Cell Mediated Immune System Hyperactivation and Complications in Surgery. Is There a Correlation?

Introduction: The role of the immune system in wound healingis multifaceted and cell-to-cell interactions may affect healingin several ways, many of which are probably still unknown. Thecase of a 19-year-old girl who, after multiple postsurgical complications,was found to have a transient immune system hyperactivationis reported.Materials and Methods: A 19-years-old woman with abreast asymmetry, previously treated with breast augmentation andcontralateral reduction mammaplasty, had her implant removedand she came to our attention seeking autologous reconstruction.A free DIEP flap was performed and, again, wound breakdownand liponecrosis ensued at both the donor and recipient sites.Bacterial cultures were negative. Three months after the operation,a second attempt at autogenous breast volume enhancementwas done with lipofilling. Fat necrosis occured again. At this pointimmunological consueling was requested.Results: Microbiologic and immunologic tests did not revealany infectious disease. Immunologic studies revealed a polyclonalhyperactivation of CD4+ and CD8+ T-lymphocytes that showedhigher rate of apoptosis and mitosis. Immunological profilesreturned to normal within 3 months after surgery.Conclusions: An unusual hyperactivation of the cell mediatedimmune system, while fat necrosis was ongoing, coupled withreturn-to-normal after healing, led us think that the cell mediatedimmune system hyperactivation could have caused a sort of selfaggression in the surgical sites. However, as this is only an incidentalfinding, further studies are needed in order to prove anycorrelation.