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

Introduction: The role of the immune system in wound healing is multifaceted and cell-to-cell interactions may affect healing in several ways, many of which are probably still unknown. The case of a 19-year-old girl who, after multiple postsurgical complications, was found to have a transient immune system hyperactivation is reported. Materials and Methods: A 19-years-old woman with a breast asymmetry, previously treated with breast augmentation and contralateral reduction mammaplasty, had her implant removed and she came to our attention seeking autologous reconstruction. A free DIEP flap was performed and, again, wound breakdown and 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 enhancement was done with lipofilling. Fat necrosis occured again. At this point immunological consueling was requested. Results: Microbiologic and immunologic tests did not reveal any infectious disease. Immunologic studies revealed a polyclonal hyperactivation of CD4+ and CD8+ T-lymphocytes that showed higher rate of apoptosis and mitosis. Immunological profiles returned to normal within 3 months after surgery. Conclusions: An unusual hyperactivation of the cell mediated immune system, while fat necrosis was ongoing, coupled with return-to-normal after healing, led us think that the cell mediated immune system hyperactivation could have caused a sort of self aggression in the surgical sites. However, as this is only an incidental finding, further studies are needed in order to prove any correlation.