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A practical classification for the surgical filling of facial lipoatrophy
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7th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV. November 13-16, 2005, Dublin, Ireland
J Fontdevila1, E Martinez 2, JM Rubio-Murillo1, A Milinkovic 2, JM Serra-Renom1 and J Gatell 2 1Plastic Surgery Department, Hospital Clinic, University of Barcelona, Barcelona, Spain; 2Infectous Diseases Unit, Hospital
Clinic, University of Barcelona, Barcelona, Spain
ABSTRACT 42
Antiviral Therapy 2005; 10:L28
Background: The surgical filling in HIV-associated facial lipoatrophy is hampered by the lack of easily available tools that reflect the degree of lipoatrophy and the amount of filling substance needed.
Methods: We have developed an anatomical-based, easily applicable classification for facial lipoatrophy. The proposed classification included four categories: 0 - slight protrusion of malar skin from the lower orbitary cavity to
the nasogenian fold; 1 - flattening of malar protrusion; 2 - sinking of cheek skin under the malar bone; and 3 - deep sinking of cheek skin with evidence of zygomatic major muscle. We tested the concordance level per each category with the kappa coefficient among different investigators previously trained on the use of the facial lipoatrophy classification. We assessed the correlation with the
Spearman rank test between the degree of lipoatrophy according to the classification (using the arithmetic mean of each patient‘s scores) and the total amount of fat placed in each patient that had undergone surgical filling.
Results:
--Standardized front and side facial photographs were taken of 110 patients. Nine investigators, including HIV physicians and plastic surgeons, scored each patient's photographs from 0 to 3.
--There were 1181 of 3174 (37%) valid patients with facial lipoatrophy.
--Concordance levels for each category were: category 0, kappa 0.89, P<0.0001;
category 1, kappa 0.99, P<0.0001; category 2, kappa 0.54, P<0.0001; and category 3, kappa 0.73, P<0.0001.
--Autologous fat was placed in 58 patients and, rounding the arithmetic mean of each patient's scores to the nearest whole number, their categories were: category 1, n=17, 24.7 ±12.4 cc; category 2, n=29, 31.2 ±13.6 cc; category 3,
n=12, 33.2 ±11.8 cc (P=0.157).
--There was a significant correlation between the arithmetic mean of each patient's scores and the total amount of fat placed in each patient that had undergone surgical filling (P=0.012).
Conclusions: The proposed anatomical-based classification for facial lipoatrophy is easily applicable, shows good reproductibility among different investigators and its categories are significantly correlated with the amount of fat needed.
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