Conditions of wound healing and cutaneous growth affect metabolic performance of skin following plastic surgery

Abstract

The mechanical and structural properties of skin subjected to expansion have been widely investigated in the context of plastic surgery. To determine the actual metabolic state of skin following skin expander placement, we determined the basic biochemical parameters for various conditions of postsurgical wound healing and cutaneous growth. Studying, for the first time, comprehensive metabolic profiles ("metabolomics") of the skin in a minipig model, we found that the lactate/alanine ratios were significantly increased (p<0.05) in skin attached to noninflated expanders vs. control skin, indicating increased anaerobic glycolysis. Furthermore, creatine/phosphocreatine ratios were decreased in skin from inflated vs. noninflated expanders, implying an improved energetic state for stretched skin. In contrast, no significant differences were detected for these parameters on comparing skin from four inflated expanders with different surface structures, even where the histologically determined capsule thickness was significantly different. Overall, the metabolic performance of skin recovering and growing under stretch was found to be superior to that of skin from noninflated expanders, and comparable to that of control skin. Our results are consistent with the assumptions of (i) major hypoxia/ischemia due to reduced perfusion in skin recovering from surgery without an appropriate supportive structure and (ii) minimal metabolic effects of expander surface structures.