From Back Bay Plastic Surgery; the Department of Plastic Surgery, University of Texas Southwestern Medical Center; the Dallas Plastic Surgery Institute; and the Venkat Center for Skin and Plastic Surgery.
Plast Reconstr Surg. 2018 Nov;142(5):1180-1192. doi: 10.1097/PRS.0000000000005020.
The intraoperative mortality and overall complication rate for gluteal augmentation with fat transplantation is unacceptably high. The current controversy among experts regarding safety is whether fat should be placed within the gluteus muscle or limited to only the subcutaneous space. The purpose of the present study was to test the hypothesis that under certain pressures, fat injected within the gluteal muscle can actually migrate out of the muscle and into a deeper plane containing critical neurovascular structures, by means of the process of deep intramuscular migration.
A total of eight human cadaver dissections were performed. Four hemibuttocks were selected for intramuscular fat injection. The patterns of subfascial fat migration were evaluated in three of these hemibuttocks by direct visual inspection and in one hemibuttock by endoscopic evaluation. Four other hemibuttocks were selected for subcutaneous or suprafascial fat injection.
Proxy fat was found to migrate through the muscle and into the deep submuscular space with each intramuscular injection. With subcutaneous injection, no proxy fat was found during dissection in the intramuscular septae or submuscular space.
The intramuscular insertion of fat, which up to this point has been considered reasonable to perform in the superficial muscle and even recommended in the literature, is now deemed to be an inexact and risky surgical technique. This technique, because of the migratory nature of injected fat, should be avoided from further use in fat transplantation to the gluteal region.
臀肌脂肪移植的术中死亡率和总并发症发生率高得令人无法接受。目前专家们对安全性的争议是脂肪是否应置于臀肌内或仅限于皮下空间。本研究的目的是通过深部肌内迁移过程来验证这样一个假设，即在一定压力下，注入臀肌内的脂肪实际上可以从肌肉迁移到包含关键神经血管结构的更深平面。
共进行了 8 个人体尸体解剖。选择了 4 个半臀部进行肌内脂肪注射。在这 3 个半臀部中通过直接肉眼观察和 1 个半臀部的内镜评估评估了筋膜下脂肪迁移的模式。选择了另外 4 个半臀部进行皮下或筋膜上脂肪注射。
每个肌内注射都发现代理脂肪通过肌肉迁移到深部肌下空间。皮下注射时，在肌间隔或肌下空间没有发现代理脂肪。
脂肪的肌内插入，到目前为止被认为在浅层肌肉中是合理的，甚至在文献中被推荐，现在被认为是一种不准确和有风险的手术技术。由于注射脂肪的迁移性质，这种技术应避免在脂肪移植到臀部区域的进一步使用。
