Zimmermann Simon, Fakin Richard M, Giesen Thomas, Giovanoli Pietro, Calcagni Maurizio
Division of Plastic and Hand Surgery, University Hospital Zurich.
Division of Plastic and Hand Surgery, University Hospital Zurich;
J Vis Exp. 2017 Nov 23(129):55962. doi: 10.3791/55962.
The purpose of this study was to methodically illustrate and highlight the crucial steps of stromal vascular fraction (SVF)-enriched fat grafting as a novel treatment of symptomatic end-neuromata of peripheral sensory nerves, and in this study, specifically of the superficial branch of the radial nerve (SBRN). Despite a multitude of existing treatments, persistent postoperative pain and common pain relapse are still very common, independent of the procedure assessed. The neuroma is microsurgically excised accordingly to standardized protocol. Instead of the relocation of the regenerating nerve stump in neighboring anatomical structures, such as muscle or bone, a fat graft is applied perifocally and acts as a mechanical barrier. In order to reduce the fat resorption rate and boost the regenerative potential of the graft, the highly concentrated SVF is integrated in the grafting. The SVF is isolated from subcutaneous fat by enzymatic and mechanic separation of the lipoaspirate by a specific commercial isolation system. The SVF-enriched fat graft provides both a mechanical barrier and various biological effects at the cellular level, including improving angiogenesis, inflammation, and fibrosis. Both mechanical and biologic effects help to reduce the disorganized axonal outgrowth of the nerve stump during nerve regeneration and hence prevent the recurrence of painful end-neuromata.
本研究的目的是系统地阐述并突出富含基质血管成分（SVF）的脂肪移植作为一种治疗周围感觉神经症状性神经瘤（在本研究中具体为桡神经浅支[SBRN]）的新方法的关键步骤。尽管现有多种治疗方法，但术后持续疼痛和常见的疼痛复发仍然非常普遍，与所评估的手术方式无关。根据标准化方案，通过显微手术切除神经瘤。脂肪移植不是将再生神经残端重新安置在相邻的解剖结构（如肌肉或骨骼）中，而是在病灶周围进行脂肪移植，起到机械屏障的作用。为了降低脂肪吸收率并提高移植组织的再生潜能，在移植中加入了高浓度的SVF。通过特定的商业分离系统对抽脂物进行酶解和机械分离，从皮下脂肪中分离出SVF。富含SVF的脂肪移植在细胞水平上既提供了机械屏障，又具有多种生物学效应，包括促进血管生成、减轻炎症和纤维化。机械效应和生物学效应都有助于减少神经再生过程中神经残端无序的轴突生长，从而防止疼痛性神经瘤的复发。
