-7182
Author ID: 1042578
E-mail: suhoparova.e@gmail.com

Khrustalyova Irina Eduardovna,
Doctor of Medical Sciences, Head of the Department of Plastic Surgery, Pavlov First Saint Petersburg State Medical University
ORCID ID: 0000-0002-2382-0090
Author ID: 468280
E-mail: Khrustalevai@gmail.com

Zinoviev Evgeniy Vladimirovich,
Doctor of Medical Sciences, Full Professor, Head of the Department of Thermal Injuries, Saint Petersburg Research Institute for Emergency Medicine named after I.I. Dzhanel
Researcher ID: E-5656-2014
Scopus ID: 57208391963
ORCID ID: 0000-0002-2493-5498
SPIN-код: 4069-2346
Author ID: 709654
E-mail: evz@list.ru

Knyazeva Ekaterina Sergeevna,
Resident of the Department of Plastic Surgery, Saint Petersburg Research Institute for Emergency Medicine named after I.I. Dzhanelidze
ORCID ID: 0000-0002-8675-1483
E-mail: ek98@list.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Sukhoparova Elena Petrovna
Candidate of Medical Sciences, Associate Professor of the Department of Plastic Surgery, Pavlov First Saint Petersburg State Medical University

197022, Russian Federation, Saint Petersburg, Tolstoy str., 6-8

Tel.: +7 (981) 2277979

E-mail: suhoparova.e@gmail.com

Materials on the topic:
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  2. REPAIR OF SEVERE POST-BURN CICATRICIAL CONTRACTURES AND DEFORMATIONS OF THE LOWER LIMB
  3. ANALYSIS OF COMPLICATIONS AFTER AUTOGRAFT TRANSPLANTATION IN SEVERE UPPER LIMB INJURY
  4. MAMMOPLASTY: FROM RECONSTRUCTIVE TO AESTHETIC SURGERY
  5. THE EFFECT OF THE MENSTRUAL CYCLE PHASE ON THE OUTCOME OF AUGMENTATION MAMMOPLASTY
  6. CORRECTION OF SOFT-TISSUE DEFECTS AND CONSEQUENCES OF NEUROVASCULAR BUNDLES DAMAGE OF THE UPPER EXTREMITIES
  7. SURGICAL TREATMENT OF POST-BURN CICATRICIAL DEFORMITIES OF WOMAN’S BREAST

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