Gentile Pietro, Cervelli Valerio, De Fazio Domenico, Calabrese Claudio, Scioli Maria Giovanna, Orlandi Augusto
Surgical Science Department, Plastic and Reconstructive Surgery, University of Rome "Tor Vergata", Via Montpellier 1, 00179, Rome, Italy.
Plastic and Reconstructive Surgery, "Madonnina Clinic", 20122, Milan, Italy.
Aesthetic Plast Surg. 2023 Oct;47(5):2051-2062. doi: 10.1007/s00266-023-03364-5. Epub 2023 May 2.
Currently, several techniques for autologous fat graft (A-FG) preparation aimed at obtaining purified tissue exist. Both mechanical digestions via centrifugation, filtration, and enzymatic digestion were considered the most effective with different impacts in terms of adult adipose-derived stromal vascular fraction cells (AD-SVFs) amount that volume maintenance.
This article aimed to report the in vivo and in vitro results, represented by fat volume maintenance and AD-SVFs amount, obtained by four different procedures of AD-SVFs isolation and A-FG purification based on centrifugation, filtration, centrifugation with filtration, and enzymatic digestion.
A prospective, case-control study was conducted. In total, 80 patients affected by face and breast soft tissue defects were treated with A-FG and divided into four groups: n=20 were treated with A-FG enhanced with AD-SVFs obtained by enzymatic digestion (study group 1 [SG-1]); n=20 were treated with A-FG enhanced with AD-SVFs obtained by centrifugation with filtration (SG-2); n=20 were treated with A-FG enhanced with AD-SVFs obtained by only filtration (SG-3); n=20 were treated with A-FG obtained by only centrifugation according to the Coleman technique (control group [CG]). Twelve months after the last A-FG session, the volume maintenance percentage was analyzed by magnetic resonance imaging (MRI). Isolated AD-SVF populations were counted using a hemocytometer, and cell yield was reported as cell number/mL of fat.
Starting with the same amount of fat analyzed (20 mL), 50,000 ± 6956 AD-SVFs/mL were obtained in SG-1; 30,250 ± 5100 AD-SVFs/mL in SG-2; 33.333 ± 5650 AD-SVFs/mL in SG-3, while 500 AD-SVFs/mL were obtained in CG. In patients treated with A-FG enhanced with AD-SVFs obtained by automatic enzymatic digestion, a 63% ± 6.2% maintenance of fat volume restoring after 1 year was observed compared with 52% ± 4.6% using centrifugation with filtration, 39% ± 4.4% using only centrifugation (Coleman), and 60% ± 5.0% using only filtration.
In vitro AD-SVFs cell analysis indicated that filtration was the most efficient system-between mechanical digestion procedures-thanks to the highest amount of cells obtained with fewer cell structure damage, producing in vivo, the most volume maintenance after 1 year. Enzymatic digestion produced the best number of AD-SVFs and the best fat volume maintenance.
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目前，存在几种旨在获取纯化组织的自体脂肪移植（A-FG）制备技术。通过离心、过滤进行的机械消化以及酶消化都被认为是最有效的方法，它们对成人脂肪来源的基质血管成分细胞（AD-SVFs）数量以及体积维持有不同影响。
本文旨在报告通过基于离心、过滤、离心结合过滤以及酶消化的四种不同AD-SVFs分离和A-FG纯化程序所获得的以脂肪体积维持和AD-SVFs数量为代表的体内和体外结果。
进行了一项前瞻性病例对照研究。总共80例面部和乳房软组织缺损患者接受了A-FG治疗，并分为四组：20例接受通过酶消化获得的AD-SVFs增强的A-FG治疗（研究组1 [SG-1]）；20例接受通过离心结合过滤获得的AD-SVFs增强的A-FG治疗（SG-2）；20例接受通过仅过滤获得的AD-SVFs增强的A-FG治疗（SG-3）；20例接受根据科尔曼技术仅通过离心获得的A-FG治疗（对照组[CG]）。在最后一次A-FG治疗后12个月，通过磁共振成像（MRI）分析体积维持百分比。使用血细胞计数器对分离的AD-SVF群体进行计数，并将细胞产量报告为每毫升脂肪中的细胞数。
从相同量（20 mL）的分析脂肪开始，SG-1中获得50,000±6956个AD-SVFs/mL；SG-2中为30,250±5100个AD-SVFs/mL；SG-3中为33,333±5650个AD-SVFs/mL，而CG中为500个AD-SVFs/mL。在用通过自动酶消化获得的AD-SVFs增强的A-FG治疗的患者中，观察到1年后脂肪体积恢复维持率为63%±6.2%，而使用离心结合过滤为52%±4.6%，仅使用离心（科尔曼法）为39%±4.4%，仅使用过滤为60%±5.0%。
体外AD-SVFs细胞分析表明，在机械消化程序中，过滤是最有效的系统，因为它在细胞结构损伤较少的情况下获得的细胞数量最多，在体内产生1年后最大的体积维持。酶消化产生的AD-SVFs数量最多且脂肪体积维持最佳。
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