Fat and Stromal Vascular Fraction of Adipose Tissue in Reconstructive and Regenerative Surgery: 5 Years Experience

Abstract

BACKGROUND The aim of this study is to estimate possible ways of using fatty tissue and its cell derivatives in reconstructive and regenerative surgery. MATERIALS AND METHODS: Since 2010, fat grafting was performed in 140 patients. Posttraumatic, postoperative, and postirradiated contour deformities were treated in 74 cases (breast, 31; head and neck, 27; and other localizations, 16). In 61 patients, fat was injected to promote chronic wound healing (venous ulcers, 22; diabetic ulcers, 17; radiation wounds, 16; and other etiology, 6). Adipose-derived stromal vascular fraction (SVF) injection was utilized in 11 patients: knee joint osteoarthritis, 7; radiation rectovaginal fistula, 2; rectum radiation wound, 1; and right leg chronic wound (Wegener’s granulomatosis), 1. Fat was harvested by liposuction. Lipoaspirate was centrifuged with 1200g during 3 minutes. Liquid fraction and oil were removed. Coleman type 1 and 3 cannulas of 0.8, 1.0, 1.2, 1.6, and 2.0 mm diameter were used to inject purified fatty tissue. Occasionally sharp needle was used. Digestion with collagenase type II was performed to isolate stromal-vascular cell fraction. Stromal cell sediment was then resuspended in a saline solution and injected with sharp 18- to 27-gauge needles. A small sample was taken out of the obtained cells to characterize final product by means of flow cytometry. Conventional treatment methods were used in all cases before experimental technique was applied. RESULTS For the group of patients with contour deformities, the required result was achieved in all cases. The number of sessions depended on lesion severity and varied from 1 to 8. All cases with combined deformities (cicatrical and irradiated damage) were the most persistent to correct. Complete wound healing was achieved in all patients with chronic radiation wounds. However, among the patients with lower extremities chronic wounds, the final result depended on etiology, ie, complete healing was achieved in 71% cases for diabetic wounds and in 46% of cases for venous congestion wounds. SVF was utilized in cases when fatty tissue injection was impossible to use because of specific local anatomy. Thus, to treat rectum radiation lesions, fat and SVF were injected into the deep planes of rectovaginal septum and rectum mucosa, respectively. Complete healing was achieved for both rectovaginal fistulas and rectum wounds. Injection of SVF into the knee joint has resulted in pain release, improvement of joint mobility, and physical activity of affected extremity. CONCLUSIONS In our opinion, fat grafting should be a method of choice for any contour deformities correction regardless of its severity. Fat injection also turned out to be a very effective tool for stimulating chronic wounds healing. Using the SVF of adipose tissue opens the new opportunities in regenerative surgery.