Gassman Andrew A, Lewis Michael S, Lee Justine C
Dallas, Texas; and Los Angeles, Calif.
From the Department of Plastic Surgery, University of Texas Southwestern Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, Los Angeles David Geffen School of Medicine; and the Department of Pathology, Greater Los Angeles VA Healthcare System.
Plast Reconstr Surg. 2016 Jul;138(1):55e-63e. doi: 10.1097/PRS.0000000000002295.
Local ischemia before the development of recipient circulation may contribute to the highly variable long-term results of fat grafting. Remote ischemic preconditioning before adipose procurement augments the retention of fat grafts and limits subsequent liposclerosis. However, there is no literature examining what role remote ischemic preconditioning has on the fat graft recipient site.
Subcutaneous adipose tissue from transgenic mice expressing green fluorescent protein/luciferase was injected into skin folds of wild-type mice. Donors and recipients experienced intermittent temporary hindlimb tourniquet application before harvest and transfer, respectively. The viability of the transferred tissue was examined over 28 days by luciferin bioluminescence and subsequent histologic analysis.
There was a difference in bioluminescence at days 0, 14, and 28. The remote ischemic preconditioning donor or recipient mouse-alone groups demonstrated an approximately 2- to 3-fold increase in bioluminescence. Donor and recipient remote ischemic preconditioning had a 9-fold increase in bioluminescence. Histologic analysis at 28 days confirmed the presence of donor adipocytes, and they were gradually replaced by recipient inflammation and scar tissue. However, the amount of interstitial fibrosis was substantially less in the remote ischemic preconditioning groups. These findings were more pronounced when remote ischemic preconditioning was used for both donor and recipient mice.
Remote ischemic preconditioning has the ability to increase the viability of donor adipocytes and limit interstitial fibrosis. More specifically, remote ischemic preconditioning treatment of both donated adipose tissue and recipient wound beds demonstrates the greatest overall adipose cellular viability and native architecture.
在受者循环建立之前的局部缺血可能导致脂肪移植长期效果的高度变异性。在获取脂肪前进行远程缺血预处理可增加脂肪移植的保留率并限制随后的脂肪硬化。然而，尚无文献研究远程缺血预处理对脂肪移植受者部位有何作用。
将表达绿色荧光蛋白/荧光素酶的转基因小鼠的皮下脂肪组织注射到野生型小鼠的皮肤褶皱中。供体和受体分别在收获和移植前经历间歇性临时后肢止血带应用。通过荧光素生物发光和随后的组织学分析在28天内检查移植组织的活力。
在第0、14和28天生物发光存在差异。单独进行远程缺血预处理的供体或受体小鼠组生物发光增加约2至3倍。供体和受体远程缺血预处理使生物发光增加9倍。28天时的组织学分析证实存在供体脂肪细胞，并且它们逐渐被受体炎症和瘢痕组织取代。然而，远程缺血预处理组的间质纤维化量明显较少。当供体和受体小鼠均使用远程缺血预处理时，这些发现更为明显。
远程缺血预处理有能力增加供体脂肪细胞的活力并限制间质纤维化。更具体地说，对捐赠的脂肪组织和受体伤口床均进行远程缺血预处理显示出总体上最大的脂肪细胞活力和天然结构。
