Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota.
Mayo Clinic School of Medicine, Rochester, Minnesota.
Wounds. 2021 Feb;33(2):E20-E23.
Delayed wound healing and ulceration in radiated tissue is a surgical challenge. Autologous fat grafting can reverse skin changes secondary to radiation such as fibrosis, scarring, contracture, and pain. Adipose-derived stem cells are thought to contribute to the regenerative properties of fat.
In this case report, the authors discuss the role of fat grafting as a means for effective wound healing in a patient with a chronic nonhealing radiation-induced skin wound.
The patient is a 79-year-old male with a history of medically complicated obesity who presented with a fluoroscopic radiation-induced wound that developed 11 years after non-ST-elevation myocardial infarction for which he underwent placement of 6 stents via percutaneous transluminal coronary angiography. The wound was complicated by several infections and remained refractory to multiple interventions despite topical steroid use, regular wound dressing changes, debridements, and hyperbaric oxygen therapy. In consideration of the patient's body mass index of greater than 50 kg/m2 and modest weight loss attempts, surgical intervention involving wide local resection and flap closure was not thought to be a solution. Fat grafting was performed 19 months after initial presentation, with near-complete healing evident 10 months after the procedure.
Chronic nonhealing wounds can provide a tremendous burden to the patient in terms of time, costs, and morbidity. Despite enduring a prolonged 19-month course involving multiple failed interventions and several wound-related infections, the patient achieved wound healing via fat grafting. Earlier intervention with fat grafting may prove helpful to patients who do not show evidence of healing via other modalities and for whom flap surgery is not an option.
放射性组织的伤口愈合延迟和溃疡是一个手术挑战。自体脂肪移植可以逆转辐射引起的皮肤变化，如纤维化、瘢痕形成、挛缩和疼痛。脂肪来源的干细胞被认为有助于脂肪的再生特性。
在本病例报告中，作者讨论了脂肪移植作为一种有效治疗放射性皮肤慢性不愈合伤口的方法的作用。
患者为 79 岁男性，患有肥胖合并多种内科疾病，因非 ST 段抬高型心肌梗死接受经皮冠状动脉介入治疗，共放置 6 个支架，11 年后出现放射诱导性伤口。该伤口并发多次感染，尽管使用了局部类固醇、定期伤口换药、清创和高压氧治疗，但仍未愈合。考虑到患者的体重指数大于 50 kg/m2，且体重减轻尝试有限，广泛局部切除和皮瓣闭合等手术干预措施并不被认为是一种解决方案。初次就诊 19 个月后进行了脂肪移植，术后 10 个月几乎完全愈合。
慢性不愈合的伤口会给患者带来巨大的负担，包括时间、费用和发病率。尽管该患者经历了长达 19 个月的时间，包括多次失败的干预措施和数次与伤口相关的感染，但通过脂肪移植实现了伤口愈合。对于那些通过其他方式没有显示出愈合迹象且不能进行皮瓣手术的患者，早期进行脂肪移植可能会有所帮助。
