生物活性因子及药物对自体脂肪移植存活率的影响

自体脂肪组织不仅生物相容性好、获取方便、来源丰富、填充后外形良好、成本低廉,而且并发症少、风险低。但是,不确定的存活率却成为自体脂肪移植的一大缺陷。本文就各种生物活性因子及药物对自体脂肪移植存活率的影响进行综述。     

Fat Grafting's Past, Present, and Future: Why Adipose Tissue Is Emerging as a Critical Link to the Advancement of Regenerative Medicine

Fat grafting is a common reconstructive and aesthetic procedure with extensive clinical applications. Recently, significant strides have been made in investigating the biology behind the success of this procedure. Surgeons and scientists alike have advanced this field by innovating fat graft harvesting and injection techniques, expanding the use of adipose tissue and its stem cell components, and broadening our understanding of the viability of fat grafting at the molecular and cellular levels. The objectives of this review are to (1) discuss the clinical applications of fat grafting, (2) describe the cellular biology of fat and the optimization of fat graft preparation, (3) illustrate the significance of adipose-derived stem cells and the potentiality of fat cells, (4) highlight the clinical uses of adipose-derived stem cells, and (5) explore the current and future frontiers of the study of fat grafting. Although collaborative knowledge has increased exponentially, many of the biological mechanisms behind fat grafting are still unknown. Plastic surgeons are in a unique position to pioneer both the scientific and clinical frontiers of fat grafting and to ultimately further this technology for the benefit of our patients.     

Stellenwert der autologen Fetttransplantation in der ästhetischen Chirurgie des Mammakarzinoms

Autologous fat grafting is considered a secondary reconstructive procedure and has the goal of improving quality of life. When lipofilling, autologous fat is transferred to the receiver location to optimize soft tissue contour of the recipient region. Breast cancer is the most common cancer in women. Thanks to individualized treatment methods, the cure rate continues to increase; however, increasingly more women must live many years with the consequences of surgery. Although the surgical procedures are becoming more individualized and are increasingly adapted to the individual situation, patients often have scars, defects, asymmetry, and volume loss of the breast, which are often enhanced by radiotherapy. Autologous fat is suitable for volume replacement of soft tissue and to improve the contour, skin perfusion, as well as augmentation of volume loss. Thereby, fat is suitable for breast reconstruction after mastectomy, flap surgery, or nipple/skin-sparing mastectomy followed by implant-based breast reconstruction. After breast-conserving therapy for breast cancer, asymmetry and scar tissue can also be treated with autologous fat. It should be noted that fat can only be transplanted into a healthy breast. Prior to autologous fat grafting, potential residual tumor or recurrence should be excluded. The longer the time interval between oncology surgery and fat grafting, the greater the safety. The success of this method is based on sound knowledge of the method, careful design of each treatment step, and depends on parameters, such as ability to analyze the breast by imaging, volume stability, and oncological safety.     

Radiographic Implications of Fat Grafting to the Reconstructed Breast

Autologous fat transfer is often used to smooth contour irregularities in the reconstructed breast. A potential concern with this technique is that it results in calcified lesions in the breast that can complicate subsequent cancer surveillance. The purpose of this review was to determine how fat grafting to the reconstructed breast impacts postoperative breast imaging. This is a matched cohort analysis of patients who underwent postmastectomy breast reconstruction with and without fat grafting as a secondary procedure. Nonfat grafted reconstructive patients were matched based on age, year of initial reconstruction, and type of reconstruction. Postoperative imaging at our institution was required for inclusion. The two groups were compared in terms of incidence and distribution of radiographic studies performed in follow‐up and the need for biopsies. Fifty‐one reconstructed breasts with a history of fat grafting were compared to 51 nonfat grafted, reconstructed breasts. The fat grafted group underwent a total of 204 breast imaging studies over a mean follow‐up of 4.2 years, while the nonfat grafted group underwent 167 studies over 4.1 years (p = 0.21). More mammograms, ultrasounds, and magnetic resonance images were performed after fat grafting, but a significant difference was evident only for mammography (34 versus 12, p = 0.05). The incidence of breast biopsy to clarify abnormal imaging was nonsignificantly higher in the fat grafted group (17.6% versus 7.8%, p = 0.14). Fewer than 10 percent of imaging studies in the fat grafted cohort were performed to investigate a clinical or radiographic abnormality occupying the same breast quadrant as prior fat injection. Breast cancer patients treated with fat grafting required more breast imaging and biopsies than their nonfat grafted counterparts, but the areas of suspicion poorly corresponded to the site of prior fat grafting. Multimodal breast reconstruction may drive the additional diagnostic burden and not the fat grafting technique itself.     

