自体脂肪颗粒隆乳术的适应证及临床分析

目的探索减少自体脂肪颗粒隆乳术后移植脂肪吸收及提高隆乳效果的方法;总结30例施行脂肪抽吸减肥术联合脂肪颗粒注射隆乳术的手术方法及要点。方法脂肪抽吸采用国内已普遍推行的肿胀法,抽出脂肪500～3250ml。将经过处理后的脂肪颗粒,注射于乳腺后间隙隆乳。其方法为以乳房下皱襞正中部或腋前线为注射进针点,行局部浸润麻醉,左手捏起乳房,将针头穿入乳腺后与胸大肌表面之间的间隙,右手用力将吸入注射器内的脂肪颗粒缓缓推入间隙内,在注射过程中不断变换方向,以利于乳房塑形。结果脂肪抽吸部位减肥明显,效果满意;隆乳30例,随访6～10个月,乳房外形好,吸收少。结论自体脂肪颗粒注射隆乳是一种切实可行的方法,值得临床推广使用。     

Large liponecrotic pseudocyst formation following cheek augmentation by fat injection

A case in which a growing cystic mass developed in the submandibular area, 6 months following fat injection to the cheek and mandibular area, is described. Histological examination revealed a liponecrotic pseudocyst. It is suggested that subcutaneous masses appearing in an area, which was previously injected with fat, should be excised. Diagnostic aspiration procedures may cause leakage of its oily content and possible further granulomatotic reactions and cysts.     

自体脂肪颗粒少量多次注射移植隆乳术脂肪吸收率的超声评价

目的通过超声技术评估自体脂肪颗粒注射移植隆乳术后脂肪的吸收率。方法超声测量自体脂肪颗粒少量多次注射移植隆乳术者33例,每例接受1～5次注射,每侧每次注入脂肪颗粒50～60ml,通过超声测量乳房不同位点的腺体后移植脂肪各时期厚度的变化,评价脂肪的吸收率。结果共测量乳房264个位点,其中224个位点脂肪颗粒位于腺体后层;32个位点脂肪颗粒位于胸大肌层;8个位点脂肪颗粒位于腺体层内。腺体后脂肪平均厚度由术前0．2cm增加到第5次注射后的1．0cm,隆乳术1个月后腺体后脂肪厚度的平均吸收率为34％～66％。结论自体脂肪颗粒少量多次注射移植隆乳术是一种有效的方式,超声技术是一种有效的诊断监测方法。     

Experience of injected fat grafting

Eighteen months' experience with the injected fat grafting technique used in 208 patients to correct various problems such as buttocks (augmentation and reshaping), trochanteric depressions, breast augmentation, scar depressions, thighs and legs (calf and ankle augmentation), small wrinkles and depressions of the face (Romberg's disease), nasolabial fold, upper outer breast quadrant, liposuction sequela, fingers and hands is presented. This method shows major advantages with few complications. Some technical details and recommendations for successful fat grafting are also presented.     

The effects of different harvesting techniques,adrenaline, and centrifuge on the survival of fat grafts

The effects of different harvesting techniques, local adrenaline infiltration, and centrifuge on fat graft survival and stability were studied. Twenty-four adult female Guinea pigs weighing 580–700 g were divided into three groups (groups A, B, and C), each with eight subjects. Fat grafts were harvested from the back of the animals. The left side was used for simple excision and the right for liposuction in harvesting the grafts; they were named subgroups 1 and 2, respectively. Group A was the control group. In group B, the grafts were incubated in 1/100,000 adrenaline solution for 15 min. In group C, they were centrifuged at 2,000 rpm for 3 min before placing them in the abdominal area of the same subjects. Again, the left side was used for placement of excised material and the right one for lipoaspirate. At the third postoperative month, all subjects were reoperated on to remove the grafts, and the extracted material was studied macroscopically and histopathologically. In the groups where liposuction was utilized for graft harvest, the graft resorption ratios and volume loss have been significantly increased. Adrenaline infiltration had no effect, either macroscopically or histopathologically. Although the centrifuge did not seem to have a significant effect macroscopically, the histopathologic study revealed its significant negative effects on grafts harvested by simple excision.     

