Benmoussa Nadia, Hansen Kevin, Charlier Philippe
From the *Section of Medical and Forensic Anthropology (UVSQ/EA 4569 Paris Descartes University), UFR of Health Sciences, Montigny-Le-Bretonneux; †Department of Otolaryngology, Head and Neck Surgery, University of Rouen, Medical Faculty, Rouen, France; ‡Department of Otolaryngology, Head and Neck Surgery, University of Cologne, Medical Faculty, Cologne, Germany; and §CASH & IPES, Nanterre, France.
Ann Plast Surg. 2017 Nov;79(5):420-422. doi: 10.1097/SAP.0000000000001221.
During the Great War of 1914 to 1918, spectacular progress was made in the field of facial reconstruction. The sheer number and severity of facial lesions inflicted during the fighting obliged French and German surgeons to take a close interest in the treatment of patients wounded in such a manner. As head surgeon of the fifth division "blessés de la face" at the hospital of Val-de-Grace, Hippolyte Morestin was responsible for one of the largest surgical departments specializing in facial surgery and reconstruction during the war. During his time of service, he developed various surgical techniques such as autoplasties using cartilaginous and adipose grafts to reconstruct tissue defects. This study focuses primarily on the adipose graft techniques and their aesthetic outcome used by Morestin during and in the aftermath of World War I.
This is a historical descriptive study. Our research is based on documents available at the museum and archives of the Val-de-Grace Army Health Service (hospital activity reports, pre- and postoperative patient photographs, newspaper clippings, documented accounts of ward nurses, wax anatomy models). Thirty-four clinical cases published by Hippolyte Morestin dealing with facial reconstruction during the World War I were studied.
Fat was mainly used to fill craniofacial substance losses after carrying out often complex reconstructions. The surgical technique is well documented and subdivided into 3 succeeding procedures. Most of the time, the grafts were of autologous origin but sometimes heterologous samples were used. Although the primary objective was to increase volume, an improved quality of skin healing and better skin flexibility were observed. The fat thus allowed the filling of substance losses, and its positive effects on scarring were noticed even before the regenerative properties of the stem cells present in body fat were discovered.
Hippolyte Morestin can be named one of the pioneers of facial reconstruction. A retroperspective analysis of his work with adipose grafts proves interesting because even though not being the first to apply this technique, he contributed, by means of experimentation and reproduction to proving it an innovative and useful method in facial reconstruction. It was not until the 1990s that adipose grafts were again applied under the name of lipostructure. Nowadays, they are commonly used in cosmetic and restorative surgery.
在1914年至1918年的第一次世界大战期间，面部重建领域取得了惊人的进展。战斗中造成的面部损伤数量之多、伤势之严重，迫使法国和德国的外科医生密切关注此类受伤患者的治疗。作为瓦尔德格拉斯医院第五师“面部伤员”的首席外科医生，伊波利特·莫雷斯廷负责战争期间最大的专门从事面部外科手术和重建的外科科室之一。在他的服役期间，他开发了各种外科技术，如使用软骨和脂肪移植进行自体移植以重建组织缺损。本研究主要关注莫雷斯廷在第一次世界大战期间及战后使用的脂肪移植技术及其美学效果。
这是一项历史描述性研究。我们的研究基于瓦尔德格拉斯陆军卫生服务博物馆和档案馆提供的数据（医院活动报告、患者术前和术后照片、剪报、病房护士的记录、蜡制解剖模型）。对伊波利特·莫雷斯廷发表的34例第一次世界大战期间面部重建的临床病例进行了研究。
脂肪主要用于在进行通常复杂的重建后填充颅面部组织缺损。手术技术有详细记录，并细分为3个连续步骤。大多数情况下，移植采用自体来源，但有时也使用异体样本。虽然主要目的是增加体积，但观察到皮肤愈合质量得到改善，皮肤柔韧性更好。脂肪因此能够填充组织缺损，甚至在发现体内脂肪中存在的干细胞的再生特性之前，就已经注意到其对瘢痕形成的积极影响。
伊波利特·莫雷斯廷可被称为面部重建的先驱之一。对他使用脂肪移植的工作进行回顾性分析很有意思，因为尽管他不是第一个应用这项技术的人，但他通过实验和复制，为证明其在面部重建中是一种创新且有用的方法做出了贡献。直到20世纪90年代，脂肪移植才以脂肪结构的名义再次应用。如今，它们在整形和修复手术中被广泛使用。
