Trojahn Kølle Stig-Frederik, Oliveri Roberto S, Glovinski Peter Viktor, Elberg Jens Jørgen, Fischer-Nielsen Anne, Drzewiecki Krzysztof Tadeusz
Department of Plastic Surgery, Breast Surgery & Burns, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, Copenhagen, Denmark.
J Plast Surg Hand Surg. 2012 Apr;46(2):59-68. doi: 10.3109/2000656X.2012.668326.
Autologous fat grafting (lipofilling) enables repair and augmentation of soft tissues and is increasingly used both in aesthetic and reconstructive surgery. Autologous fat has several advantages, including biocompatibility, versatility, natural appearance, and low donor site morbidity. The main limitation is unpredictable graft resorption, which ranges from 25%-80%, probably as a result of ischaemia and lack of neoangiogenesis. To obviate these disadvantages, several studies have searched for new ways of increasing the viability of the transplanted tissue. One promising approach has been to enrich the fat graft with adipose tissue-derived mesenchymal stem cells (ASC) before transplantation. We have reviewed original studies published on fat transplantation enriched with ASC. We found four murine and three human studies that investigated the subject after a sensitive search of publications. In the human studies, so-called cell assisted lipotransfer (CAL) increased the ASC concentration 2-5 times compared with non-manipulated fat grafts, which caused a questionable improvement in survival of fat grafts, compared with that of traditional lipofilling. In contrast, in two of the murine studies ASC-concentrations were increased 1250 and 6250 times, respectively, by ASC ex vivo expansion, which resulted in considerably improved fat transplant survival as well as quality. This effect of high-level enrichment with ASC is thought to have been caused by paracrine signalling, cellular differentiation, or both. The surgical and tissue handling techniques used in lipofilling are well proved, but the added effect of high-level enrichment with ex vivo expanded ASC still needs to be investigated properly in human lipofilling studies, combined with a thorough follow up and matched control groups. In conclusion, ASC-enriched lipofilling theoretically has the potential for transforming lipofilling from a relatively unpredictable intervention into one in which the resorption rate, quality of tissue, and safety can be predicted, and possibly superior to prosthetic implantation.
自体脂肪移植（脂肪填充）可实现软组织的修复和增大，在美容手术和重建手术中应用越来越广泛。自体脂肪具有多种优势，包括生物相容性、多功能性、自然外观以及供区发病率低。主要局限性是移植脂肪吸收不可预测，吸收率在25%至80%之间，这可能是由于缺血和缺乏新生血管形成所致。为避免这些缺点，多项研究探寻了提高移植组织存活率的新方法。一种有前景的方法是在移植前用脂肪组织来源的间充质干细胞（ASC）富集脂肪移植物。我们回顾了关于用ASC富集脂肪移植的原始研究。经过对出版物的全面检索，我们找到了四项小鼠研究和三项人体研究。在人体研究中，与未处理的脂肪移植物相比，所谓的细胞辅助脂肪移植（CAL）使ASC浓度提高了2至5倍，与传统脂肪填充相比，这对脂肪移植物存活率的改善存疑。相比之下，在两项小鼠研究中，通过ASC体外扩增分别使ASC浓度提高了1250倍和6250倍，这显著提高了脂肪移植的存活率和质量。ASC高水平富集的这种效果被认为是由旁分泌信号传导、细胞分化或两者共同作用引起的。脂肪填充中使用的手术和组织处理技术已得到充分验证，但在人体脂肪填充研究中，结合全面的随访和匹配的对照组，对体外扩增的ASC高水平富集的附加效果仍需进行适当研究。总之，富含ASC的脂肪填充理论上有可能将脂肪填充从一种相对不可预测的干预转变为一种可以预测吸收速率、组织质量和安全性的干预，甚至可能优于假体植入。