低能量激光熔脂临床效果观察

目的探索一种辅助吸脂的新技术、新方法，使吸脂术更为省时、省力、安全有效。方法应用低能量激光熔脂技术辅助减肥塑形为402例患者1407个部位行负压或振动吸脂术。结果与振动吸脂组回顾性对比，本组更为省时、省力，损伤小．恢复快，合并症少，安全性高．术后疼痛轻。结论低能量激光熔脂技术是一种安全有效的辅助吸脂的新技术、新方法，值得推广。     

自体脂肪颗粒移植在修复面部整形术后局部凹陷并发症中的应用

目的 探讨自体脂肪颗粒移植对面部整形术后常见的局部凹陷并发症进行修复的方法和临床效果.方法 选择腹部、大腿部等作为脂肪供区,在局部肿胀麻醉伴或不伴静脉麻醉下行脂肪抽吸术,将抽吸获得的脂肪混悬液低速离心纯化后按需要均匀地注射移植于面部整形术后局部凹陷的部位.根据预后情况可多次注射.结果 自2007年3月至2012年9月,共采用此方法对28例患者进行治疗,术后修复部位充盈、自然,效果满意.结论 自体脂肪颗粒移植是进行面部整形术后修复局部凹陷的有效方法,值得临床推广应用.     

Fat injection: Long-term follow-up

We used this procedure of fat injection to correct soft tissue defects, using the patient's own fatty tissue obtained by liposuction. We show the results of long-term follow up from 1984 to 1994. The main idea was to find a successful procedure in order to attain good specimen graft and long-term results. It was not an easy goal because of the high reabsortion of fatty tissue.     

Adipose tissue and lipid droplet embolism following periurethral injection of autologous fat: Case report and review of the literature

The authors present a case of a death associated with pulmonary adipose tissue and lipid droplet embolism following autologous fat harvesting, periurethral injection and videocystourethroscopy for the treatment of recurrent genuine stress incontinence.     

注射法颗粒脂肪移植的临床应用

报道了应用注射器抽吸腹部脂肪并经浓缩后注射于需充填部位的皮下，以矫正面部凹陷畸形及皱纹的新技术。自１９９１年至今应用８例，获得了良好的效果。对脂肪注射后的成活及吸收问题和应用中的注意事项进行了讨论。认为这是一种值得推广的新技术，在整形美容外科中具有广泛的应用价值。     

金葡素治疗吸脂术后血清肿机制的初步探讨

目的 探讨金葡素治疗吸脂术后血清肿的可能机制.方法 对64例吸脂术后血清肿患者分别应用常规和金葡素治疗,然后每日采集渗出液,并对渗出液的比重、pH值、细胞类别及数量,以及总蛋白(TP)、碱性磷酸酶(ALP)、乳酸脱氢酶(LDH)、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、γ-谷氨酰基转移酶(γ-GT)、腺苷脱氨酶(ADA)、载脂蛋白B(ApoB)、总胆固醇(TC)等生化指标进行分析.结果 金葡素治疗组患者治疗7 d后渗出液比重增高,淋巴细胞、间皮细胞的数量增加,TP、LDH、ADA、TC等多种生化指标均有明显升高,其中渗出液比重1.086±0.002、TP(42.1±0.32)g/L、LDH(343.2±9.1)U/L、ADA(19.2±5.14)U/L、TC(0.42±0.02)mmol/L.有核细胞计数平均为600×106/L,其中淋巴细胞占78%,间皮细胞占10%,与常规治疗组比较差异有统计学意义(P<0.05,P<0.01).结论 金葡素治疗组渗出液比重、细胞类别、数量以及多种生化指标的变化是金葡素刺激浆膜以及周围组织产生炎性反应引起的,无菌性炎性反应可能是金葡素治疗吸脂术后血清肿的机制.     

Aspiration lipectomy and adipose tissue injection pathophysiologic commentary

Summary The subcutis, made up of connective and adipose tissue, may consist of one or two layers, depending on the part of the body. The superficial layer, up to 10 mm in thickness, has the function of giving contour. In localizations where one typically sees relatively large fat deposits a padding layer is added to the contour layer, and this may be centimeters in thickness. Aspiration lipectomy should be limited to reducing the padding layer. The advancing cannula perforates the supportive structures in the subcutis and breaks up the fat lobules. Analysis of the aspirated material suggests that residues of fat lobules remain adhering to the chamber walls; it may be assumed that they necrose and are removed by the mechanisms of foreign body reaction. Some stiffening of the reduced subcutis due to fibroproductive processes appears to be inevitable. Implantation of fat fragments obtained through lipectomy offers little biological advantage; at the same time one must expect extensive necrosis of the implanted tissue. With fat cell suspensions, failure to heal seems to be due to inadequate restoration of the capillary bed. The use of cultured preadipocytes to build up adipose tissue is an attractive idea, but the method is still at the experimental stage. Presented on the 19th Congress of the German Society for Plastic Surgery in Düsseldorf, September 27–30, 1989     

自体脂肪移植在隆鼻术中的临床应用

目的 探讨自体脂肪移植在隆鼻术中的临床应用效果.方法 对16例鼻背低平的求美者,用注射器抽吸大腿内、外侧脂肪约20.0 ml备用.离心法去除水分和油滴,采用1.0 ml注射器在鼻背皮下注射填充脂肪2.0 ～5.0 ml.结果 本组共16例求美者,术后随访3～12个月,其中14例求美者对效果满意,2例求美者经过第2次脂肪移植后,效果满意.结论 应用自体脂肪注射移植行隆鼻术,具有效果确切,损伤轻,恢复快的特点,对于不能接受假体隆鼻的求美者是一种有益的选择.     

