Department of Neurosurgery and Oncology, the Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
World Neurosurg. 2011 May-Jun;75(5-6):696-9. doi: 10.1016/j.wneu.2010.11.014.
A review of Harvey Cushing's surgical cases at Johns Hopkins Hospital revealed new information about his early work with the use of fat grafts to close dural defects.
The Johns Hopkins Hospital surgical records from 1896 to 1912 were reviewed. A single case in which Cushing used an autologous fat graft to repair a dural defect in 1912 after a traumatic brain injury was selected for further study.
An 18-year-old white female patient presented with recurring seizures in her sleep approximately 12 years after a traumatic brain injury. A depressed skull fracture as a result of this injury was explored by Cushing, and a dural defect was found. Fat was harvested from the thigh of the patient and was sutured in layers to cover the defect. Cushing noted that this was the first of its kind of operation and "probably of very little use." The patient was discharged within 2 weeks after the operation despite recurrence of her seizure episodes.
Despite its questionable functional success, we report herein a previously unpublished operative case by Harvey Cushing's in which an autologous fat graft was used to close a traumatic wound resulting in a dural defect. This report predates currently known published reports of the use of fat to seal dural defects. Cushing recognized that a factor found in fat tissue may aid in wound healing. Contemporary studies indicate the presence of mesenchymal stem cells in fat tissue may be responsible for the accelerated healing and reduced incidence of cerebral spinal fluid leaks after cranial surgery.
对哈维·库欣（Harvey Cushing）在约翰·霍普金斯医院（Johns Hopkins Hospital）的手术病例进行回顾，揭示了他在早期使用脂肪移植物封闭硬脑膜缺损方面的新信息。
回顾了 1896 年至 1912 年约翰·霍普金斯医院的手术记录。选择了库欣在 1912 年因颅脑外伤后使用自体脂肪移植物修复硬脑膜缺损的单个病例进行进一步研究。
一名 18 岁白人女性患者在颅脑外伤后约 12 年出现睡眠中反复发作的癫痫。库欣对其颅骨凹陷性骨折进行了探查，发现了硬脑膜缺损。从患者大腿采集脂肪，并分层缝合以覆盖缺损。库欣指出，这是首例此类手术，“可能用处不大”。尽管患者癫痫发作再次发作，但在手术后 2 周内出院。
尽管其功能效果存在疑问，但我们在此报告哈维·库欣（Harvey Cushing）以前未发表的手术病例，其中使用自体脂肪移植物封闭外伤性伤口导致的硬脑膜缺损。这一报告早于目前已知的脂肪用于封闭硬脑膜缺损的发表报告。库欣认识到脂肪组织中存在的某种因子可能有助于伤口愈合。当代研究表明，脂肪组织中存在间充质干细胞，这可能是颅后手术愈合加速和降低脑脊液漏发生率的原因。
