Nelissen Xavier, Lhoest Florence, Preud'Homme Laurence
Clinique Mont Saint-Martin, Mont Saint-Martin, Liège, Belgium.
Plast Reconstr Surg Glob Open. 2015 Sep 25;3(9):e526. doi: 10.1097/GOX.0000000000000495. eCollection 2015 Sep.
The deep inferior epigastric perforator (DIEP) flap technique gives good clinical results, but aesthetic surgical adjustments are often necessary. Lipofilling represents a good complementary method, but fat resorption within the few months after surgery limits its use. Recently, a new protocol was introduced and successfully evaluated on murine models. This study aims to evaluate this protocol following a DIEP procedure by three-dimensional analysis.
Within a period of 4 months, every patient having undergone breast reconstruction with DIEP and who required a lipofilling adjustment was invited to take part in this study. All surgeries were performed using the Adip'sculpt disposable medical device MACROFILL (Laboratoires SEBBIN, Boissy-l'Aillerie, France). Fat resorption was analyzed using a three-dimensional photography system.
Twenty-three patients were included, with a total of 25 breasts operated on. Injections were carried out on irradiated breasts in 73% of cases, and average injection volume was 124 mL (SD = 39 mL), whereas average operating time was 68 minutes (44-96 minutes). At an average follow-up of 5 months (4-8 months), 70.9% of projection gain afforded by the lipofilling was still present.
It is now clear that particular rules should be respected for an efficient lipofilling, particularly regarding aspiration cannula characteristics, vacuum used, and the necessity of washes and soft centrifugations. We demonstrate here that by following a specific protocol that addresses these precautions, while using material that is specifically adapted, a 70.9% fat survival rate can be achieved, even in the very unfavorable case of postirradiation DIEP breast reconstruction.
腹壁下深动脉穿支（DIEP）皮瓣技术临床效果良好，但通常需要进行美学手术调整。脂肪填充是一种很好的补充方法，但术后几个月内的脂肪吸收限制了其应用。最近，一种新方案被引入并在小鼠模型上成功评估。本研究旨在通过三维分析评估DIEP手术后的该方案。
在4个月的时间内，邀请每一位接受过DIEP乳房重建且需要进行脂肪填充调整的患者参与本研究。所有手术均使用Adip'sculpt一次性医疗设备MACROFILL（法国布瓦西 - 拉伊勒里的SEBBIN实验室）进行。使用三维摄影系统分析脂肪吸收情况。
纳入23例患者，共对25个乳房进行了手术。73%的病例在接受过放疗的乳房上进行了注射，平均注射量为124 mL（标准差 = 39 mL），而平均手术时间为68分钟（44 - 96分钟）。平均随访5个月（4 - 8个月）时，脂肪填充带来的隆起增加量仍有70.9%存在。
现在很清楚，为了实现有效的脂肪填充，应遵循特定规则，特别是关于抽吸套管的特性、使用的真空度以及冲洗和轻柔离心的必要性。我们在此证明，通过遵循解决这些预防措施的特定方案，同时使用专门适配的材料，即使在放疗后DIEP乳房重建这种非常不利的情况下，也能实现70.9%的脂肪存活率。
