Fat and Dermis Grafting in Oral and Maxillofacial Surgery

Abstract

SUMMARY Autogenous fat, dermis, and their combination have a long-established ability to survive transplantation. The tissues are abundant in supply, are readily harvested from multiple sites, and are easily adaptable to most areas of the maxillofacial region. They have found application primarily in immediate or delayed correction of soft tissue defects, prevention or correction of scar contraction, protection of vital structures, and augmentation of facial contours. The graft bulk is rather easily modified, and the proce-dures can be repeated if necessary. Use of these tissues causes only moderate morbidity to the patient at either donor or host sites. The histologic potentials for foreign body excitation or pathologic proliferation of epidermal inclusions, while consistently demonstrated on a transient microscopic basis in myriad investigations, rarely lead to clinical consequence. The chief biologic shortcoming of these tissues is their unpredictable degree of resorption/atrophy in the long term, particularly in regard to fat alone. This uncertainty is aggravated by the facts that, despite myriad very good histologic investigations, long-term clinical evaluations of any one technique on significant numbers of patients have not been done, and objective criteria for evaluating long-term esthetic effects have not been established. Fat and dermal-fat grafts often do not assume the character of the tissues they replace and in many cases impart an unnatural texture to their host sites. Generally speaking, small grafts of fat and/or dermis are more stable and predictable in behavior than are larger grafts. Despite their disadvantages, however, and the emphasis on and great clinical activity in microvascular grafting today, free grafts of dermis, fat, and their composite still find appropriate application in several established clinical circumstances.