Bennett Katelyn G, Thurston Todd E, Vercler Christian J, Kasten Steven J, Buchman Steven R
Ann Arbor, Mich.
From the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System.
Plast Reconstr Surg. 2017 Aug;140(2):362-368. doi: 10.1097/PRS.0000000000003521.
Buccal fat is often used as a pedicled flap in cleft palate repairs to minimize scarring and fortify tenuous closures. Although many surgeons have adopted this technique, others have remained circumspect because of the concern for subsequent facial asymmetry.
Patients who underwent cleft palate repair using buccal fat pad flaps for closure between 2007 and 2015 were reviewed. Only patients with unilateral buccal fat pad flaps and three-dimensional photography were included. Volumetric analysis was performed on each patient to measure cheek volumes of both the flap and nonflap sides. A subgroup analysis on cleft palate and bilateral cleft lip and palate patients was performed to eliminate the confounding asymmetries of unilateral cleft lip and palate patients. Paired t tests were used to determine differences in cheek volumes. In addition, three reviewers examined photographs of patients and were asked to determine the side of fat pad harvest.
Twenty-four patients met inclusion criteria. Mean follow-up was 55 months. The volume difference between the flap and nonflap sides was not significant (p = 0.81). Subgroup analysis on cleft palate and bilateral cleft lip and palate patients did not reveal a volume difference between the flap and nonflap sides (p = 0.98). When asked to determine which side buccal fat pads were harvested from based on patient photographs, the average percentage correct for three independent reviewers was 57 percent and the Cohen's kappa was -0.084, indicating poor agreement.
Although the buccal fat pad is thought to play a role in facial aesthetics, the authors found no difference in volume between harvest and nonharvest sides, nor was there a clinically detectable difference.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
在腭裂修复术中，颊脂常被用作带蒂皮瓣，以尽量减少瘢痕形成并加强薄弱的创口闭合。尽管许多外科医生已采用此技术，但由于担心术后面部不对称，其他医生仍持谨慎态度。
回顾2007年至2015年间使用颊脂垫瓣进行腭裂修复术闭合创口的患者。仅纳入使用单侧颊脂垫瓣且有三维摄影资料的患者。对每位患者进行体积分析，以测量皮瓣侧和非皮瓣侧的面颊体积。对腭裂及双侧唇腭裂患者进行亚组分析，以消除单侧唇腭裂患者的混杂不对称因素。采用配对t检验确定面颊体积的差异。此外，三名评估者查看患者照片，并被要求确定取脂垫的一侧。
24例患者符合纳入标准。平均随访55个月。皮瓣侧和非皮瓣侧的体积差异不显著（p = 0.81）。对腭裂及双侧唇腭裂患者的亚组分析未显示皮瓣侧和非皮瓣侧的体积差异（p = 0.98）。当被要求根据患者照片确定从哪一侧获取颊脂垫时，三名独立评估者的平均正确百分比为57%，Cohen's kappa值为 -0.084，表明一致性较差。
尽管颊脂垫被认为对面部美学有作用，但作者发现取脂侧和未取脂侧在体积上没有差异，临床上也未检测到差异。
临床问题/证据级别：治疗性，IV级。
