Department of Plastic Surgery, Royal Free Hospital, London, United Kingdom; Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom; Division of Surgery & Interventional Science, University College London, London, United Kingdom.
Department of Plastic Surgery, Royal Free Hospital, London, United Kingdom; Charles Wolfson Center for Reconstructive Surgery, Royal Free Hospital, London, United Kingdom.
J Plast Reconstr Aesthet Surg. 2023 Jun;81:9-25. doi: 10.1016/j.bjps.2023.01.003. Epub 2023 Feb 13.
Autologous fat grafting (AFG) is a versatile technique in reconstructive and cosmetic surgery. Graft processing is a key source of variability resulting in unreliable clinical outcomes, with no consensus on the optimal methodology. This systematic review identifies the evidence base supporting different processing paradigms.
A systematic literature search was conducted using the PubMed, Scopus and The Cochrane Foundation databases. Studies comparing AFG processing methods and reporting long-term patient outcomes were identified.
Twenty-four studies (2413 patients) were identified. Processing techniques evaluated included centrifugation, decantation, washing, filtration, gauze rolling, as well as commercial devices and adipose-derived stem/stromal cell (ASC) enrichment methods. Objective volumetric and subjective patient-reported outcomes were discussed. There was a variable reporting of complications and volume retention rates. Complications were infrequent; palpable cysts (0-20%), surgical-site infections (0-8%) and fat necrosis (0-58.4%) were the most reported. No significant differences in long-term volume retention between techniques were found in AFG in the breast. In head and neck patients, greater volume retention was documented in ASC enrichment (64.8-95%) and commercial devices (41.2%) compared to centrifugation (31.8-76%).
Graft processing through washing and filtration, including when incorporated into commercial devices, results in superior long-term outcomes compared to centrifugation and decantation methods. ASC enrichment methods and commercial devices seem to have superior long-term volume retention in facial fat grafting.
自体脂肪移植（AFG）是重建和美容外科中一种多用途的技术。移植物的处理是导致临床结果不可靠的可变性的主要来源，目前尚无关于最佳方法的共识。本系统评价确定了支持不同处理范例的证据基础。
使用 PubMed、Scopus 和 Cochrane 基金会数据库进行了系统文献检索。确定了比较 AFG 处理方法和报告长期患者结局的研究。
确定了 24 项研究（2413 名患者）。评估的处理技术包括离心、沉淀、洗涤、过滤、纱布滚动以及商业设备和脂肪源性干细胞/基质细胞（ASC）富集方法。讨论了客观的体积和主观的患者报告结局。并发症和体积保留率的报告存在差异。并发症罕见；可触及的囊肿（0-20%）、手术部位感染（0-8%）和脂肪坏死（0-58.4%）是最常见的报告。在乳房 AFG 中，未发现技术之间长期体积保留率存在显著差异。在头颈部患者中，ASC 富集（64.8-95%）和商业设备（41.2%）比离心（31.8-76%）记录到更大的体积保留率。
与离心和沉淀方法相比，通过洗涤和过滤进行移植物处理，包括将其纳入商业设备中，可获得更好的长期结局。在面部脂肪移植中，ASC 富集方法和商业设备似乎具有更好的长期体积保留率。