Facial fat grafting: the search for predictable results

Since the majority of volume loss to the face is due to fat atrophy, autologous fat grafting with living fat cells represents the ideal tissue replacement. Recent technical improvements have led to excellent results utilizing fat grafting for cosmetic and reconstructive indications. The purpose of this article is to describe our clinical and laboratory experience with successful facial fat grafting for volume augmentation. Our laboratory experience with facial fat grafting centers around the results of multiple studies utilizing a nude mouse model of facial fat transplantation. Armed with the knowledge gained from our laboratory experience we present modified techniques to optimize fat grafting in the clinical setting. Furthermore, we present the results of several clinical studies examining a variety of recipient sites including nasolabial folds, glabella, lips, and lower eyelids. Lastly we describe our experience utilizing fat grafting to treat patients with hemifacial atrophy. When utilized in the appropriate areas, facial fat grafting can provide long-lasting aesthetically superior replacement for the soft tissues lost through aging or disease.     

Review of fat grafting and the fate of the subperiostal fat graft

Fat grafting has been widely used over the past100 years for soft tissue augmentation. Despite a number of publications which show poor long-term results, it is still one of the most preferred soft tissue fillers. After liposuction became popular in 1980s, an easier method of transfer, lipoinjection, once again brought attention to fat grafting. New methods to increase durability of fat grafts were developed. Placing the fat graft into a well vascularized recipient site was one of the most accepted ideas. Fat grafting into the muscle and over periosteum showed satisfactory results in the long term. All the fat tissue transplanted into a recipient site will probably not survive; the area then contains necrotic fat tissue and this can cause depressions which are easily seen if the overlying skin is thin and has been previously traumatized. Placing the fat grafts subperiostally can be a solution to this problem. In our experimental study we compared subperiostal fat grafting with supraperiostal fat grafting in a rat model. Fat graft weight changes and histopathological examinations in both of the groups showed similar properties. Thus subperiostal grafting is an alternative augmentation technique in areas where the overlying skin is thin.     

自体脂肪移植修复面部凹陷性及萎缩性瘢痕

目的:探讨自体脂肪移植修复面部凹陷性及萎缩性瘢痕的方法和临床疗效。方法:对10例面部凹陷性及萎缩性瘢痕患者采用自体脂肪移植进行治疗。脂肪获取、提纯及注射采用3M3L移植技术。每例自体脂肪移植1~3次,每次间隔3~6个月,综合评价患者术后面部轮廓畸形、瘢痕皮肤质地改善情况。结果:患者均获随访3个月~1年,无感染、囊肿、钙化、血管和神经损伤等并发症发生,也未产生新畸形及新瘢痕。轮廓凹陷畸形得到矫正,瘢痕皮肤质地及色泽有所改善,患者均对治疗效果满意。结论:自体脂肪移植是一种治疗面部凹陷性及萎缩性瘢痕可行的微创方法。     

The current status of autologous fat grafting

The opinion of the majority of surgeons is fat grafting does not work. The fat cells do not survive transfer. Many have attempted the techniques only to become discouraged and abandon it. This article describes certain principles necessary for successful fat grafting: for harvesting use of a large-diameter syringe and needles, an atraumatic method of cleaning the fat cells, and an anaerobic method of storage. A method of autologous fat cell transfer including harvesting, processing, and injection of the fat is described. Long-term results are shown and limitations of the procedure are presented.Presented at the 9th Annual Meeting of the Lipoplasty Society of North America, Seattle, Washington, September 1991     

Autologous fat grafting in secondary breast reconstruction

Autologous fat grafting has become a common technique for revisional breast surgery. The purpose of this series is to review our experience with fat grafting for the correction of acquired breast deformities. A retrospective review was performed on 107 patients with a history of breast cancer between 1996 and 2010, who had autologous fat grafting at the time of secondary breast reconstruction. The indications were for improvement in contour, shape, and volume of the breast following transverse rectus abdominis myocutaneous (TRAM) flap reconstruction (n = 55), latissimus dorsi with or without implant (n = 20), implant reconstruction (n = 20), and breast conservation therapy deformity (n = 12). The average volume of injection was 40 mL (range, 5-150 mL), the most common location being upper and medial quadrants. Fat was harvested mainly from the abdomen, thighs, and flanks. Complications occurred in 11% of the patients, and included fat necrosis, erythema, keloid scarring, and pain. Complications were higher when performed with implant reconstructions. Repeat fat injection was performed in 25% (n = 27/107), which increased with the length of follow-up. Patients with a history of radiation therapy had an increased incidence of repeat injections (36% vs. 18%). Patients with >6 months follow-up reported an improvement of about 83%. Autologous fat grafting is a safe and effective tool for secondary breast reconstruction. It is helpful in all types of reconstructions to improve contour, volume, and overall breast shape and symmetry. Repeat injections are often required and this is more common in patients with longer follow-up and in those with a history of radiation therapy. The popularity of this approach in reconstructive breast surgery will likely continue to increase.     

