Department of Surgery, Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Quebec, Canada.
McGill University, Montreal, Quebec, Canada.
Aesthet Surg J. 2020 Jan 1;40(1):78-89. doi: 10.1093/asj/sjz166.
Microscopic fat embolism syndrome (micro-FES) has been recently identified as a potentially fatal complication following gluteal augmentation utilizing autologous fat grafts; safety recommendations advocating for subcutaneous lipo-injections may be insufficient for its prevention.
The authors of this systematic review evaluated the potential role of corticosteroid prophylaxis for the prevention of micro-FES in gluteal augmentation procedures.
The authors performed a systematic search employing the National Library of Medicine (PubMed), Medline, and Embase databases. Search terms were those pertaining to studies reporting the efficacy of prophylactic corticosteroid administration on micro-FES incidence in a high-risk surrogate population.
Thirteen articles met the inclusion criteria for review, comprising 2 studies reporting on the efficacy of a single intravenous (IV) corticosteroid dose for the prophylaxis of micro-FES, 9 studies reporting on multiple prophylactic IV doses, and 2 additional studies reporting on the efficacy of inhaled corticosteroids in this context. All studies were identified from the orthopedic literature given that none were available directly from within plastic surgery. The prophylactic efficacy of multiple IV doses of methylprednisolone, or a single larger dose, was established, whereas the efficacy of inhaled corticosteroids remains elusive.
A single perioperative IV dose of methylprednisolone may be most appropriate for utilization by plastic surgeons; the safety and implication of this therapy on wound healing and fat graft survival are discussed. Further studies directly evaluating the efficacy of corticosteroid prophylaxis in the gluteal augmentation population are indicated. Finally, recommendations pertaining to the prevention, timely recognition, and effective management of micro-FES are discussed.
最近发现，在使用自体脂肪移植进行臀部增大术后，微小脂肪栓塞综合征（micro-FES）是一种潜在致命的并发症；提倡皮下脂肪注射的安全建议可能不足以预防其发生。
本系统评价的作者评估了皮质类固醇预防在臀部增大术中预防微小 FES 的潜在作用。
作者使用美国国立医学图书馆（PubMed）、Medline 和 Embase 数据库进行了系统搜索。检索词是针对在高危替代人群中报告预防性皮质类固醇给药对微小 FES 发生率的疗效的研究。
13 篇文章符合综述的纳入标准，其中 2 篇报道了单次静脉（IV）皮质类固醇剂量预防微小 FES 的疗效，9 篇报道了多次预防性 IV 剂量，另外 2 篇报道了吸入皮质类固醇在这种情况下的疗效。所有研究均来自骨科文献，因为没有直接来自整形外科的研究。已确定多次 IV 剂量甲泼尼龙或单次较大剂量的预防疗效，而吸入皮质类固醇的疗效仍不明确。
单次围手术期 IV 甲泼尼龙可能是整形外科医生最适合的选择；讨论了这种治疗方法对伤口愈合和脂肪移植存活的安全性和影响。需要进一步研究直接评估皮质类固醇预防在臀部增大人群中的疗效。最后，讨论了预防、及时识别和有效管理微小 FES 的建议。
