The neglected “Free fat graft,” Its behavior and clinical use

Abstract

Summary In the author's experience, free autogenous fat grafts with overlying dermis provide the best available grafting material to substitute for soft tissue deficiencies in the cheeks and breasts where a soft, even contour is required. There are apparently conflicting viewpoints regarding the origin, replacement and activities of white adipose tissue. Adipose tissue is regarded by some as merely ordinary connective tissue in which fat has been deposited, and by others as an independent tissue to a large extent, more on the order of the ductless glands. The structural properties of fatty tissue, as its individuality, the regeneration of the fat cell, the storage of fat and changes in fat content, are discussed. Free abdominal adipose grafts take on fat when the abdominal donor site takes on a load of fat. Conversely, if the patient loses abdominal fat, the transplant also gives up sonic of its stored fatty material. Preoperative fat-free reducing diets are recommended for patients who are to have free abdominal fat transplantations, this being advantageous for the “take” of the graft. All of the living cells in fresh homogenous fat grafts die. after transplantation and the graft structure is replaced by host fibrous tissue. About So per cent of the fat cells in free autogenous fat grafts survive and these constitute the adipose cells in fat grafts in eight to twelve months following transplantation. The new blood circulation in free autogenous fat grafts arises at about the fourth day through anastomosis between host and graft blood vessels. Success in the take of the fat graft is conditioned by selection of the host site, considerations in the grafting procedure and certain clinical measures. With proper management, large massive abdominal fat grafts with attached dcrmis may “take” almost as well as small adipose grafts. It may be advantageous to “delay” adipose tissue before transplanting it as a free graft.