[Post-operative fibrosis: pathophysiological aspects and therapeutical perspectives]

Area of Science:

• Surgical pathology
• Fibrosis research
• Wound healing mechanisms

Context:

• Postoperative fibrosis (POF) is a rare, irreversible complication following surgery across various tissues.
• POF presents a significant clinical challenge due to its delayed onset and progressive nature.
• Current understanding of POF pathogenesis and therapeutic interventions remains limited.

Purpose:

• To synthesize current knowledge on the clinical, histopathological, and molecular aspects of postoperative fibrosis.
• To elucidate the cellular and molecular mechanisms driving POF development.
• To explore potential therapeutic strategies for managing POF based on its distinct phases.

Summary:

• POF progresses through three distinct phases: prefibrotic chronic inflammation, a cellular phase, and matricial densification/remodeling.
• Key players include myofibroblasts, extracellular matrix, and transforming growth factor-beta1 (TGF-β1), with roles evolving over time.
• Therapeutic interventions are phase-dependent, utilizing anti-inflammatory drugs, pentoxifylline-tocopherol (PE), and PE-clodronate (pentoclo).

Impact:

• This synthesis clarifies the mechanistic basis of POF, aiding in the development of targeted treatments.
• Phase-specific therapeutic strategies offer a novel approach to managing this debilitating condition.
• Further randomized trials are crucial to validate the efficacy of proposed treatments for postoperative fibrosis.