No-Touch Technique for Autologous Fat Harvesting

A new technique for autologous fat harvesting is presented. It is termed the no-touch technique because the concentrated fat graft is obtained with no handling of fatty tissue. With the no-touch technique, fat aspiration is performed under tourniquet. There is no need for any mechanical manipulations such as centrifugation, washing, whisking, filtering, or straining. The medial aspect of the knee is used as the donor area. Fat is aspirated through a disposable 10-ml syringe and a 14-gauge microcannula, which consists of a curved, semiblunted tip such as that of the Tuohy needle. What remains in the syringe is the concentrated fat without blood, serum, or lidocaine. The authors report their experience with 30 patients.This study was presented at the XVI Congress of ISAPS at Istanbul in 2002.     

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.     

Current state and exploration of fat grafting

Fat grafting has become one of the most frequently used techniques in plastic and reconstructive surgery. Many studies have focused on optimizing procedures, such as donor site selection, harvesting, processing, and grafting. Representative basic techniques include Coleman’s and “3L3M” techniques. A new technique called compartment-based targeted fat grafting (CTFG) has gradually been established based on anatomical findings of the facial and hand compartments. CTFG achieved precise restoration of the fat volume in the anatomical state. Cell-based fat grafting has introduced new fields involving tissue repair and regeneration, including facial rejuvenation and scar improvement, among others. In this review, we summarize the timeline for the development of fat grafting.     

A New Simple Method Used to Prepare Fat for Injection

Various clinical and experimental studies on harvesting techniques, donor sites, preparation, and preservation of fat for injection imply that there is no universal agreement on an ideal methodology. Unpredictable and irregular resorption of fat leads to uncertainty about volume maintenance of the transplanted fat necessitating repeat procedures. In this report, the authors present their 5-year clinical experience with facial fat grafting by isolated and combined procedures using a simple method that they developed for fat preparation. This technique includes fat harvesting with syringe aspiration and filtration of the fat aspirate instead of centrifugation. The idea for filtration was inspired by a yogurt concentration method used in Anatolia. The authors also aimed to increase fat survival by using multiple fat injections of minimal amounts into different levels.     

葡萄糖转移方法检测脂肪颗粒活性的研究

目的 以高速离心为损伤模型,了解以葡萄糖转移量来体现组织块活性的可能性、可靠性,建立新的脂肪颗粒活性检测方法,为脂肪移植研究提供一基础.方法 将同条件抽取的脂肪颗粒分为5组,分别经1 000、2000、3 000、4 000、5 000 r/min离心纯化后,每组得60 ml样本,每个样本分为12个实验标本（5 ml/标本）置于12个培养皿中（内含10 mlDMEM、1 U正规胰岛素/皿）,每组设一个不含脂肪颗粒的空白标本,所有标本同时进行孵育,1 h后测量每个标本DMEM中葡萄糖的浓度.以5组空白标本的葡萄糖浓度均值为基础浓度,其与每个实验标本的葡萄糖浓度差值代表标本的葡萄糖转移量即活性.t检验分析比较每组标本的活性.将5组样本送病理学检查,比较各组切片完整细胞数,并与上述实验结果进行对比.结果 各组样本经含糖DMEM孵育后,其葡萄糖转移量即活性用SNK方差分析检验得出：1 000 r/min组＞2 000 r/min组＞3 000 r/min组＞4 000 r/min组,5000 r/min组与4 000 r/min组比较,差异无统计学意义,但显著小于前4组（P＜0.05）,即随离心速率增大,脂肪颗粒活性逐渐下降.病理切片显示：5 000 r/min组大部分细胞壁形态不规则或碎裂.完整细胞计数结果用SNK方差分析检验得出：5 000 r/min组明显较其他各组少（P＜0.05）;其他4组完整细胞数差异无统计学意义（P＞0.05）.结论 葡萄糖转移实验可较准确地检测脂肪颗粒活性的活性状态,病理学检查在反应脂肪颗粒活性方面有局限性.     

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.     

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.     

