From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Ann Plast Surg. 2023 Jun 1;90(6S Suppl 5):S495-S498. doi: 10.1097/SAP.0000000000003475. Epub 2023 Feb 4.
Scleroderma (systemic sclerosis [SSc]) is a rare autoimmune, connective tissue disorder. Perioral fibrosis is a local cutaneous complication, negatively impacting functional capabilities and aesthetic satisfaction. Fat grafting has been postulated to aid in the management of SSc fibrosis thanks to stem cell enrichment. This technique's success has been demonstrated using different graft origin sites and different injection targets. We aim to demonstrate our SSc patients' success using abdominal fat and perioral target.
We queried our records for patients with preexisting SSc who underwent incisional release and fat grafting for perioral fibrosis from 2018 to 2021. For perioral release, a semisharp cannula was tunneled under the vermilion border into the vermilion and along the skin. For grafting, cannulas were used to infiltrate the fat with a retrograde filling technique in a radial-fanning manner. Their autoimmune diagnosis, anesthetic risk assessment, systemic disease complications, and degree of presenting symptoms were reviewed along with their postoperative outcomes.
From 2018 to 2021, 16 patients diagnosed with SSc were treated with incisional release and fat grafting for the management of perioral fibrosis. Of the SSc patients, 8 presented with limited SSc, and 8 presented with diffuse SSc. The mean patient age was 54.31 years. All SSc patients presented with functional symptoms with the most common concern (n = 9) being "decreased mouth opening." Other common complaints were "difficulty eating" (n = 3) or "difficulty drinking" (n = 2). Some patients (n = 11) also presented with cosmetic concerns with "perioral rhytids" being the most common (n = 6). The mean number of systemic complications, at the time of presentation, was 3.06. The mean anesthetic risk assessment was 2.44. The average amount of fat grafted intraoperatively was 14.89 mL. Two patients with SSc required regrafting. For one patient, this was part of the original treatment plan and for the other due to fat resorption. Patients who followed up reported improved functionality and were pleased aesthetically.
Patients with perioral fibrosis due to SSc can benefit from autologous fat grafting. Incisional release in combination with fat grafting can enhance procedure outcomes. This technique provides beneficial functional and aesthetic outcomes. Patients with both diffuse and limited disease are appropriate candidates for this procedure.
硬皮病（系统性硬皮病[SSc]）是一种罕见的自身免疫性结缔组织疾病。口周纤维化是一种局部皮肤并发症，会降低功能能力和美容满意度。由于富含干细胞，脂肪移植被认为有助于 SSc 纤维化的管理。这项技术的成功已经通过不同的供体部位和不同的注射靶点得到了证明。我们旨在展示使用腹部脂肪和口周靶区治疗我们的 SSc 患者的成功案例。
我们从 2018 年至 2021 年的记录中查询了患有 SSc 的患者，这些患者因口周纤维化而行切开松解和脂肪移植。对于口周松解，半锐套管在唇红缘下隧道进入唇红和皮肤。对于移植，套管用于以逆行填充技术以放射状扇形方式浸润脂肪。回顾了他们的自身免疫诊断、麻醉风险评估、系统性疾病并发症和表现症状的严重程度，以及他们的术后结果。
2018 年至 2021 年，16 例 SSc 患者因口周纤维化接受切开松解和脂肪移植治疗。在 SSc 患者中，8 例为局限型 SSc，8 例为弥漫型 SSc。患者平均年龄为 54.31 岁。所有 SSc 患者均有功能症状，最常见的问题是“张口度减小”（n=9）。其他常见的抱怨是“进食困难”（n=3）或“饮水困难”（n=2）。一些患者（n=11）也有美容方面的顾虑，其中“口周皱纹”最为常见（n=6）。就诊时，平均系统并发症数为 3.06。平均麻醉风险评估为 2.44。术中移植的平均脂肪量为 14.89 毫升。2 例 SSc 患者需要再次移植。对于其中 1 例患者，这是原始治疗计划的一部分，对于另 1 例患者，则是由于脂肪吸收。随访的患者报告功能改善，并且对美容效果满意。
由于 SSc 导致口周纤维化的患者可以从自体脂肪移植中获益。切开松解联合脂肪移植可以增强手术效果。该技术提供有益的功能和美容效果。弥漫性和局限性疾病的患者均适合进行该手术。
