Davison Steven P, Timpone Joseph, Hannan Catherine M
Washington, D.C. From the Department of Plastic Surgery and Division of Infectious Disease, Department of Medicine, Georgetown University Medical Center.
Plast Reconstr Surg. 2007 Dec;120(7):1843-1858. doi: 10.1097/01.prs.0000267341.14550.a7.
The accepted standard for treatment of human immunodeficiency virus disease, highly active antiviral therapy, may cause significant side effects, such as facial lipoatrophy and lipodystrophy. Facial wasting or a buffalo hump deformity may be pathognomonic for treated human immunodeficiency virus disease. In addition to facial wasting, cystic parotid degeneration may further distort the face. The authors outline the defects as a series of triangles defined by anatomical boundaries.
In a group of 27 patients, 17 were treated for buffalo hump (three isolated and 14 with associated facial wasting). Another 10 patients were treated for isolated facial wasting.
The 14 patients who underwent liposuction of the buffalo hump with subsequent injection of the aspirate into the face had approximately 40 to 50 percent of the grafts survive. Recurrent or severely fibrous humps were treated with ultrasound-assisted liposuction. In six patients, autografts to the lypoatrophic face were utilized. Two patients undergoing gynecomastia reduction had successful grafting with the resected breast. Three patients with cystic degeneration of the parotid underwent superficial parotidectomy with rotation or grafting of the parotid into the defect, for a total of six individual procedures.
The authors present an algorithm for treatment of buffalo hump and facial wasting deformities associated with human immunodeficiency virus lipodystrophy syndrome, with an emphasis on long-term results with autogenous tissue.
公认的人类免疫缺陷病毒病治疗标准——高效抗逆转录病毒疗法，可能会引起显著的副作用，如面部脂肪萎缩和脂肪代谢障碍。面部消瘦或水牛背畸形可能是接受治疗的人类免疫缺陷病毒病的特征性表现。除面部消瘦外，腮腺囊性变性可能会进一步使面部变形。作者将这些缺陷描述为由解剖边界界定的一系列三角形。
在一组27例患者中，17例接受了水牛背治疗（3例为孤立性，14例伴有面部消瘦）。另外10例患者接受了孤立性面部消瘦治疗。
14例接受水牛背吸脂并随后将吸出物注射到面部的患者，约40%至50%的移植物存活。复发性或严重纤维化的水牛背采用超声辅助吸脂治疗。6例患者对脂肪萎缩的面部进行了自体移植。2例接受男性乳房肥大缩小术的患者利用切除的乳房成功进行了移植。3例腮腺囊性变性患者接受了腮腺浅叶切除术，并将腮腺旋转或移植到缺损处，共进行了6例个体手术。
作者提出了一种治疗与人类免疫缺陷病毒脂肪代谢障碍综合征相关的水牛背和面部消瘦畸形的算法，重点是自体组织的长期效果。
