Tsimponis Antonios, Dionyssiou Dimitrios, Papamitsou Theodora, Demiri Efterpi
Department of Plastic Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki Greece.
Laboratory of Histology-Embryology, Aristotle University of Thessaloniki, Greece.
JPRAS Open. 2023 Sep 12;38:134-146. doi: 10.1016/j.jpra.2023.08.009. eCollection 2023 Dec.
Because lipofilling is often associated with various reconstructive procedures, especially breast reconstructions, improving fat-graft retention remains a major concern for plastic surgeons. We conducted an experimental protocol in a rat model simulating an autologous breast reconstruction method using the fat-augmented latissimus dorsi myocutaneous (LDM) flap. This study aimed to compare the survival rates of autologous adipocytes when injected subcutaneously and intramuscularly and to evaluate the role of recipient host tissue, volume of the injected fat, and postoperative radiation on fat-graft retention. Thirty rats were divided into five groups (A, B, C, D, and E), of six rats each. All animals underwent a pedicled LDM flap transfer to the anterior thoracic wall, and different volumes of autologous fat were injected into three recipient areas, namely, the pectoralis major and latissimus dorsi muscles and the subcutaneous tissue of the flap's skin island, as follows: 1 mL of fat was injected in total in group A, 2 mL in groups B and D, and 5 mL in group C. Group D animals received postoperative radiation (24 Gy), whereas group E animals (controls) did not undergo any fat grafting procedure. Eight weeks after surgery, adipocyte survival was assessed in all groups using histological and immunochemistry techniques. The results showed that the pectoralis major muscle was the substrate with the highest adipocyte survival rates, which were proportional to the amount of fat injected, followed by the latissimus dorsi muscle and the subcutaneous tissue. Increased volumes of transplanted fat into the subcutaneous tissue did not correspond to increased adipocyte survival. Irradiation of host tissues resulted in a statistically significant decrease in surviving adipocytes in all three recipient sites (p<0.001). Our study strongly suggests that muscle ensures optimal fat-graft retention, whereas postoperative radiation negatively affects adipocyte survival following fat transplantation.
由于脂肪填充常常与各种重建手术相关，尤其是乳房重建，因此提高脂肪移植的留存率仍是整形外科医生主要关注的问题。我们在大鼠模型中开展了一项实验方案，模拟使用脂肪增强的背阔肌肌皮瓣（LDM）的自体乳房重建方法。本研究旨在比较皮下注射和肌肉注射时自体脂肪细胞的存活率，并评估受体宿主组织、注射脂肪量和术后放疗对脂肪移植留存率的作用。30只大鼠被分为五组（A、B、C、D和E组），每组6只。所有动物均接受带蒂LDM瓣转移至胸前壁，并将不同体积的自体脂肪注射到三个受体区域，即胸大肌、背阔肌以及皮瓣皮岛的皮下组织，具体如下：A组共注射1 mL脂肪，B组和D组注射2 mL，C组注射5 mL。D组动物接受术后放疗（24 Gy），而E组动物（对照组）未进行任何脂肪移植手术。术后8周，使用组织学和免疫化学技术评估所有组的脂肪细胞存活率。结果显示，胸大肌是脂肪细胞存活率最高的基质，其存活率与注射的脂肪量成正比，其次是背阔肌和皮下组织。皮下组织中移植脂肪量的增加与脂肪细胞存活率的增加并不对应。宿主组织的放疗导致所有三个受体部位存活脂肪细胞数量在统计学上显著减少（p<0.001）。我们的研究强烈表明，肌肉可确保最佳的脂肪移植留存率，而术后放疗会对脂肪移植后的脂肪细胞存活产生负面影响。