Superficial liposuction: A new application of the technique for aged and flaccid skin

From 1982 to 1991, 2500 patients underwent liposuction to thin the superficial areolar layer of fat. The patients were of all ages and had different types of skin. From the results the author concludes that the new superficial liposculpting, based on the controlled scar retraction of the thin cutaneous adipose flap remaining after the treatment, allows for very good results even in very flaccid and aged skin. A digital molding of the residual fat also improves the contouring. So-called cellulite is finally meliorated.Presented at the First and Second International RAPS Congress, Sao Paulo, Brasil, March 1989 and 1991 and at the Nineth LSNA Meeting, Seattle, Washington, September 1991     

Comprehensive liposuction of lower limbs: Basic concepts

The basic concepts of the aesthetics of proportioning the lower limb region by liposuction are discussed. The operative technique and some clinical cases are also discussed.     

Liponecrotic cysts after augmentation mammaplasty with fat injections

A 26-year-old woman underwent breast augmentation with fat injections from trochanteric liposuction. After one year firm lumps developed in both breasts. Surgical treatment included excising the cysts through an inframammary approach. Volume replacement consisted of a silicone gel prosthesis inserted through an axillary retropectoral approach. In a second stage, a supra-areolar dermopexy was done to centralize the nipple-areola complex.     

Liposuction fat grafts in face wrinkles and hemifacial atrophy

We present the idea of correcting soft tissue defects with an injection of fat obtained by liposuction. Our method has great advantages, with few serious complications. The technique is described and the results are demonstrated in several patients treated over a period of one year.     

Fat grafting of the buttocks and lower limbs

This article presents the senior author's experience in fat grafting for the treatment of contour deformities of the buttocks and lower limbs. This method has been termedliposculpture and consists in removal of adipose tissue by cannula and syringe and cleaning of the aspirated material with saline. All external contact is thus carefully avoided, preventing contamination. Fat grafting is done in multiple tunnels in a deep plane. Total of 140 patients were treated over the last 5 years and results were considered uniformly satisfactory. Fat absorption was estimated by clinical evaluation to be less than 20% volume. A low rate of complications (less than 3%) supports the authors' opinion that this is an efficient and safe procedure to correct or enhance contour deformities of the lower limbs.     

自体脂肪移植综合技术在面部轮廓整形中的应用

目的 探讨自体脂肪移植综合技术在面部轮廓整形方面的疗效.方法 对83例要求面部轮廓整形的患者(颞部凹陷、颊部凹陷、眶周凹陷、消瘦衰老脸型以及面部不对称)采用"3L3M"综合技术(low pressure suction,low speed centrifugation,low volume,multi-plane,multitunnel,multi-point injection)进行治疗.自体脂肪移植注射1～3次,中间间隔3～6个月.通过术前、术后不同角度照片的比较,以及患者术后表情恢复,局部吸收和囊肿发生情况,自我感觉等随访,来评价治疗效果.结果 最长8年,平均4.23年的随访发现在1～3次自体脂肪注射后,脂肪可以在受区长期存活.73.5%以上患者对疗效满意,小于4.8%的患者对疗效不满意.结论 "3L3M"的自体脂肪移植综合技术用于面部轮廓整形是一项安全而有效的治疗方法.     

Fat Embolism Syndromes Following Liposuction

Fat embolism syndrome (FES) after liposuction is likely a life-threatening disorder, though its incidence is low. The three chief clinical manifestations include respiratory insufficiency, cerebral involvement, and petechial rash. Although FES is a multisystem disorder, the most seriously affected organs are the lungs, brain, cardiavascular system, and skin. Many laboratory findings are characteristic but nonspecific. The pathogenesis of FES after liposuction has been looked at both mechanically and biochemically. Diagnosis is difficult; Gurd and Wilson's diagnostic criteria based on clinical examination is still extensively used in clinics at present. There is no specific therapy for FES after liposuction for the moment, so prevention, early diagnosis, and supportive therapies are important. In this article we discuss the clinical presentation, pathogensis, and current methods to prevent FES and, if possible, ways to treat this complication.