From the Department of Plastic Surgery, University of Pittsburgh Medical Center; TriBeCa Plastic Surgery; the Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York University Langone Medical Center; and the Department of Radiation Oncology, University of Pittsburgh.
Plast Reconstr Surg. 2021 Apr 1;147(4):819-838. doi: 10.1097/PRS.0000000000007705.
Radiation-induced changes in skin and soft tissue result in significant cosmetic and functional impairment with subsequent decrease in quality of life. Fat grafting has emerged as a therapy for radiation-induced soft-tissue injury, and this narrative review aims to evaluate the current clinical evidence regarding its efficacy. A review was conducted to examine the current clinical evidence of fat grafting as a therapy for radiation-induced injury to the skin and soft tissue and to outline the clinical outcomes that can be used to more consistently quantify chronic radiation-induced injury in future clinical studies. The current clinical evidence regarding the efficacy of fat grafting to treat radiation-induced injury of the skin and soft tissue suggests that fat grafting increases skin softness and pliability, induces volume restoration, improves hair growth in areas of alopecia, reduces pain, and improves cosmetic and functional outcomes. However, literature in this field is far from robust and mired by the retrospective nature of the studies, lack of adequate controls, and inherent limitations of small case series and cohorts. A series of actions have been identified to strengthen future clinical data, including the need for physical examination using a validated scale, appropriate imaging, skin biomechanics and microcirculation testing, and histologic analysis. In conclusion, radiation-induced soft-tissue injury is a significant health burden that can lead to severe functional and aesthetic sequelae. Although still in a preliminary research phase, there is promising clinical evidence demonstrating the benefits of fat grafting to treat chronic changes after radiation therapy. Future clinical studies will require larger cohorts, adequate controls, and consistent use of objective measurements.
辐射引起的皮肤和软组织变化导致显著的美容和功能障碍，随后生活质量下降。脂肪移植已成为治疗辐射引起的软组织损伤的一种方法，本叙述性综述旨在评估其疗效的现有临床证据。进行了一次审查，以检查脂肪移植作为治疗皮肤和软组织辐射损伤的治疗方法的现有临床证据，并概述可用于更一致地量化未来临床研究中慢性辐射诱导损伤的临床结果。关于脂肪移植治疗皮肤和软组织辐射损伤的疗效的现有临床证据表明，脂肪移植可增加皮肤的柔软度和柔韧性，诱导体积恢复，改善脱发区域的毛发生长，减轻疼痛，并改善美容和功能结果。然而，该领域的文献远非稳健，受到研究的回顾性性质、缺乏足够对照以及小病例系列和队列的固有局限性的困扰。已经确定了一系列加强未来临床数据的行动，包括使用经过验证的量表进行体格检查、适当的影像学检查、皮肤生物力学和微循环测试以及组织学分析。总之，辐射引起的软组织损伤是一个重大的健康负担，可导致严重的功能和美容后遗症。尽管仍处于初步研究阶段，但有令人鼓舞的临床证据表明脂肪移植治疗放射治疗后慢性变化的益处。未来的临床研究将需要更大的队列、足够的对照和一致使用客观测量。
