Byrne Miriam, O'Donnell Michelle, Fitzgerald Lisa, Shelley Odhran P
National Burns Centre & Department of Plastic, Reconstructive and Hand Surgery, Ireland.
Department of Occupational Therapy, St. James's Hospital, Dublin 8, Ireland.
Burns. 2016 Mar;42(2):356-65. doi: 10.1016/j.burns.2015.06.017. Epub 2015 Dec 29.
INTRODUCTION: Fat transfer is increasingly used as part of our reconstructive armamentarium to address the challenges encountered in secondary burn reconstruction. The aim of this study was to review our experience with autologous fat transfer in relation to hand function, scarring and cosmesis, in patients undergoing secondary reconstruction after burns. METHOD: Retrospective analysis of burn patients (2010-2013) who underwent autologous fat transfer to improve scarring, contour deformity and/or scar contracture was performed. Hand function was assessed using grip strength measurement, Total Active Movement (TAM), the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire and Michigan Hand Outcome Questionnaire (MHQ). Patients' satisfaction was assessed using the Patient Observer Scar Assessment Scale (POSAS). RESULTS: Thirteen patients were included in this analysis. The average time from burns and from fat transfer were 2.3 years (10 months-3.9 years) and 9.1 months (3 months-1.3 years), respectively. There was a statistically significant improvement in TAM measurement. The total score, activity of daily living score and satisfaction score of the MHQ also statistically increased following fat transfer. The changes in function score, work score and pain score of the MHQ were not significant. Grip strength measurement and DASH score did not show improvement. For scar assessment, total score and overall score of POSAS improved significantly. Similarly, scores for scar colour, scar thickness, scar stiffness and scar regularity increased significantly. DISCUSSION: Autologous fat transfer directly replaces volume loss in the subcutaneous layer, physically releases tethered skin from underlying tissues and exerts downstream regenerative effects. Skin quality improvements combined with replacement of the subcutaneous adipose volume in the hand reduces overall scar tightness and tissue tethering and has the potential to enhance hand therapy. In our series, modest improvement in range of movement, scar quality and hand outcome scores were demonstrated following a single session of fat transfer.
引言：脂肪移植越来越多地被用作我们重建手段的一部分，以应对二期烧伤重建中遇到的挑战。本研究的目的是回顾我们在烧伤后二期重建患者中进行自体脂肪移植与手部功能、瘢痕形成和美容效果相关的经验。 方法：对2010年至2013年接受自体脂肪移植以改善瘢痕形成、轮廓畸形和/或瘢痕挛缩的烧伤患者进行回顾性分析。使用握力测量、总主动活动度（TAM）、手臂、肩部和手部功能障碍（DASH）问卷以及密歇根手部结果问卷（MHQ）评估手部功能。使用患者观察者瘢痕评估量表（POSAS）评估患者满意度。 结果：本分析纳入了13名患者。烧伤后和脂肪移植后的平均时间分别为2.3年（10个月至3.9年）和9.1个月（3个月至1.3年）。TAM测量有统计学意义的改善。脂肪移植后，MHQ的总分、日常生活活动得分和满意度得分也有统计学意义的增加。MHQ的功能得分、工作得分和疼痛得分变化不显著。握力测量和DASH评分没有改善。对于瘢痕评估，POSAS的总分和总体得分显著改善。同样，瘢痕颜色、瘢痕厚度、瘢痕硬度和瘢痕平整度的得分显著增加。 讨论：自体脂肪移植直接替代皮下层的体积损失，从深层组织物理性地松解束缚的皮肤，并产生下游再生效应。皮肤质量的改善与手部皮下脂肪体积的替代相结合，可降低整体瘢痕紧绷度和组织束缚，并有可能增强手部治疗效果。在我们的系列研究中，单次脂肪移植后，活动范围、瘢痕质量和手部结果评分有适度改善。
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