自体脂肪移植在面部静脉畸形注射平阳霉素后继发组织缺损中的临床应用

Application of autologous fat transplantation in facial tissue defect caused by PYM injected into facialvenous malformation

目的探讨自体脂肪注射移植修复面部静脉畸形注射平阳霉素后继发组织缺损的应用策略及技巧。方法自2011年5月至2014年12月，对收治的5例面部静脉畸形注射平阳霉素后（4—14年）继发组织缺损患者，采用自体脂肪移植并分期联合皮瓣转移及假体置入等方法进行综合性修复。其中，2例接受2次自体脂肪注射移植（间隔6～24个月）；2例接受1次自体脂肪移植及Ⅱ期任意皮瓣的修复；1例接受2次自体脂肪移植及1次假体置入隆颏术。结果所有患者术后切口均I期愈合。随访6～12个月，组织瓣成活良好，脂肪无感染及囊肿发生。采用单纯脂肪移植者，其外形及组织量有一定改善；采用分期联合脂肪注射与皮瓣、假体的综合修复后，效果满意。结论采用自体脂肪注射移植能够改善静脉畸形因注射平阳霉素继发软组织缺损区域内的血供及组织容量，在一定程度内改善了外形。对中、重度软组织缺损者，同时伴有解剖结构缺失、骨性发育不足等，需联合皮瓣、假体置入等综合技术修复，才能达到外形满意。因此，自体脂肪移植具有增加假体表面软组织覆盖，促进发育，增加血供，缓解瘢痕挛缩等辅助作用。

Objective To explore the application of autologous fat transplantation （AFT） in correction of facial tissue defects caused by PYM injected into vascular malformation of children together with other procedures. Methods Five children with facial tissue defects caused by PYM injection for treating the vascular malformation were treated by AFT with or without flap and implant according to the size and location of the defects. Among them, 2 patients received twice AFT （ interval of 6 to 24 mouths）, 2 patients received once AFT and second-stage flap repair, 1 patient received twice AFT and a chin augmentation with prosthesis. Results All incisions healed well primarily. The patients were followed up for 6 to 12 months. There were no infection and cysts occurring. These patients with only fat transplantation were satisfied with the improved shape, showed good results, while the others with combined repairs of fat injection, flap and prosthesis were very satisfied with the good results. Con- clusion AFT can improve the blood supply and the soft tissue capacity in soft tissue defects caused by PYM in- jection within certain degree. As moderate to severe tissue defection usually has anatomical structures missing and the shortage of osseous tissue development, simply using of AFT is not effective enough, then comprehensive re- pair, including AFT, flaps and implant angrnentation could highly improve the appearance and the patients＇satis- faction. In that condition, the transplanted fat provides better coverage of the implant, promote growth, increase the blood supply and reduce sear contracture and other auxiliary function.