自体脂肪乳糜移植治疗增生性瘢痕和瘢痕相关疾病。

BACKGROUND: Scarring is the product of natural restoration, yet its treatment remains challenging. Both collagen and fibroblasts are abnormally abundant in scars, leading to scar hyperplasia or contracture. Several clinical studies have reported that wrinkles at the recipient site are reduced, pores are narrowed, pigmentation is decreased, and skin is softened after autologous fat transplantation. In this study, we investigated the ability of autologous chyle fat injection to normalize the fibroblasts and collagen of scar tissue in 80 adult patients with hypertrophic scars resulting from severe burns received more than 1 year previously. METHODS: The patients underwent autologous chyle fat injection, and scar samples were collected at different time points. Differences in the number of adipocytes before and after chylosis were assessed by cell culture, and changes in the structural organization of the scars were detected via histologic and immunohistochemical analyses. RESULTS: After preparation, the chyle fat contained few autologous adipocytes and large amounts of extracellular matrix. Following the injection of chyle fat, the thickness, color, and elasticity of hypertrophic scar tissue tended toward normalization, and patient satisfaction increased. The three adipose tissue donor sites used for the preparation of chyle fat were the abdomen, buttocks, and inner thigh, of which the inner thigh yielded the best therapeutic outcomes. The density and quantity of fibroblasts in the scars decreased following the injection of chyle fat, and the arrangement, quantity, and shape of type III collagen fibers tended toward normalization. After three treatments, the results of immunohistochemical staining showed that type III collagen was significantly less abundant than before treatment. CONCLUSIONS: Autologous chyle fat transplantation has a good therapeutic effect on hypertrophic scar tissue. The injection of chyle fat into hypertrophic scar tissue reduced the density and quantity of fibroblasts and prompted the arrangement, quantity, and shape of type III collagen to normalize.

背景：瘢痕是自然修复的产物，但治疗仍然具有挑战性。瘢痕中胶原和成纤维细胞异常丰富，导致瘢痕增生或挛缩。几项临床研究报告称，自体脂肪移植后，受区皱纹减少、毛孔变窄、色素沉着减少、皮肤变软。在这项研究中，我们调查了自体乳糜脂肪注射在 80 例因严重烧伤导致的肥厚性瘢痕患者中的作用，这些患者在 1 年以上前接受了治疗，研究结果表明，自体乳糜脂肪注射能够使瘢痕组织中的成纤维细胞和胶原正常化。

方法：患者接受自体乳糜脂肪注射，并在不同时间点采集瘢痕样本。通过细胞培养评估乳糜化前后脂肪细胞数量的差异，并通过组织学和免疫组织化学分析检测瘢痕结构组织的变化。

结果：乳糜脂肪制备后，其中含有少量自体脂肪细胞和大量细胞外基质。注射乳糜脂肪后，肥厚性瘢痕组织的厚度、颜色和弹性趋于正常，患者满意度增加。用于制备乳糜脂肪的三个脂肪组织供体部位是腹部、臀部和大腿内侧，其中大腿内侧的治疗效果最好。注射乳糜脂肪后，瘢痕中成纤维细胞的密度和数量减少，III 型胶原纤维的排列、数量和形状趋于正常。三次治疗后，免疫组织化学染色结果显示，III 型胶原明显少于治疗前。

结论：自体乳糜脂肪移植对肥厚性瘢痕组织有良好的治疗效果。将乳糜脂肪注入肥厚性瘢痕组织可减少成纤维细胞的密度和数量，并促使 III 型胶原的排列、数量和形状正常化。