HNO-Praxis Hanse-Viertel, Hamburg, Germany.
Department of Plastic Surgery, University of California, Irvine School of Medicine, Irvine, California.
Facial Plast Surg. 2021 Oct;37(5):590-598. doi: 10.1055/s-0041-1723785. Epub 2021 Feb 26.
A thin or damaged skin soft tissue envelope may cause concerns in primary and secondary rhinoplasty. During postoperative healing, unpredictable scarring and contraction may occur and lead to significant aesthetic and trophic sequelae. Besides a meticulous surgical technique, there are no reliable techniques to prevent long-term skin damage and shrinkage. Fat transfer with addition of platelet-rich fibrin (PRF) harbors the possibility of local soft tissue regeneration and skin rejuvenation through growth factors and mesenchymal stem cells. It may also facilitate the creation of a thin fat layer on the dorsum to prevent shrink-wrap forces and conceal small irregularities. The goal is to provide evidence for the feasibility, durability, and beneficial effect of diced macrofat transfer bonded with PRF on the nasal dorsum. We present the technique of fat transfer conjugated with PRF as a nasal dorsal graft. Clinical endpoints were the prevention of trophic disturbances and atrophy at a 1-year postoperative follow-up. We present the skin mobility test as a clinical indicator of a healthy soft tissue envelope. The presented case series consists of 107 rhinoplasties. Fat was harvested in the umbilical or costal region. PRF was created by centrifugation of autologous whole blood samples. Macrofat was diced, cleaned, and bonded with PRF. The compound transplants were transferred to the nasal dorsum. There were no perioperative complications or wound-healing issues. Mean follow-up was 14 months. Clinical inspection showed good skin quality and no signs of shrinkage, marked scarring, or color changes with positive skin mobility test in all patients. Survival of fat was confirmed by ultrasonography and magnetic resonance imaging. Diced macrofat transfer in conjunction with PRF to the nasal dorsum is a feasible and safe method. A beneficial effect on the soft tissue envelope is demonstrated as well as the prevention of shrink-wrap forces.
在初次和再次鼻整形术中，可能会对菲薄或受损的皮肤软组织包膜产生顾虑。在术后愈合过程中，可能会出现不可预测的瘢痕和挛缩，导致明显的美学和营养后遗症。除了精细的手术技术外，目前还没有可靠的技术可以预防长期的皮肤损伤和收缩。富含血小板的纤维蛋白（PRF）的脂肪转移具有通过生长因子和间充质干细胞促进局部软组织再生和皮肤年轻化的可能性。它还可以促进在鼻背形成薄脂肪层，以防止收缩包装力并隐藏小的不规则。其目的是为脂肪转移与 PRF 结合在鼻背的可行性、持久性和有益效果提供证据。我们提出了将 PRF 结合的脂肪转移作为鼻背移植物的技术。临床终点是在术后 1 年随访时预防营养障碍和萎缩。我们提出皮肤移动测试作为软组织包膜健康的临床指标。该病例系列包括 107 例鼻整形术。在脐部或肋部采集脂肪。通过离心自体全血样本来制备 PRF。将大块脂肪切成丁状、清洗并与 PRF 结合。将复合移植物转移到鼻背。没有围手术期并发症或伤口愈合问题。平均随访时间为 14 个月。临床检查显示所有患者皮肤质量良好，无收缩、明显瘢痕或变色迹象，皮肤移动测试均为阳性。超声和磁共振成像证实了脂肪的存活。将 PRF 与大块脂肪转移到鼻背是一种可行且安全的方法。证明对软组织包膜有有益的影响，并能防止收缩包装力。
