Warren Anne G, Borud Loren J
Harvard Medical School, Boston, MA, USA.
Aesthet Surg J. 2008 Mar-Apr;28(2):147-52. doi: 10.1016/j.asj.2007.12.003.
The development of effective antiretroviral therapy for the treatment of human immunodeficiency virus (HIV) has allowed for prolonged and healthier lives for affected patients. However, significant side effects from the drugs have been well documented, including syndromes of abnormal fat distribution. Cervicodorsal lipodystrophy, or "buffalo hump" deformity, is a common presentation of lipodystrophy syndrome and can cause significant disfigurement to the patient. Surgical correction has been the mainstay of treatment.
The authors report on the use of excisional lipectomy to correct cervicodorsal lipodystrophy.
Six male patients and one female patient (mean age, 47.2 years) underwent excisional lipectomy for buffalo hump deformity caused by HIV protease inhibitor use. Common complaints on presentation included disfigurement, neck pain, and difficulty sleeping. Deformity had first been observed an average of 4.75 years before presentation (range 2 to 7 years). At the time of consultation all patients were on antiretroviral regimens that included protease inhibitors.
Excisional lipectomy of the hypertrophied cervicodorsal fat pad was performed on all patients, with suction-assisted lipoplasty (SAL) additionally to optimally contour the nondystrophic fat at the periphery of the resection. One patient also underwent simultaneous abdominoplasty, another underwent rhytidectomy with autologous fat transfer, and one patient received malar autologous fat injections. The average operative time for all procedures was 2.7 hours (range 1.0 to 5.8 hours). Complications included seroma in three cases and wound dehiscence in one patient, none of which required reoperation. At an average of 26.6 months of follow-up, all patients report satisfaction with their results, and there have been no recurrences.
Cervicodorsal lipodystrophy is a well-described complication of extended use of HIV protease inhibitor therapy. Patients may seek consultation with plastic and reconstructive surgeons for correction of the aesthetic and functional morbidity associated with the deformity. Because of the fibrous nature of the hypertrophied cervicodorsal fat and the high rate of recurrence after SAL alone, an approach with excisional lipectomy (with or without SAL) may provide improved results and superior long-term outcomes.
用于治疗人类免疫缺陷病毒（HIV）的有效抗逆转录病毒疗法的发展，使受影响患者能够延长寿命并过上更健康的生活。然而，这些药物的显著副作用已有充分记录，包括异常脂肪分布综合征。颈背脂肪营养不良，即“水牛背”畸形，是脂肪营养不良综合征的常见表现，会给患者造成严重的容貌损毁。手术矫正一直是主要的治疗方法。
作者报告使用切除性脂肪切除术矫正颈背脂肪营养不良。
6名男性患者和1名女性患者（平均年龄47.2岁）因使用HIV蛋白酶抑制剂导致水牛背畸形而接受了切除性脂肪切除术。就诊时的常见主诉包括容貌损毁、颈部疼痛和睡眠困难。畸形首次被观察到的时间平均为就诊前4.75年（范围为2至7年）。在咨询时，所有患者都在接受包含蛋白酶抑制剂的抗逆转录病毒治疗方案。
对所有患者均进行了颈背肥厚脂肪垫的切除性脂肪切除术，并额外采用吸脂辅助脂肪抽吸术（SAL）以优化切除周边非营养不良性脂肪的轮廓。1例患者同时接受了腹部整形术，另1例接受了自体脂肪转移的除皱术，1例患者接受了颧骨自体脂肪注射。所有手术的平均手术时间为2.7小时（范围为1.0至5.8小时）。并发症包括3例血清肿和1例伤口裂开，均无需再次手术。平均随访26.6个月时，所有患者均对结果表示满意，且无复发情况。
颈背脂肪营养不良是长期使用HIV蛋白酶抑制剂疗法的一种已被充分描述的并发症。患者可能会寻求整形和重建外科医生的咨询，以矫正与该畸形相关的美学和功能问题。由于颈背肥厚脂肪的纤维性质以及单独使用SAL后较高的复发率，采用切除性脂肪切除术（有或无SAL）的方法可能会提供更好的效果和更优的长期预后。
