Abstract
INTRODUCTION: Pedal fat pad atrophy impacts function, pain, and appearance. We previously published clinical trial data demonstrating that pedal fat grafting improves pain and quality of life, despite loss of grafted fat.1 Benefits of fat grafting may be attributed to resultant changes in fat pad or dermal thicknesses.2,3 We hypothesize that these changes may account for the prolonged improvement in pain and quality of life in patients with pedal atrophy following fat grafting. METHODS: Patients with pedal atrophy were enrolled in a randomized cross-over clinical trial. Group 1 underwent fat grafting upon enrollment with 2-year follow-up. Group 2 was managed conservatively for 1 year then crossed-over into the fat grafting group with 1-year follow-up. Fat was harvested and injected into each forefoot. Patients followed-up with ultrasounds at 1, 2, 6, and 12 months post-injection, with Group 1 continuing to 18- and 24-month follow-up. Additionally, the Manchester Foot Pain and Disability Index, a validated survey assessing foot pain and function, was administered to patients. RESULTS: 3 men and 20 women were enrolled with an average age of 63 ± 6 years. The average BMI was 26.0 ± 4.6 kg/m2. 26 and 17 feet were injected in Groups 1 and 2 respectively. There was no variance in BMI or age between groups. In Group 1, fat pad thickness returned to baseline by 12 months post-injection (p<0.05). In Group 2, fat pad thickness returned to baseline by 2 months post-injection, though fat pad thickness decreased prior to injection (p<0.05). In Group 1, dermal thickness increased by 6 months post-injection (p<0.05). This increase persisted through 24 months. In Group 2, dermal thickness decreased prior to injection, but increased to baseline after injection through 12-month follow-up (p<0.05). Group 1 had improved pain and function by 1 month post-injection that was maintained through 24 months (p<0.05). Group 2 had improvement in these measures by 2 months post-injection that was maintained through 12 months (p<0.05). CONCLUSION: In both groups, fat grafting for pedal atrophy positively impacted pain and function. These measures demonstrated a persistent improvement, though fat volume returned to baseline. This finding may be attributed to the observed increase in dermal thickness. Together, these results suggest that fat grafting may thicken or stabilize the dermis, contributing to improved clinical outcomes despite loss of grafted fat. Reference Citations: 1. Gusenoff JA, Mitchell RT, Jeong K, Wukich DK, Gusenoff BR. “Autologous Fat Grafting for Pedal Fat Pad Atrophy: A Prospective Randomized Clinical Trial.” Plastic and Reconstructive Surgery Journal. 2016. 138: 1099–1108. 2. Coleman SR. “Structural Fat Grafting: More Than a Permanent Filler.” Plastic and Reconstructive Surgery Journal. 2016. 118: 108-120S. 3. Mojallal A, Lequeux C, Shipkov C, et al. “Improvement of Skin Quality after Fat Grafting: Clinical Observation and an Animal Study.” Plastic and Reconstructive Surgery Journal. 2009. 124: 765–774.
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