背景:色素性瘢痕,特别是在暴露的身体区域,很难掩盖,可能会引起心理困扰。虽然疤痕色素异常的确切原因尚未完全了解,黑色素生成活性的改变似乎比黑色素细胞数量的改变更重要。目前的治疗包括激光干预。然而,必须考虑它们的成本和潜在的并发症,因为它们有限的已证明的有效性。由于其再生特性,脂肪移植作为疤痕调制技术已经引起了人们的兴趣,目前正在研究其减少瘢痕色素沉着的功效。
方法:根据PRISMA指南进行系统评价和荟萃分析。PubMed,Embase,并访问了Cochrane图书馆数据库。PROSPERO注册号是CRD42023457778。主要结果是脂肪移植后瘢痕色素沉着的变化。根据POSAS和VSS量表,使用基线和术后评分之间的标准化平均差(SMD)计算脂肪移植后的色素沉着变化。根据美国国立卫生与临床卓越研究所的质量评估工具进行偏差评估。
结果:共确定了8篇符合纳入和排除标准的文章,涉及323例色素沉着性瘢痕患者,接受脂肪移植治疗。根据观察者的评级,脂肪移植治疗后,瘢痕色素沉着有显著差异。SMD为-1.09[95%CI:-1.32;-0.85],p<0.01。脂肪移植治疗后患者报告的瘢痕色素沉着的SMD为-0.99[96%CI:-1.31;-0.66],p<0.01。四项研究提供了脂肪移植后黑色素变化的客观测量,并揭示了与主观观察结果不一致的发现。
结论:基于主观评估,脂肪移植有望改善色素沉着瘢痕,但是需要客观措施的进一步佐证。
方法:本期刊要求作者为每篇文章分配一定程度的证据。对于这些循证医学评级的完整描述,请参阅目录或在线作者说明www。springer.com/00266.
BACKGROUND: Hyperpigmented scars, particularly in exposed body areas, can be difficult to conceal and may evoke psychological distress. While the precise causes of scar dyschromia are not fully understood, alterations in melanogenic activity appear to hold more significance than changes in melanocyte quantity. Current treatments encompass laser interventions. However, it is essential to consider their costs and potential complications in relation to their limited proven effectiveness. Fat grafting has gained interest as a scar modulation technique due to its regenerative properties, and its efficacy in reducing scar hyperpigmentation is currently under investigation.
METHODS: A systematic
review and meta-analysis was reported according to PRISMA guidelines. PubMed, Embase, and Cochrane Library databases were accessed. PROSPERO registration number is CRD42023457778. The primary outcome was a change in scar
pigmentation after fat grafting.
Pigmentation changes after fat grafting were calculated using the standardized mean difference (SMD) between baseline and postoperative scores according to POSAS and VSS scales. Bias assessment was conducted according to the National Institute for Health and Clinical Excellence quality assessment tool.
RESULTS: A total of 8 articles meeting inclusion and exclusion criteria were identified, involving 323 patients with hyperpigmented scars treated with fat grafting. A significant difference in scar
pigmentation was noted after treatment with fat grafting according to observers\' ratings, with a SMD of - 1.09 [95% CI: - 1.32; - 0.85], p<0.01. The SMD for patient-reported scar
pigmentation after treatment with fat grafting was - 0.99 [96% CI: - 1.31; - 0.66], p<0.01. Four studies provided objective measurements of melanin changes after fat grafting and revealed inconsistent findings compared to subjective observations.
CONCLUSIONS: Fat grafting shows promise in ameliorating hyperpigmented scars based on subjective assessments, but further corroborating evidence from objective measures is required.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .