颗粒脂肪移植在预防深部组织粘连中的作用研究肖静

中国美容医学2012年12月第21卷第12期(上)Chinese Journal of Aesthetic Medicine.Dec.2012.Vol.21.No.12

外伤是临床常见的疾病，常伴有肌肉、肌腱的损伤，特别是手前臂等外露部位损伤可累及皮肤、肌腱、肌肉组织，修复术后由于患肢制动，创伤愈合后局部极易形成粘连，影响活动和外观。另外颈部和眼睑部手术后也易形成皮肤与深部组织的粘连，需手术松解矫正。传统治疗方法需沿原手术切口切开皮肤，松解增生粘连瘢痕组织，但术后由于皮肤和深部组织之间缺乏脂肪组织或筋膜组织，皮肤创口处与深层组织直接接触，伤口愈合后粘连易复发。临床上，自体颗粒脂肪移植较常用于组织的修复以及组织瘢痕预防，已有研究利用自体颗粒脂肪修复多种畸形的重睑以及眼睑内畸形，包括修复局部粘连所引起的畸形，并取得满意的临床治疗效果［１－２］。为此，笔者采用自体颗粒脂肪移植技术处理瘢痕粘连松解术后再发粘连问题，获得较好的临床效果，现报到如下。

１资料和方法

１．１一般临床资料：１５例瘢痕与深部组织粘连形成患者为暨南大学附属第一医院整形外科和广州军区广州总医院整形外科住院患者，均有明确的外伤或手术史，并伴有肌腱断裂

·论著·

颗粒脂肪移植在预防深部组织粘连中的作用研究

肖静１，李升红１，刘宏伟１，程飚２，肖丽玲１

（１．暨南大学附属第一医院烧伤整形外科·再生医学教育部重点实验室广东广州５１０６３０；２．广州军区广州总医院整形外科）

［摘要］目的：探讨自体脂肪颗粒组织移植预防瘢痕与深部组织粘连松解术后再发生粘连的方法和效果观察。方法：２０１０年８月～２０１１年４月期间，笔者对符合条件的１５例皮肤外伤或手术后瘢痕与深部肌肉和腱性组织粘连的病例采用原瘢痕处小切口，仔细分离松解皮下粘连组织，并在粘连处形成皮下袋，将经２０ｍｌ注射器抽吸得到的下腹部脂肪颗粒用２ｍｍ内径注射针注入到分离的皮下袋内，移植的自体脂肪颗粒作为隔离层填充于原粘连组织间，缝合伤口，术后随访３～６个月。结果：术后随访病例检查未发现粘连复发，并发现局部皮肤质地及活动度明显改善。结论：脂肪颗粒是预防瘢痕与深部组织粘连松解术后粘连复发粘连的理想材料，有良好的生物相容性。具有防止或减轻术后粘连、改善肌腱滑动的作用，同时还可改善局部皮肤组织修复的质量，是简单易行的粘连松解和防复发的方法，值得推广。

［关键词］颗粒脂肪；瘢痕；创伤愈合；组织移植

［中图分类号］Ｒ６２２［文献标识码］Ａ［文章编号］１００８－６４５５（２０１２）１２－２１６７－０３

Autologous particle fat transplantation for preventing postoperative adhesion recurrence

between cutaneous scar and deep tissue

XIAO Jing1,LI Sheng-hong1,LIU Hong-wei1,CHENG Biao2,XIAO Li-ling1

（1.The First Affiliated Hospital of Jinan University,Key Laboratory for Regenerative Medicine,

Ministry of Education,Huangpu West Road613,Guangzhou510630,Guangdong,China；2.Department of Plastic Surgery,

Guangzhou General Hospital of PLA)

Abstract:Objective A clinical study was done to explore management for preventing postoperative adhesion recurrence between cutaneous scar and deep tissue.Methods During of August2010to April2011,A group of15 patients with scar adhesion between skins and deep tissue after traumatic or operation were included in this study.The particle fat was harvested from the abdomen by20ml syringe suction using2mm inner diameter cannula.Less than1cm incisions in the original scar of operation or trauma were done,the adhesions cutaneous scar and deep tissues under the scars were separated to form compartment,in which the particle fat was transplanted.Then,the harvested autologous particles fat is injected into the cutaneous compartment,the incisions were closed with0-nylone suture.All patients received only one treatment.11cases of15were followed up3to6months after operation.Results Adhesion recurrence was not found in follow-up cases.Moreover,improvement of local skin texture was found.Conclusion The particles fat transplantation is an ideal management for preventing scar and deep tissue adhesion,which could prevent or reduce the adhesion,and improve the sliding function of tendons and local skin texture.Further long-term studies are necessary to confirm the favorable results seen in this study.

Key words:lipotransfer;scar;wound healing;tissue transplantation

通讯作者：刘宏伟，副主任医师，博士研究生导师；研究方向：组织再生与创面愈合；Ｅ－ｍａｉｌ：ｌｉｕｈｏｎｇｗｅｉ０５２１＠ｈｏｔｍａｉｌ．ｃｏｍ

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