Bourne Debra A, Bliley Jacqueline, James Isaac, Donnenberg Albert D, Donnenberg Vera S, Branstetter Barton F, Haas Gretchen L, Radomsky Elizabeth, Meyer Ernest Michael, Pfeifer Melanie E, Brown Spencer A, Marra Kacey G, Coleman Sydney, Rubin J Peter
Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA.
Ann Surg. 2021 May 1;273(5):1004-1011. doi: 10.1097/SLA.0000000000003318.
This study aimed to prospectively assess outcomes for surgical autologous fat transfer (AFT) applied for traumatic and postsurgical craniofacial deformities. The minimally invasive nature of AFT has potential for reduced risk and superior outcomes compared with current reconstructive options.
Craniofacial deformities have functional and psychosocial sequelae and can profoundly affect quality of life. Traditional reconstructive options are invasive, invasive, complex, and often lack precision in outcomes. Although AFT is safe, effective, and minimally invasive, only anecdotal evidence exists for reconstruction of craniofacial deformities.
In this Institutional Review Board-approved prospective cohort study, 20 subjects underwent AFT (average volume: 23.9 ± 13.2 mL). Volume retention over time was determined using high-resolution computed tomography. Flow cytometry was used to assess cellular subpopulations and viability in the stromal vascular fraction. Quality of life assessments were performed. After the completion of 9-month follow-up, 5 subjects were enrolled for a second treatment.
No serious adverse events occurred. Volume retention averaged 63 ± 17% at 9 months. Three-month retention strongly predicted 9-month retention (r=0.996, P < 0.0001). There was no correlation between the total volume injected and retention. Patients undergoing a second procedure had similar volume retention as the first (P = 0.05). Age, sex, body mass index, and stromal vascular fraction cellular composition did not impact retention. Surprisingly, former smokers had greater volume retention at 9 months compared with nonsmokers (74.4% vs 56.2%, P = 0.009). Satisfaction with physical appearance (P = 0.002), social relationships (P = 0.02), and social functioning quality of life (P = 0.05) improved from baseline to 9 months.
For craniofacial defects, AFT is less invasive and safer than traditional reconstructive options. It is effective, predictable, and reaches volume stability at 3 months. Patient-reported outcomes demonstrate a positive life-changing impact.
本研究旨在前瞻性评估手术自体脂肪移植（AFT）应用于创伤性和术后颅面畸形的效果。与目前的重建方法相比，AFT的微创性质具有降低风险和获得更好效果的潜力。
颅面畸形具有功能和心理社会后遗症，可深刻影响生活质量。传统的重建方法具有侵入性、复杂，且效果往往缺乏精确性。虽然AFT安全、有效且微创，但用于颅面畸形重建的仅有轶事证据。
在这项经机构审查委员会批准的前瞻性队列研究中，20名受试者接受了AFT（平均体积：23.9±13.2mL）。使用高分辨率计算机断层扫描确定随时间的体积保留情况。流式细胞术用于评估基质血管成分中的细胞亚群和活力。进行生活质量评估。在完成9个月的随访后，5名受试者参加了第二次治疗。
未发生严重不良事件。9个月时体积保留平均为63±17%。3个月时的保留情况强烈预测了9个月时的保留情况（r=0.996，P<0.0001）。注射的总体积与保留情况之间无相关性。接受第二次手术的患者的体积保留情况与第一次相似（P=0.05）。年龄、性别、体重指数和基质血管成分的细胞组成均不影响保留情况。令人惊讶的是，与非吸烟者相比，既往吸烟者在9个月时的体积保留情况更好（74.4%对56.2%，P=0.009）。从基线到9个月，对身体外观（P=0.002）、社会关系（P=0.02）和社会功能生活质量（P=0.05）的满意度有所提高。
对于颅面缺损，AFT比传统的重建方法侵入性更小且更安全。它有效、可预测，并在3个月时达到体积稳定。患者报告的结果显示出对生活有积极的改变作用。
