Choi Jaemin, Choi Hyungon, Shin Donghyeok, Kim Jeenam, Lee Myungchul, Kim Soonheum, Jo Dongin, Kim Cheolkeun
Department of Plastic and Reconstructive Surgery, Konkuk University Medical Center, Seoul, Korea.
Department of Plastic and Reconstructive Surgery, Konkuk University Choongju Hospital, Konkuk University School of Medicine, Choongju, Korea.
Arch Plast Surg. 2018 Jan;45(1):69-73. doi: 10.5999/aps.2017.01088. Epub 2017 Oct 27.
Temporal hollowing is inevitable after decompressive craniectomy. This complication affects self-perception and quality of life, and various techniques and materials have therefore been used to restore patients' confidence. Autologous fat grafting in postoperative scar tissue has been considered challenging because of the hostile tissue environment. However, in this study, we demonstrate that autologous fat grafting can be a simple and safe treatment of choice, even for postoperative depressed temporal scar tissue.
Autologous fat grafting was performed in 13 patients from 2011 to 2016. Fat was harvested according to Coleman's strategy, using a tumescent technique. Patient-reported outcomes were collected preoperatively and at 1-month and 1-year follow-ups. Photographs were taken at each visit.
The thighs were the donor site in all cases for the first procedure. The median final volume of harvested fat was 29.4 mL (interquartile range [IQR], 24.0-32.8 mL). The median final volume of fat transferred into the temporal area was 4.9 mL on the right side (IQR, 2.5-7.1 mL) and 4.6 mL on the left side (IQR, 3.7-5.9 mL). There were no major complications. The patient-reported outcomes showed significantly improved self-perceptions at 1 month and at 1 year.
Despite concerns about the survival of grafted fat in scar tissue, we advise autologous fat grafting for patients with temporal hollowing resulting from a previous craniectomy.
减压性颅骨切除术后颞部凹陷不可避免。这种并发症会影响自我认知和生活质量，因此人们采用了各种技术和材料来恢复患者的信心。由于术后瘢痕组织的不良组织环境，自体脂肪移植一直被认为具有挑战性。然而，在本研究中，我们证明自体脂肪移植可以成为一种简单且安全的治疗选择，即使对于术后颞部凹陷性瘢痕组织也是如此。
2011年至2016年期间，对13例患者进行了自体脂肪移植。采用肿胀技术，按照科尔曼方法采集脂肪。术前以及术后1个月和1年随访时收集患者报告的结果。每次就诊时均拍摄照片。
所有病例首次手术时大腿均为供区。采集脂肪的最终体积中位数为29.4 mL（四分位间距[IQR]，24.0 - 32.8 mL）。右侧颞部移植脂肪的最终体积中位数为4.9 mL（IQR，2.5 - 7.1 mL），左侧为4.6 mL（IQR，3.7 - 5.9 mL）。未发生重大并发症。患者报告的结果显示，术后1个月和1年时自我认知有显著改善。
尽管担心移植脂肪在瘢痕组织中的存活情况，但我们建议对因先前颅骨切除术导致颞部凹陷的患者进行自体脂肪移植。
