Phulpin Bérengère, Gangloff Pierre, Tran Nguyen, Bravetti Pierre, Merlin Jean-Louis, Dolivet Gilles
Vandoeuvre les Nancy and Nancy, France From the Head and Neck Surgery Unit, Oncologic Surgery Department, and the Tumor Biology Unit, Centre Alexis Vautrin, the Oral Surgery Department, Odontological Faculty, and the Laboratory of Surgery School-INSERM U684, Faculty of Medicine, UHP-Nancy.
Plast Reconstr Surg. 2009 Apr;123(4):1187-1197. doi: 10.1097/PRS.0b013e31819f2928.
Treatment of head and neck cancers allows good carcinologic results but induces aesthetic and functional sequelae. Autologous fat transplants have been used to correct aesthetic defects since the past century and exhibit many of the qualities of the ideal filler. Results reported here stem from experiences from 2000, with abdominal fat grafting in 11 patients who were referred to the authors' center for aesthetic subcutaneous or submucous head and neck reconstruction after radiotherapy.
Abdominal fat tissues were harvested, and injection into host sites was performed in a manner similar to that of the lipostructure technique described by Coleman. The postoperative follow-up periods ranged from 2 to 88 months (mean, 39.9 months). Clinical monitoring of the patients was carried out. Additional pathologic study was performed on irradiated tissues surrounding the scar and on abdominal fat and treated tissues.
No surgical procedure complications occurred. For all cases, except for one patient, the rehabilitation was aesthetic and functional. The quality of life of the patients was improved. The pathologic data highlighted a decrease in irradiated morphologic patterns characterized by an absence of necrotic areas and a high vascular network density associated with a normal histologic structure.
Fat tissues can be successfully transplanted into irradiated areas, inducing both aesthetic and functional improvement. The cellular and/or tissular mechanisms underlying these changes need further investigation.
头颈部癌症的治疗能取得良好的肿瘤学效果，但会引发美学和功能方面的后遗症。自上世纪以来，自体脂肪移植就被用于纠正美学缺陷，并且具备理想填充物的诸多特性。此处报告的结果源于2000年的经验，对11例患者进行腹部脂肪移植，这些患者因放疗后美学性皮下或黏膜下头颈部重建被转诊至作者所在中心。
采集腹部脂肪组织，并以类似于科尔曼描述的脂肪移植技术的方式将其注射到宿主部位。术后随访期为2至88个月（平均39.9个月）。对患者进行临床监测。对瘢痕周围的受照射组织、腹部脂肪及治疗后的组织进行额外的病理研究。
未发生手术并发症。除1例患者外，所有病例的修复在美学和功能方面均良好。患者的生活质量得到改善。病理数据显示，受照射形态模式有所减少，其特征为无坏死区域，血管网络密度高且组织结构正常。
脂肪组织可成功移植到受照射区域，实现美学和功能的改善。这些变化背后的细胞和/或组织机制有待进一步研究。
