From the Department of Surgery, University of Chicago Medicine and Biological Sciences; and Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2022 Nov 1;150(5):955-962. doi: 10.1097/PRS.0000000000009613. Epub 2022 Aug 22.
Autologous fat grafting is a useful tool in breast reconstruction. The authors have previously demonstrated a difference in the rate of processing adipose grafts in a randomized time and motion clinical trial. The purpose of this study was to compare clinical outcomes in commonly used grafting systems.
Three methods to prepare adipose grafts were compared: a passive washing filtration system (Puregraft system), an active washing filtration system (Revolve system), and centrifugation (Coleman technique). Postoperative complications, rates of fat necrosis, revision procedures, and additional imaging were recorded.
Forty-six patients were included in the prospective, randomized study (15 active filtration, 15 passive filtration, and 16 centrifugation). Their mean age was 54 years and mean body mass index was 28.6 kg/m 2 . The mean length of follow-up was 16.9 ± 4 months. The overall complication rate was 12.1 percent. The probability of fat necrosis was no different between the groups (active filtration, 15 percent versus passive filtration, 14.3 percent] versus centrifugation, 8 percent; p = 0.72). Fat necrosis was highest in patients with breast conservation before grafting (60 percent; p = 0.011). There was no significant difference in contour irregularity (active filtration, 40 percent versus passive filtration, 38 percent versus centrifugation, 36 percent; p = 0.96) or additional grafting (active filtration, 40 percent versus passive filtration, 24 percent versus centrifugation, 32 percent; p = 0.34).
This is the first prospective, randomized study to compare clinical outcomes of adipose graft preparation. There was no significant difference in early complications, fat necrosis, or rates of additional grafting among the study groups. There was significantly higher risk of fat necrosis in patients with previous breast conservation treatment regardless of processing technique.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
自体脂肪移植是乳房重建的一种有用工具。作者此前在一项随机时间和动作临床试验中证明了脂肪移植物处理率的差异。本研究的目的是比较常用的移植系统的临床结果。
比较了三种制备脂肪移植物的方法：被动洗涤过滤系统（Puregraft 系统）、主动洗涤过滤系统（Revolve 系统）和离心（Coleman 技术）。记录术后并发症、脂肪坏死率、修正程序和额外的影像学检查。
46 例患者纳入前瞻性、随机研究（主动过滤 15 例，被动过滤 15 例，离心 16 例）。他们的平均年龄为 54 岁，平均体重指数为 28.6kg/m2。平均随访时间为 16.9±4 个月。总的并发症发生率为 12.1%。各组脂肪坏死的概率无差异（主动过滤 15%与被动过滤 14.3%比离心 8%；p=0.72）。在接受移植前进行保乳治疗的患者中，脂肪坏死的发生率最高（60%；p=0.011）。轮廓不规则（主动过滤 40%与被动过滤 38%与离心 36%；p=0.96）或额外移植（主动过滤 40%与被动过滤 24%与离心 32%；p=0.34）无显著差异。
这是第一项比较脂肪移植制备的临床结果的前瞻性、随机研究。研究组之间在早期并发症、脂肪坏死或额外移植的发生率方面没有显著差异。无论处理技术如何，先前有保乳治疗的患者脂肪坏死的风险显著增加。
临床问题/证据水平：治疗，II 级。
