Lipofilling (fat grafting) in the prevention of ischial tuberosity pressure ulcers in patients with spinal cord injury

Abstract

To evaluate the efficacy of lipofilling technique (fat grafting) in the prevention of ischial tuberosity pressure ulcers Eleven consecutive patients presenting with chronic spinal cord injury (SCI) benefited from bilateral ischial lipofilling, using the Coleman technique. There were 9 paraplegic and 2 tetraplegic patients, 2 women for 9 men. Mean time since SCI was 22 years (5–39 years). They all had a history of ischial tuberosity pressure ulcer surgery (unilateral or bilateral). All patients attended a seating clinic with pressure mapping, before surgery and at follow-up. Autologous fat was taken from the abdomen, thighs or hips through liposuction. The removed fat was then concentrated and grafted in tiny amounts within the interstitial tissues underneath the ischial tuberosities. The procedure was performed under a local or general anaesthetic in one session. There were no significant side-effects or complications. Mean follow-up time was 13 months (1–24 months). No patient developed any pressure ulcers during this period. Nine patients showed persistent ischial tuberosity fat issue remodelling. Pressure mapping found improvement in the seated buttock pressure distribution in most of them. Two patients showed significant fat wasting on clinical assessment. Lipomodelling and lipofilling have become widely applied in reconstruction following breast cancer surgery, or cosmetic augmentation. To our knowledge, this is the first time this technique has been used in the prevention of pressure ulcers in patients with SCI, and our early results are very encouraging.