超声和钼靶检查对乳房受区脂肪移植术后脂肪坏死的诊断价值

目的 探讨超声和钼靶检查对乳房受区脂肪移植术后坏死脂肪的诊断价值及病理特征.方法 对2005年6月至2012年6月收治的13例共96处脂肪移植术后坏死脂肪标本的超声、钼靶检查结果,以及所摘除乳房结节的病理诊断资料,进行回顾性分析.结果 96处病损病理诊断均为脂肪坏死.病理表现有薄壁、厚壁囊肿和无壁囊肿3类.29处为薄壁脂性囊肿和52处厚壁脂性囊肿,在超声和钼靶上都有成像,但15处无壁囊肿在钼靶上有成像而超声上无成像.96处病损的钼靶表现均为良性包决的征象,未见恶性肿块征象.结论 大部分坏死脂肪在乳房受区呈现特征性的薄壁或厚壁囊性超声和钼靶影像表现,不规则形脂肪灶性坏死在钼靶中可以成像,但在超声检查中有可能漏诊,未发现与乳房肿瘤相混淆的钼靶征象.     

骨髓脂肪细胞在激素性骨坏死发生过程中的时序变化特点

目的血管外脂肪堆积如何参与激素性骨坏死的发病机制目前仍然不清楚。本课题应用建立的激素性骨坏死家兔模型研究骨髓脂肪细胞在骨坏死发生过程中组织病理形态学上的时序变化特点。方法32只28-32周龄成年新西兰大白兔分为正常对照组（n=16）和激素处理组（n=16）。激素处理组动物接受1次耳静脉内毒素注射和连续3次肌内糖皮质激素注射诱导骨坏死,正常对照组注射相应剂量的生理盐水。各组动物在最后一次注射糖皮质激素2周（早期）和4周（晚期）以后分别处死8只动物,获取双侧近端股骨,应用组织形态计量学技术分别测定股骨髓内脂肪细胞密度、脂肪细胞直径和脂肪细胞面积,同时进行骨坏死的组织病理学评价。结果激素处理早期组和晚期组骨髓脂肪细胞密度分别明显高于正常对照组67.1%和54.4%,但是早期组与晚期组之间差异不显著。激素处理晚期组骨髓脂肪细胞直径明显高于正常对照组,但是早期组骨髓脂肪细胞直径与正常对照组比较有减小趋势;激素处理早期组和晚期组骨髓脂肪细胞面积都分别明显高于正常对照组44%和83.6%,且晚期组亦显著高于早期组;脂肪细胞直径的频数分布显示,正常对照组峰值介于40-50μm,激素处理早期组较正常对照组增多的脂肪细胞直径介于30-40μm,晚期组较正常对照组增多的脂肪细胞直径介于50-60μm。组织病理学评价显示早期组骨坏死发生率为25%（2/8）,晚期组骨坏死发生率为87.5%（7/8）。结论在激素性骨坏死发生过程中,早期血管外脂肪堆积表现为大量生成的小脂肪细胞,后期血管外脂肪堆积表现为脂肪细胞出现肥大。     

成人脂肪组织动物移植实验研究

目的建立人类脂肪组织移植实验的动物模型,并对几种不同的脂肪移植方式进行比较和评价。方法我们引用Balb／C（nu／nu）裸鼠建立了人类脂肪组织移植实验的动物模型并将成人的脂肪小叶、真皮脂肪块和脂肪微粒分别移植于14只裸鼠背部的肉膜下,间隔5天到4个月取样进行组织学和组织化学检查。结果脂肪小叶移植后具有最好的组织学结果和体积的维持。结论裸鼠是研究人类游离脂肪移植的有效工具。对三种游离脂肪移植方式的比较研究显示出以脂肪小叶为单位进行移植的优越性,在一定程度上证实了体积／面积比率和损伤因素对游离脂肪存活的重要意义.     

中链甘油三酯对手术后接受肠外营养患者代谢的影响

目的比较长链甘油三酯(LCT)和中链甘油三酯(MCT)2种脂肪乳的代谢效应差异.方法24例胃、结肠手术患者和6例志愿者参加本研究,均有知情同意.患者随机分为2组,分别接受含50%MCT或单纯LCT的肠外营养.测定前臂动静脉血中甘油三酯的浓度差及氮平衡.结果MCT组肌肉利用脂肪乳的能力明显提高,氮平衡也有所改善,且术后体重减轻较少.在脂肪乳廓清试验中发现,血清酮体浓度MCT组[(0.063±0.004)mmol/L]明显高于LCT组[(0.039±0.002)mmol/L].氮储存的增加与酮体和胰岛素水平的增加相关.结论含50%MCT的脂肪乳用于肠外营养是安全的,可作为又一种能改善机体蛋白代谢的能量物质.     