Fat grafting to the nose: personal experience with 36 patients

Background  

Clinicians are facing an increasing trend toward nonsurgical nose reshaping using synthetic injectables, mainly for patients who refuse standard rhinoplasties. Autologous fat grafting is a safer and convenient alternative to permanent or semipermanent injectables due to better results as well as fewer and milder side effects. The author reports his experience with fat grafting to the nose using his personal technique for 36 consecutive patients. The experience covers primary treatments of noses not treated by surgery, treatment of post rhinoplasty deformities, and combination fat grafting and rhinoplasties.     

Tear trough deformity: review of anatomy and treatment options

The lower eyelid can be a challenging area in facial rejuvenation. While lower eyelid bags are commonly the reason that patients present for lower eyelid rejuvenation, a separate entity known as a tear trough deformity may occur in conjunction with lower eyelid bags or alone. In this article, the authors outline the current understanding of the tear trough anatomy; describe multiple classification systems, which provide an objective means of evaluating the deformity and aid the surgeon in choosing appropriate treatment options; and review surgical and nonsurgical techniques for correcting the tear trough deformity. Treatment options include hyaluronic acid filler, fat grafting, skeletal implants, and fat transposition. Each procedure is associated with advantages and disadvantages, and each should be considered more complex than traditional lower blepharoplasty alone. While lower blepharoplasty removes excess fat and may tighten the anterior lamella, tear trough procedures require the addition of volume to the underlying depression. These procedures requiring release of the ligamentous structures and orbicularis (of which the tear trough is composed), as well as fat transposition or fat grafting, are associated with additional complications, which are also reviewed.     

Fat grafting and stem cell enhanced fat grafting to the breast under oncological aspects – Recommendations for patient selection

Reconstructive and aesthetic fat grafting has been introduced to the breast level over the last years. The safety of such procedures has so far not been completely clarified. The concept has now been refined to stem cell enhanced fat grafting. However beside the promise of using adult stem cells in terms of tissue rejuvenation and augmentation, scar treatment and reconstruction, the variance of adipose stem cell function – including angiogenetic, antiapoptotic, immunomodulatory, chemotactic and anti-scarring potential – raises new scepsis about oncological safety.Herein we reviewed experimental and clinical data on fat grafting and stem cell enhanced fat grafting addressing surgical promise and oncological concerns. Based on these data we suggest clinical criteria for patient selection undergoing fat grafting for aesthetic or reconstructive reasons based on their individual breast cancer risk.     

A fifteen-year experience of buttock contouring with combination of silicone implant, liposuction, and structural fat grafting

Buttock augmentation is one of the most popular procedures to shape and augment the gluteal region. The major literature regarding this topic accentuates the role of the implant in gluteal shaping. The goal of this study is to present our personal experience and approach while emphasizing the role of implant positioning and structural fat grafting to yield a more satisfied buttock contouring. Gluteal implants were placed with various orientation mostly the more spherical portion facing inferiorly to simulate the round shape of the midportion of the gluteal region as an alternative to its classical positioning. Patients were analyzed based on the projection as well as the shape and contour of buttocks. Gluteal contouring with rationale positioning of the gluteal implants combined with structural fat grafting may play a role to yield a more satisfied buttock contouring.     

A comparative study of full-thickness skin grafting with and without subcutaneous fat preservation

Skin grafting is an important method of wound repair and reconstruction. Skin grafting can be classified using multiple classification criteria. We often perform full-thickness skin grafting (FTSG) for small wound areas; however, the traditional FTSG technique frequently causes postoperative scar depression at the donor site, especially in the abdomen. This study aimed to determine whether preserving the subcutaneous fat when performing FTSG can improve donor site prognosis. We reviewed 25 patients who underwent autologous FTSG in the last 3 years. Among them, subcutaneous fat was preserved in 11 patients (experimental group), whereas it was not preserved in 14 patients (control group). Using a 3D camera and the Patient and Observer Scar Assessment Scale (POSAS), we evaluated the donor site postoperatively. According to POSAS, vascularization was significantly more severe in the experimental group. The Antera 3D camera revealed more severe scar depression at the donor site in the control group. The processing time for graft take, subcutaneous fat trimming and donor site closure was less in the experimental group than in the control group. Preserving subcutaneous fat at the donor site improved patient outcomes by reducing donor site depression after FTSG.     

