Canizares Orlando, Thomson Jennifer E, Allen Robert J, Davidson Edward H, Tutela John P, Saadeh Pierre B, Warren Stephen M, Hazen Alexes
New York, N.Y.
From the Institute of Reconstructive Plastic Surgery Laboratories, New York University Medical Center.
Plast Reconstr Surg. 2017 Nov;140(5):933-943. doi: 10.1097/PRS.0000000000003812.
Wide variations in fat graft survival have been reported. The authors hypothesize that treating the adipose tissue on Telfa gauze creates a processed lipoaspirate with a more functional adipokine profile that improves fat graft survival.
Suction-assisted lipoaspirate was harvested from humans and was either processed by centrifugation, rolled on Telfa gauze, or left unprocessed. Progenitor cell populations were quantified and characterized by flow cytometry. Glycerol-3-phosphate dehydrogenase assay was used to measure the functional adipocytes. The lipoaspirates were grafted into (n = 45) wild-type mice and harvested to assess fat graft persistence. Vascular endothelial growth factor and platelet-derived growth factor-BB secretions were measured by enzyme-linked immunosorbent assay technique.
Centrifuged lipoaspirate had a greater number of progenitor cells per gram of tissue than Telfa-processed and unprocessed lipoaspirate. However, Telfa-processed lipoaspirate had a greater number of functional adipocytes (0.104 U/ml) than centrifuged (0.080 U/ml) and unprocessed lipoaspirate (0.083 U/ml) on glycerol-3-phosphate dehydrogenase assay (p < 0.05). After 10 weeks of grafting, it had greater fat graft persistence (70.9 ± 6.2 percent) than centrifuged (56.7 ± 5.5 percent) and unprocessed lipoaspirate (42.2 ± 2.7 percent) (p < 0.05). It also maintained a greater secretion of vascular endothelial growth factor and platelet-derived growth factor-BB at weeks 1 and 2 than centrifuged and unprocessed lipoaspirate. Furthermore, CD31 staining demonstrated an increase in vascular density of the Telfa-processed lipoaspirate at week 2 compared with the centrifuged lipoaspirate (37 ± 1 percent and 14 ± 4 percent per high-power field; p < 0.05).
Lipoaspirate processing technique has a significant impact on fat graft survival rate. Increasing the number of functional adipocytes by processing the fat on Telfa gauze may augment the secretion of angiogenic and mitogenic adipokines within the graft, thereby improving its survivability.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
据报道，脂肪移植存活率存在很大差异。作者推测，在特氟纶纱布上处理脂肪组织可产生一种具有更具功能性的脂肪因子谱的处理过的脂肪抽吸物，从而提高脂肪移植存活率。
从人体获取抽脂辅助脂肪抽吸物，分别通过离心、在特氟纶纱布上滚动或不进行处理。通过流式细胞术对祖细胞群体进行定量和表征。使用甘油-3-磷酸脱氢酶测定法测量功能性脂肪细胞。将脂肪抽吸物移植到45只野生型小鼠体内，并进行取材以评估脂肪移植的存留情况。采用酶联免疫吸附测定技术测量血管内皮生长因子和血小板衍生生长因子-BB的分泌量。
每克组织中，离心后的脂肪抽吸物比经特氟纶处理和未处理的脂肪抽吸物含有更多的祖细胞。然而，在甘油-3-磷酸脱氢酶测定中，经特氟纶处理的脂肪抽吸物的功能性脂肪细胞数量（0.104 U/ml）比离心后的（0.080 U/ml）和未处理的脂肪抽吸物（0.083 U/ml）更多（p<0.05）。移植10周后，其脂肪移植存留率（70.9±6.2%）高于离心后的（56.7±5.5%）和未处理的脂肪抽吸物（42.2±2.7%）（p<0.05）。在第1周和第2周时，其血管内皮生长因子和血小板衍生生长因子-BB的分泌量也高于离心后的和未处理的脂肪抽吸物。此外，与离心后的脂肪抽吸物相比，第2周时经特氟纶处理的脂肪抽吸物的CD31染色显示血管密度增加（每高倍视野分别为37±1%和14±4%；p<0.05）。
脂肪抽吸物处理技术对脂肪移植存活率有显著影响。通过在特氟纶纱布上处理脂肪来增加功能性脂肪细胞的数量，可能会增加移植体内血管生成和促有丝分裂脂肪因子的分泌，从而提高其存活率。
临床问题/证据水平：治疗性，V级