脂肪清除和脂肪变性技术处理直肠癌标本的比较

目的比较应用脂肪清除和脂肪变性技术在直肠癌标本寻找淋巴结的效果。方法收集2007年1月至12月问收治的64例直肠癌患者（男38例、女26例,平均年龄54岁）的手术标本,按手术时间的先后分为脂肪清除组（30例）和脂肪变性组（34例）．对比两组标本所获得的淋巴结总数及其大小和转移情况以及处理标本的时间。结果脂肪清除组标本检出淋巴结平均37．4（17～69）枚／例,其中转移淋巴结3．3枚／例,平均直径为3．6mm;脂肪变性组则平均检出36．2（18～62）枚／例,其中转移淋巴结3．2枚／例．平均直径为3．7nm。两组差异均无统计学意义（P〉0．05）。脂肪清除和脂肪变性两组预处理标本的时间分别为72和28h,脂肪变性组处理标本的时间明显短于脂肪清除组（P〈0．05）;寻找淋巴结的时间则分别为2．1和2．0h,两组差异均无统计学意义（P〉0．05）。结论脂肪变性技术处理直肠癌标本,不但可获得与脂肪清除技术同样的淋巴结数量．而且可明显缩短处理标本的时间。     

Effect of rhVEGF gene transfection on survival of grafts after autologous free granular fat transplantation in rats

Objective： To investigate the effect of recombinant human vascular endothelial growth factor （rhVEGF） on autologous free granular fat grafts in rats.
Methods： Forty-eight Sprague Dawley （ SD ） rats, weighing 190-280 g and regardless sex, were randomly divided into three groups, sixteen in each. After fat transplantation, the rats were treated with plasmid DNA encoding rhVEGF protein （the experimental group ）, plasmid DNA （ the negative group） and normal saline （ the blank control group ）, respectively. At 3, 7, 15 and 30 days after transplantation, the rats were killed and the grafts were weighed, respectively. Histopathological changes were evaluated. Microvessel density and the expression of VEGF were examined by immunohistochemical staining and Western blotting.
Results： The weights of the negative and blank control groups were significantly reduced on the 7th, 15th and 30th days compared with those of the experimental group. The expression of VEGF and the microvessel density in the experimental group were significantly higher than the other two groups during the latter periods.
Conclusion： The plasmid encoding VEGF can induce expression of VEGF and angiogenesis in fat grafts and reduce the absorption of free fat grafts.     

Syringe liposculpture: A two-year experience

Syringe liposcupture is a method that combines two relatively new techniques of plastic surgery: syringe liposuction and fat grafting. We can reshape the face and the body by removing localized fat deposits and reinjecting this fat where needed. When we do not reinject, we call the technique reduction liposculpture. In 1989 we introduced a new technique—superficial syringe liposculpture—to treat patients with flaccid skin, superficial irregularities or depressions, cellulite, and liposuction sequelae. The technique combines syringe liposculpture, superficial liposuction, and our method of treating skin irregularities by breaking the fibrous adherences and injecting fat superficially.     

低能量激光熔脂联合负压振动吸脂临床实验效果观察

目的探讨辅助负压振动吸脂术安全有效、创伤小、痛苦少、恢复快的方法,联合低能量激光熔脂技术,使其优点更突出,更省时省力。方法对192例求美者462个部位联合低能量激光熔脂后行负压振动脂肪抽吸术,与169例求美者406个部位行单纯负压振动脂肪抽吸术进行对比,并观察脂肪细胞的扫描电镜、透射电镜和光镜透视下的形态。结果低能量激光熔脂每部位平均用时和单位吸脂量平均用时明显减少,镜下显示大部分脂肪细胞膜多处破裂,脂滴溢出,细胞间质损伤小。结论低能量激光熔脂辅助负压振动吸脂,术后创伤小,疼痛减轻,抽吸部位平整,省时、省力,效果可靠,安全性高。     

Fat injections for the correction of facial lipodistrophies: A preliminary report

We present our experience with fat injections in the treatment of two cases of facial lipodistrophies. The surgical technique as well as the followup of the two clinical cases are presented in order to evaluate the long post-operative results. Among the different techniques used by us for correcting the soft tissues of the facial contour, this has been by far the simpliest and easiest. We need longer followups and more clinical cases in order to point out some definite conclusions, however. Nevertheless, it is our impression in this preliminary report that this technique could have a place in the treatment of problems related to the soft tissues of the facial contour.     

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.