自体颗粒脂肪移植技术在面部临床应用的进展

目的总结自体颗粒脂肪移植技术在面部的研究与实践,探讨该技术在实际操作中的不同观点。方法查阅近年来国内外有关面部自体颗粒脂肪移植的文献,进行综合分析。结果自体颗粒脂肪移植技术已日趋成熟,应用在面部不仅能调整面部轮廓比例、恢复组织容量,还能改善局部皮肤质地,用于面部填充、面部年轻化等治疗,可获得良好临床效果。目前在供区选择、颗粒脂肪采集方法、纯化处理技术等具体操作方面尚存在争议,但所采取的自体颗粒脂肪移植技术的基本原则一致。结论从循证医学角度来看,自体颗粒脂肪移植技术在面部应用的临床经验很多,但是客观证据不足,有待进一步研究。     

自体脂肪移植治疗川字纹

目的探索自体脂肪移植治疗川字纹的临床疗效。方法2010年9月至2012年4月．对8例川字纹患者的累及皮肤区域内进行真皮下自体脂肪注射,提升局部皮肤张力。结果8例川字纹患者均随访1年．自体脂肪移植3个月后川字纹皱折消失,局部皮肤平坦;6个月后只有1例患者川字纹复发。结论对于特定类型的川字纹．局部自体脂肪移植可使得发生皱折的皮肤得到充填和支撑,本方法操作简便、安全,疗效良好。     

Autologous fat grafting for primary breast augmentation: a systematic review

As the technique of autologous fat grafting is being refined and perfected, its clinical applications are expanding. The use of autologous fat grafting for primary breast augmentation is controversial due to a lack of clarity regarding its safety and efficacy. Most notably, concerns about interference with the detection of breast cancer have been raised, but these have not been clearly addressed in the literature. To help surgeons gain further insight, the authors conducted a systematic review of the literature, carefully comparing technique, clinical outcome, radiologic impact, and complications in all available data on this subject. Although an optimal method of autologous fat grafting for primary breast augmentation is yet to be standardized, further strong evidence-based studies are necessary to confirm the findings of this approach.     

Oncologic risks of autologous fat grafting to the breast

As the frequency of fat grafting to the breast has increased, some investigators have raised the possibility that this procedure may potentially increase the risks associated with breast cancer. Their concerns included not only interference with cancer detection, but also promotion of tumor formation or recurrence mediated by mechanisms such as aromatase expression, angiogenesis, and tumor stromal cells. However, published clinical studies describing outcomes of fat grafting to the breast in more than 2000 patients have not reported any increase in new or recurrent cancers. The reason for this apparent disconnect may lie in the small sample sizes and relatively short follow-up, but it may also reside in the considerable gap between laboratory studies or theoretical considerations suggesting potential risks and the actual clinical practice. This review discusses potential risks of current and novel approaches to autologous fat grafting to the breast within the context of both the underlying science and clinical practice.     

Long-term clinical outcomes of fat grafting by low-pressure aspiration and slow centrifugation (Lopasce technique) for different indications

Abstract

Autologous fat grafts have been used successfully for structural fat grafting in facial, lip, and hand rejuvenation, body contour improvement, and traumatic defect restoration. The purposes of this study were to define a new fat graft harvesting and processing technique, which is named the “Lopasce technique” (low-pressure aspiration and slow centrifugation technique), and to evaluate the late clinical outcomes of fat grafting by this technique for different indications. A retrospective study was performed using the medical records of 21 patients (17 women and four men). The mean injected fat volume was 33.2 ± 34 cc (range 6–125 cc). The mean follow-up period was 13.2 ± 5.6 months (range 6–26 months). Postoperative results were evaluated by subjective and objective methods. In the subjective evaluation, 19 patients stated that there had been little resorption and that it was not necessary to repeat the fat grafting, one patient reported that the fat was resorbed in part, and one patient reported that the fat was resorbed completely. In the objective evaluation, the amount of fat graft taken in the recipient sites was between 60%–80% (average 70%) when compared with preoperative and late postoperative photographs of the patients at the 6- and 26-month follow-ups. Fat grafting is a simple, effective, and reproducible technique with a high satisfaction rate and few disadvantages or complications. We consider that structural fat grafting with the lopasce technique is an easy, effective, and long-lasting treatment for correction of congenital or acquired defects associated with various medical conditions.