Denadai Rafael, Raposo-Amaral Cesar Augusto, Pinho Andre Silveira, Lameiro Thais Miguel, Buzzo Celso Luiz, Raposo-Amaral Cassio Eduardo
Campinas, São Paulo, Brazil.
From the Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital.
Plast Reconstr Surg. 2017 Jul;140(1):50e-61e. doi: 10.1097/PRS.0000000000003440.
Autologous free fat graft outcomes are not always predictable, and variables that can potentially influence fat graft retention are still not well understood or investigated. The purposes of this study were to assess fat graft retention in the management of craniofacial contour deformities and to identify possible predictive factors of this retention.
A prospective analysis was conducted using consecutive patients with unilateral craniofacial contour deformities who underwent autologous free fat grafting between 2012 and 2015. Standardized ultrasonographic craniofacial soft-tissue thickness measurements were adopted to determine the fat graft retention. Bivariate and multivariate analyses were performed to identify independent predictors of 12-month postoperative fat graft retention.
One hundred forty-two patients were enrolled. There was significant (all p < 0.05) and progressive reduction in fat graft retention within the first 3 postoperative months, and the retained fat graft was maintained (all p > 0.05) from 3 to 12 months postoperatively, with a 12-month fat graft retention rate of 67.7 percent. Age, Parry-Romberg syndrome, previous craniofacial bone surgery, grafted volume, and forehead unit were independently negative (all p < 0.05) predictors of fat graft retention, whereas cheek unit was an independently positive (all p < 0.05) predictor of retention.
Craniofacial fat graft retention is achievable but remains somewhat unpredictable, with age, Parry-Romberg syndrome, previous bone surgical intervention, grafted volume, and recipient sites affecting retention.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
自体游离脂肪移植的效果并非总是可预测的，而可能影响脂肪移植留存的变量仍未得到充分理解或研究。本研究的目的是评估脂肪移植在颅面轮廓畸形治疗中的留存情况，并确定这种留存的可能预测因素。
对2012年至2015年间连续接受自体游离脂肪移植的单侧颅面轮廓畸形患者进行前瞻性分析。采用标准化超声测量颅面软组织厚度来确定脂肪移植的留存情况。进行双变量和多变量分析以确定术后12个月脂肪移植留存的独立预测因素。
共纳入142例患者。术后前3个月脂肪移植留存率显著（所有p<0.05）且逐渐降低，术后3至12个月留存的脂肪移植保持稳定（所有p>0.05），12个月时脂肪移植留存率为67.7%。年龄、帕里-罗姆伯格综合征、既往颅面骨手术、移植体积和额部区域是脂肪移植留存的独立负性预测因素（所有p<0.05），而颊部区域是留存的独立正性预测因素（所有p<0.05）。
颅面脂肪移植留存是可行的，但仍有些不可预测，年龄、帕里-罗姆伯格综合征、既往骨手术干预、移植体积和受区部位会影响留存。
临床问题/证据级别：风险，III级。
