Rao Ajit, Saadeh Pierre B
New York, N.Y. From Icahn School of Medicine at Mount Sinai; and the Department of Plastic Surgery, New York University Langone Medical Center and School of Medicine.
Plast Reconstr Surg. 2014 Dec;134(6):1202-1212. doi: 10.1097/PRS.0000000000000700.
Fat necrosis is a well-known complication of free tissue transfer and fat grafting that is becoming increasingly reported in the literature. However, there is no clear consensus on how fat necrosis is defined and classified in the plastic surgery literature.
A systematic review of the literature was performed using the PubMed database of the National Library of Medicine and National Institutes of Health and Google Scholar from January 1, 2003, to November 1, 2013. The keywords used in the search included "fat necrosis" and "plastic surgery."
Sixty-nine articles were chosen that met the authors' criteria and were included in this review. There was wide variation on the size requirements and postoperative timing when defining fat necrosis. In addition, the workup sought after clinical examination to confirm a diagnosis of fat necrosis varied, including radiographic studies, histopathologic examination, or a series of studies.
Based on the articles reviewed in this article, a more uniform definition needs to exist that is clearly defined in all articles that report on fat necrosis. The authors suggest defining fat necrosis as a palpable, discrete, and persistent subcutaneous firmness found postoperatively that measures at least 1 cm during physical examination. Fat necrosis can be identified and confirmed by imaging and histopathology or through intraoperative findings. The authors provide a classification system for fat necrosis that can be used by clinicians to describe fat necrosis into varying grades of severity to ultimately help guide clinical decision-making.
脂肪坏死是游离组织移植和脂肪移植的一种常见并发症，在文献中的报道越来越多。然而，在整形外科学术文献中，对于脂肪坏死如何定义和分类尚无明确共识。
使用美国国立医学图书馆和国立卫生研究院的PubMed数据库以及谷歌学术，对2003年1月1日至2013年11月1日期间的文献进行系统综述。搜索使用的关键词包括“脂肪坏死”和“整形手术”。
选择了69篇符合作者标准的文章纳入本综述。在定义脂肪坏死时，对大小要求和术后时间的界定存在很大差异。此外，用于通过临床检查确诊脂肪坏死的检查方法也各不相同，包括影像学检查、组织病理学检查或一系列检查。
基于本文所综述的文章，需要存在一个在所有报道脂肪坏死的文章中都明确界定的更统一的定义。作者建议将脂肪坏死定义为术后可触及的、离散的、持续存在的皮下硬结，体格检查时至少为1厘米。脂肪坏死可通过影像学和组织病理学或术中发现来识别和确诊。作者提供了一个脂肪坏死的分类系统，临床医生可用来将脂肪坏死描述为不同严重程度等级，以最终帮助指导临床决策。
