From the Department of Plastic and Reconstructive Surgery, Sapienza University; the Institute of Anatomy and Cell Biology, Università Cattolica del Sacro Cuore; Fondazione Policlinico Universitario "Agostino Gemelli", Rome, Italy.
Plast Reconstr Surg. 2018 Jul;142(1):136-147. doi: 10.1097/PRS.0000000000004506.
Although fingertip injuries account for a high proportion of trauma patients, the correct surgical approach is still debated. The authors compared the traditional conservative approach and a new treatment based on the injection of liposuction aspirate fluid.
Forty consecutive patients with a fingertip injury were dichotomized into group A (control group; conservative approach) and group B (treatment group). Group B underwent liposuction, followed by filtration of the lipoaspirate in a closed device (MyStem EVO kit), allowing the nonenzymatic separation of liposuction aspirate fluid, which was then injected at the site of injury. Objective outcomes were time for healing, strength, mobility of joint, and touch and sensory function. Subjective outcomes were cold intolerance, pain, hand disability, and aesthetic result. An aliquot of liposuction aspirate fluid was sent to the laboratory for cellular isolation and analysis by flow cytometry and in vitro differentiation assays.
The average healing time was 22.3 days in group B and 24.9 days in group A (p < 0.05). Eighty-five percent of group B patients and 67 percent of group A patients scored normal to diminished superficial sensibility (p < 0.05). Group A had higher pain and cold intolerance scores (p < 0.05). Group B scored greater aesthetic and disabilities outcome results (p < 0.05). The cell isolation yield was 8.3 × 10(5)/ml, with a percentage of viable cells of 74.3 percent. Flow cytometry identified a mesenchymal immunophenotype, and in vitro osteogenic and adipogenic induction confirmed the bilinear potential of the isolated cells.
This clinical study demonstrates for the first time the regenerative potential of liposuction aspirate fluid adipose-derived stem cells in a clinical application.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
尽管指尖损伤占创伤患者的很大比例，但正确的手术方法仍存在争议。作者比较了传统的保守治疗方法和一种新的基于脂肪抽吸液注射的治疗方法。
40 例指尖损伤患者分为 A 组（对照组；保守治疗）和 B 组（治疗组）。B 组行脂肪抽吸术，然后在封闭装置（MyStem EVO 试剂盒）中过滤脂肪抽吸液，允许非酶分离脂肪抽吸液，然后将其注射到损伤部位。客观结果为愈合时间、力量、关节活动度以及触觉和感觉功能。主观结果为怕冷、疼痛、手部残疾和美学结果。抽取一部分脂肪抽吸液送实验室进行细胞分离和流式细胞术分析及体外分化试验。
B 组的平均愈合时间为 22.3 天，A 组为 24.9 天（p<0.05）。B 组 85%的患者和 A 组 67%的患者浅表感觉正常或减弱（p<0.05）。A 组疼痛和怕冷评分较高（p<0.05）。B 组的美学和残疾结果评分较高（p<0.05）。细胞分离产量为 8.3×10^5/ml，活细胞百分比为 74.3%。流式细胞术鉴定出间充质免疫表型，体外成骨和成脂诱导证实了分离细胞的双线性潜能。
这项临床研究首次证明了脂肪抽吸液脂肪来源干细胞在临床应用中的再生潜力。
临床问题/证据水平：治疗性，II 级。
Zotero 插件