Clinical Study And Discussion Of Cell-assisted Lipotransfer In The Treatment Of Cicatricial Facial Depression And Atrophy

Background:Facial depression and atrophy is a deformity whose main characteristics are loss of facial soft tissue,depression and atrophy.It is caused by congenital factors,infection,trauma and iatrogenic injury.Facial depression and atrophy caused by cicatrix are commonly seen in clinically study.Facial hyperpigmentation,hypopigmentation,loss,and texture changes caused by cicatrix have seriously affected the appearance and function of the patients.There are different kinds of the methods,the common methods mainly include dermabrasion,laser treatment,soft tissue transplantation and filling,filler injection and surgical correction,etc.The above treatment could improve the facial deformity to some extent,however,it is unlikely to fundamentally improve the texture of cicatrix.After treatment,there may be adverse reactions such as hyperpigmentation,contracture and synechia of cicatrix,rejection to the foreign objects,inflammation.Since the invention of fat transplantation technology,it has been widely used in facial rejuvenation,cicatrix treatment,breast reconstruction,etc.,for it has abundant sources with simple operation,satisfactory filling effect and good histocompatibility.In recent years,with the deepening research on autologous fat transplantation technology,various reformed techniques for improving the survival rate of fat have emerged in endlessly,which has led to the rapid development of treatment in various fields.The proposal of Cell-assisted lipotransfer?CAL?technology has further advanced fat transplantation technology into the era of stem cell.The core of the theory is to obtain stromal vascular fraction and various cellular components,especially ADSCs,through physical or chemical methods,mix and transplant with fat after further purification and concentration,using its physiological mechanism and biochemical characteristics to improve the treatment effect of fat transplantation to achieve more efficient use of autologous fat,while reducing the incidence of complications at the same time.Nanofat is a method of mechanically emulsification to destroy mature large-sized fat cells in adipose tissue to obtain ADSCs by concentration.It is a relatively novel method for realizing CAL technology.This article collected the cases of traditional autologous fat transplantation and nanofat-assisted fat transplantation in the treatment of cicatricial facial depression and atrophy from January 2012 to April 2018 in Department of Plastic Surgery,the First Affiliated Hospital of the Army Military Medical University,and established animal models to simulate pathological conditions to obtain results of CAL technical treatment.Objective:This study explores and evaluates the effect of stem cell in treatment and the advantages of nanofat-assisted autologous fat transplantation technology?CAL?in the treatment of cicatricial facial depression and atrophy through clinical observational studies and animal model simulation experiments and comparing the short-term and long-term effects of traditional fat transplantation techniques in the treatment of cicatrix facial depression and atrophy.At the same time,the study conducts preliminary research on the mechanism and effect of stem cells in treatment.Methods:1.Clinical study:including review on 105 cases with facial fat transplantation in the Department of Plastic Surgery,the First Affiliated Hospital of the Army Military Medical University from January 2012 to April 2018?54 cases in the traditional surgery group and51 in the CAL group?;the follow-up survey on the degree of satisfaction in March and June;comparison between image data and secondary surgery rate and statistical analysis.2.Animal experiments:including rat ADSCs cultured in vitro;the properties identification after stable passage for standby application.Eighteen 4-week-old male SD rats are randomly and equally divided into ADSCs transplantation group,cicatricial model group and control group,and each group is provided corresponding drug treatment to establish a control model.After continuous treatment for 28 days,fresh skin tissue of rats is embedded in paraffin and made into slices,used for immunohistochemistry and histopathological observation.Results:1.The situation of all patients with facial depression and atrophy have been improved after treatment.The patients of CAL group have no complications such as effusion in surgery areas,hematoma and adiponecrosis.The fullness of adipose cell and microvascular regeneration are better than the traditional surgery group when observed under the electron microscope.The patient's satisfaction six months after surgery in the CAL group is?78.43%of satisfaction,13.73%of general satisfaction and 7.84%of dissatisfaction?higher than the traditional surgery group?55.56%of satisfaction,24.07%of general satisfaction,and 20.37%of dissatisfaction??P<0.05?,while the secondary surgery rate?7.84%?of CAL group is lower than the traditional surgery group?22.22%??P<0.05?.The statistical results have statistical significance.2.Stable passage cells could be obtained from culturing in vitro cell.Cell morphology and immunofluorescence staining clearly show the morphological characteristics of the cells cultured.Through flow cytometry identification,the passage cells express ADSCs common immune markers CD29,CD44.Induced differentiation experiments prove that the experimental cells still retain the potential for multidirectional differentiation after serial subcultivation.3.Masson's Trichome staining shows that the dermal collagen fibers,inflammatory cells and myofibroblasts in the ADSCs transplantation group are increased compared with the blank control group,however the thickness of collagen fibers,permutation or cellular components are closer to the normal tissues of the control group than the scar model group.The overall situation is between that of the control group and the cicatricial model group.The fiber bundles are arranged close to the control group and a small amount of inflammatory cells could be observed.Immunohistochemistry shows that the expressio n of TGF-?₁ and?-SMA are significantly inhibited in the cicatricial tissue of ADSCs group,and collagen fibrosis and inflammatory infiltration are also slighter than those in the cicatricial model group.Conclusion:CAL technology can effectively improve the long-term survival rate of transplanted fat,while reducing and avoiding postoperative complications.Among them,ADSCs can effectively improve the cicatrix texture,inhibit the growth of collagen fibers and reduc e the infiltration of inflammatory cells in areas with cicatrix.CAL technology has obvious advantages over traditional fat transplantation operation in the capacity filling of cicatricial facial depression and atrophy and improvement of cicatrix texture,worth popularizing.