Yang Xiaonan, Wu Rongwei, Bi Hui, Lu Haibin, Jia Zhenhua, Jin Xiaolei, Qi Zuoliang
From the *Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical Collage, Beijing; and †Department of Nephrology, Tianjin Union Medicine Center, Tianjin, PR China.
Ann Plast Surg. 2016 Sep;77(3):308-13. doi: 10.1097/SAP.0000000000000641.
Autologous fat grafting (AFG) has been widely used to treat progressive hemifacial atrophy (PHA). However, objective and quantitative analyses in patients with PHA are complicated because of multidimensional atrophy and fat absorption. This study aimed to introduce a new method to predict volumetric deficiency of soft tissues and objectively evaluate the survival of grafted fat with 3-dimensional (3D) and mirror-image analysis (MIA).
Thirty-one patients with PHA were classified into 2 groups based on the location of the facial midsagittal plane (FMP), which was established through our proposed method using nasion (point a), anterior nasal spine (point b), and pogonion (point c). The included cases with centered FMP were treated using serial AFG and followed up for 12 to 15 months. Images were obtained preoperatively (pre-OP) and postoperatively at 2 time points (3 months and 12 months). Three-dimensional computed tomography (CT) was performed before the first surgery to locate the FMP and predict the volumetric deficiency of soft tissues with MIA. Three months after the first surgery, 3D laser scanning was conducted to evaluate the volume of surviving fat. Patient characteristics, satisfaction, and soft tissue augmentation results were analyzed.
Twenty-seven cases (9 men and 18 women) with PHA were included and treated using serial AFG (mean number of operation, 3.1 times). The mean age was 22.1 years. With 3D CT or 3D laser-scanning camera and MIA, we obtained the mean deficient volume of the affected area (30.48 mm) and the mean volume of the total fat injection (133.61 mm). The mean fat absorption ratio was 47.92%. The mean satisfaction score immediately obtained at first postoperative (score = 4.3) was higher than that at 3 months postoperatively (score = 4.1) and 12 months postoperatively (score = 4.0). No complications and donor-site morbidity were noted.
The facial symmetry of patients with centered FMP can be successfully restored using serial AFG alone. The combined 3D and MIA can be used to predict the volumetric deficiency of soft tissues and objectively evaluate the survival of grafted fat.
自体脂肪移植（AFG）已被广泛用于治疗进行性半侧颜面萎缩（PHA）。然而，由于存在多维度萎缩和脂肪吸收，对PHA患者进行客观和定量分析较为复杂。本研究旨在引入一种新方法，通过三维（3D）和镜像分析（MIA）来预测软组织的体积缺损，并客观评估移植脂肪的存活率。
31例PHA患者根据面部正中矢状平面（FMP）的位置分为2组，该平面通过我们提出的使用鼻根点（a点）、前鼻棘（b点）和颏前点（c点）的方法来确定。FMP居中的纳入病例采用系列AFG治疗，并随访12至15个月。在术前（术前）以及术后2个时间点（3个月和12个月）获取图像。在首次手术前进行三维计算机断层扫描（CT）以定位FMP，并通过MIA预测软组织的体积缺损。首次手术后3个月，进行3D激光扫描以评估存活脂肪的体积。分析患者特征、满意度和软组织增大效果。
纳入27例PHA患者（9例男性和18例女性）并采用系列AFG治疗（平均手术次数为3.1次）。平均年龄为22.1岁。通过3D CT或3D激光扫描相机以及MIA，我们获得了患侧平均缺损体积（30.48立方毫米）和总脂肪注射平均体积（133.61立方毫米）。平均脂肪吸收率为47.92%。术后即刻获得的平均满意度评分（评分 = 4.3）高于术后3个月（评分 = 4.1）和术后12个月（评分 = 4.0）。未观察到并发症和供区并发症。
仅使用系列AFG即可成功恢复FMP居中患者的面部对称性。联合使用3D和MIA可用于预测软组织的体积缺损，并客观评估移植脂肪的存活率。
