© Springer Science + Business Media, Inc. Obesity Surgery, 17, 2007 1325 Obesity Surgery, 17, 1325-1331 Background: In this prospective study, we followed patients after laparoscopic adjustable gastric band- ing for morbid obesity who underwent abdomino- plasty for body contouring. Our purposes were: 1) to determine if a significant relationship between cigarette smoking and postoperative wound infec- tions existed, 2) the relative risk conferred by ciga- rettes and 3) a cut-off value for the increased risk. Methods: Patients scheduled for body contour- ing abdominoplasty were considered eligible. We excluded those with ongoing clinical infections, recent antibiotic administration, those within 1 year from their bariatric surgery and those with systemic diseases. Smokers were asked to stop smoking at least 4 weeks before surgery. Results: Since November 2004, we recruited 60 patients. Postoperative infections were present in 25% (n=15) of patients and 86.7% of these (n=13) were superficial. All except one occurred in smok- ers (P = 0.0001): 47% of smokers and 3% of non- smokers developed infections. Significant differ- ences between infections vs infection-free patients were present for the number of cigarettes smoked per day (P<0.001), years of smoking (P< 0.001), overall estimated cigarettes smoked and the num- ber of pack years (P = 0.001). A cut-off value of ~62,000 overall estimated cigarettes (8.5 pack years) distinguished between infections vs infec- tion-free patients (6.2% false positives and 7.1% false negatives). Relative risk conferred by smok- ing was 14 (95% confidence intervals 13.3-16.7). Conclusions: The incidence of infections in post- bariatric patients undergoing body contouring abdominoplasties is 25%. The relative risk conferred by smoking was 14 and the cut-off value was 62,000 overall cigarettes (8.5 pack years). Key words: Post-obesity, bariatric surgery, body contour- ing, abdominoplasty, smoking complications, postopera- tive infections Introduction Morbid obesity has reached epidemic proportions in developed countries. The massive weight loss that follows bariatric surgery leaves patients with func- tional and esthetic deformities that usually require multiple body contouring operations for correction. Abdominoplasty is one of them: it removes exces- sive tissues from the middle-lower abdomen, ame- liorates the silhouette and reduces the loss of skin elasticity. However, even if thousands of abdomino- plasties are performed each year, they are not free from postoperative complications. Wound infection is one of the most common problems postoperative- ly and, when present, endangers the esthetic out- come and the final patient satisfaction. Its incidence is about 2-7% in non-obese patients, but greater with obesity or after bariatric surgery. 1-4 The effects of cigarette smoking on wound heal- ing were studied for the first time by Mosely and Finseth in 1977. 5 These authors established that the recovery of an injury is compromised in atheroscle- rotic, smoking patients. 6 Other studies have shown that smokers have an increased incidence of flap necrosis after face lifts and abdominoplasties, 7,8 worse esthetic wounds 3,9 and increased incidences of wound dehiscence in reduction mammaplasties and abdominoplasties. 10,11 All these studies confirmed the Wound Infections in Post-bariatric Patients undergoing Body Contouring Abdominoplasty: the Role of Smoking G. Gravante 1 ; A. Araco 2 ; R. Sorge 3 ; F. Araco 2 ; D. Delogu 4 ; V. Cervelli 5 1 Department of General Surgery, University of Tor Vergata in Rome, Italy; 2 Dolan Park Hospital. Birmingham. United Kingdom; 3 Department of Human Physiology, Laboratory of Biometry, University of Tor Vergata in Rome, Italy; 4 University “La Sapienza” of Rome; 5 Department of Plastic Surgery, University of Tor Vergata in Rome, Italy Correspondence to: Dr. Gianpiero Gravante, via U. Maddalena 40/a, 00043 Ciampino (Roma), Italy. E-mail: ggravante@hot- mail.com