Bucky Louis P, Percec Ivona
Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA, USA.
Aesthet Surg J. 2008 May-Jun;28(3):313-21; quiz 322-4. doi: 10.1016/j.asj.2008.02.004.
The reader is presumed to have a broad understanding of plastic surgical procedures and concepts. After studying this article, the participant should be able to: 1. Describe the current clinical applications and limitations of autologous fat grafting. 2. Identify the important physiological steps and molecular pathways of neoadipogenesis. 3. Cite current in vitro and in vivo models for the analysis of fat grafting techniques. Physicians may earn 1 AMA PRA Category 1 credit by successfully completing the examination based on material covered in this article. The examination begins on page 322. ASAPS members can also complete this CME examination online by logging on to the ASAPS Members-Only website (http://www.surgery.org/members) and clicking on "Clinical Education" in the menu bar. Autologous fat transplantation has become a well established and frequently applied method of soft tissue augmentation for both cosmetic and reconstructive indications. There is no consensus, however, about the best fat grafting technique, nor is there reproducible data regarding its durability. The most significant drawback to autologous fat grafting remains its largely unpredictable rate of resorption. A thorough understanding of the developmental biology and molecular regulation of adipogenesis and adipocyte survival is critical to optimizing the fat grafting technique. Consequently, numerous in vitro and in vivo studies on fat graft viability have recently been undertaken. Here, we discuss the latest advances in the basic science of adipogenesis, adipocyte viability, and its clinical application to fat grafting, arguing that the data produced by in vitro and in vivo studies still fail to produce a clear picture of the required components for successful, consistent, and durable fat transplantation; however, it is undetermined if this lack of clarity may simply be a lack of systematic scientific data acquisition or if these findings truly reflect the biology of neoadipogenesis. As a first step in strengthening autologous fat grafting scientific data collection, we recommend that a collective, multidisciplinary, multicenter effort be undertaken to establish in vitro and in vivo models of neoadipogenesis that are clearly reproducible from one investigator to another. With the implementation of systematic scientific approaches to the study of neoadipogenesis, we anticipate the future of autologous fat transplantation for correction of soft tissue volume loss to be extremely promising.
假定读者对整形手术程序和概念有广泛的了解。在研读本文后，参与者应能够：1. 描述自体脂肪移植的当前临床应用及局限性。2. 识别新脂肪形成的重要生理步骤和分子途径。3. 列举用于分析脂肪移植技术的当前体外和体内模型。医生通过基于本文涵盖内容成功完成考试可获得1个美国医学协会（AMA）普拉（PRA）1类学分。考试从第322页开始。美国整形外科学会（ASAPS）会员也可通过登录ASAPS会员专属网站（http://www.surgery.org/members）并点击菜单栏中的“临床教育”在线完成此继续医学教育考试。自体脂肪移植已成为一种成熟且频繁应用于美容和重建适应症的软组织填充方法。然而，对于最佳脂肪移植技术尚无共识，关于其持久性也没有可重复的数据。自体脂肪移植最显著的缺点仍然是其吸收率在很大程度上不可预测。深入了解脂肪生成和脂肪细胞存活的发育生物学及分子调控对于优化脂肪移植技术至关重要。因此，最近开展了许多关于脂肪移植存活率的体外和体内研究。在此，我们讨论脂肪生成、脂肪细胞存活的基础科学及其在脂肪移植临床应用方面的最新进展，认为体外和体内研究产生的数据仍未能清晰呈现成功、一致且持久的脂肪移植所需的组成部分；然而，尚不确定这种不清晰是仅仅由于缺乏系统的科学数据收集，还是这些发现真正反映了新脂肪形成的生物学特性。作为加强自体脂肪移植科学数据收集的第一步，我们建议开展一项集体、多学科、多中心的工作，以建立从一个研究者到另一个研究者都能清晰重复的新脂肪形成的体外和体内模型。随着对新脂肪形成研究采用系统的科学方法，我们预计自体脂肪移植用于纠正软组织体积损失的未来前景极为广阔。
