Komorowska-Timek Ewa, Turfe Zaahir, Davis Alan T
Grand Rapids and Detroit, Mich.
From Advanced Plastic Surgery; College of Human Medicine and the Department of Surgery, Michigan State University; Grand Rapids Medical Education Partners; and the Department of Otolaryngology, Henry Ford Health System.
Plast Reconstr Surg. 2017 Jan;139(1):1e-9e. doi: 10.1097/PRS.0000000000002916.
Fat grafting may be beneficial in prosthetic reconstruction of irradiated tissues, but there is a paucity of data on the complication rates associated with this clinical scenario.
All consecutive patients who had undergone fat grafting and prosthetic reconstruction from 2010 to 2013 were enrolled. Variables obtained related to fat grafting and history of irradiation. Implant-related complications in relation to irradiation status were also noted.
Eighty-five patients (age 49 ± 10 years) underwent 117 fat grafting procedures. The mean follow-up was 2.6 ± 0.7 years. Fat grafting was predominantly performed to correct soft-tissue deficiency [112 of 117 (95.7 percent)] or to alter skin after irradiation [five of 117 (4.3 percent)]. Thirty-two procedures (27.4 percent) were associated with a complication, with the most common being palpable fat necrosis (23.1 percent). Volume of transferred fat averaged 151.2 ± 76.6 ml per breast. Fat grafting complications did not depend on donor site, technique of fat processing, volume of transferred fat, number of procedures, or irradiation. Implant-related complications were observed after 26 of 117 overall procedures (22.2 percent). No association between implant-related complications and irradiation was observed (OR, 1.3; 95 percent CI, 0.4 to 4.1; p = 0.63). Overall complications following fat grafting in nonirradiated [37 of 82 (45.1 percent)] and irradiated [16 of 35 (45.7 percent)] breasts were not statistically different (OR, 1.02; 95 percent CI, 0.41 to 2.57; p = 0.96).
Similar outcomes of irradiated and nonirradiated prosthetic breast reconstruction can be achieved with additional fat grafting.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
脂肪移植可能有助于放疗后组织的假体再造，但关于这种临床情况相关并发症发生率的数据较少。
纳入2010年至2013年期间所有连续接受脂肪移植和假体再造的患者。获取与脂肪移植及放疗史相关的变量。还记录了与放疗状态相关的植入物相关并发症。
85例患者（年龄49±10岁）接受了117次脂肪移植手术。平均随访时间为2.6±0.7年。脂肪移植主要用于纠正软组织缺损[117例中的112例（95.7%）]或改善放疗后的皮肤状况[117例中的5例（4.3%）]。32例手术（27.4%）出现并发症，最常见的是可触及的脂肪坏死（23.1%）。每侧乳房转移脂肪的平均体积为151.2±76.6 ml。脂肪移植并发症不取决于供区、脂肪处理技术、转移脂肪体积、手术次数或放疗情况。117例手术中有26例（22.2%）观察到植入物相关并发症。未观察到植入物相关并发症与放疗之间存在关联（比值比，1.3；95%可信区间，0.4至4.1；P = 0.63）。未放疗乳房[82例中的37例（45.1%）]和放疗乳房[35例中的16例（45.7%）]脂肪移植后的总体并发症无统计学差异（比值比，1.02；95%可信区间，0.41至2.57；P = 0.96）。
额外进行脂肪移植可使放疗和未放疗的假体乳房再造取得相似的效果。
临床问题/证据水平：治疗性，Ⅲ级
