Autologous Augmentation Research Articles

Reliability of Chest Wall Perforator Flaps for Breast Reshaping following Massive Weight Loss

Abstract Background Breast deformity following massive weight loss poses a unique challenge inadequately managed by traditional methods. Patients also have considerable lateral and posterior upper trunk tissue surplus. Multiple studies have used chest wall flaps for auto-augmentation with mastopexy to tackle this problem. However, the outcome measures did not include any objective tools to assess the reliability of these flaps. Hence, in this study sono-mammography and breast anthropometric measurements are used for evaluation of the added volume and long-term sustainability of chest wall perforator flaps. Methodology Twenty massive weight loss patients with Pittsburgh Rating Scale score 2-3 underwent mastopexy with autologous augmentation through perforator flaps encompassing lateral chest wall skin. Outcome measures were breast volume, and the presence of fat necrosis on mammography, and direct breast anthropometry. Conclusion All patients showed a consistent increase in volume postoperatively and no fat necrosis in postoperative mammography, reflecting flap reliability over one year of follow-up. All postoperative anthropometric measurements showed improvement in the breast deformities addressed. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Explantation with Concomitant Autologous Augmentation Mammoplasty Utilizing De-epithelialized Intercostal Perforator (IP) Flaps

Explantation with Concomitant Autologous Augmentation Mammoplasty Utilizing De-epithelialized Intercostal Perforator (IP) Flaps

Contralateral Autologous Augmentation in DIEP Flap Reconstruction: Employing CT Angiography & Volumetric Analysis for Preoperative Planning.

Autologous reconstruction accounts for approximately 20% of all breast reconstruction. In cases of unilateral reconstruction, contralateral breast augmentation using autologous tissue can be performed to improve symmetry and is a viable option for patients interested in having more volume relative to their current size without the use of implants. CT scans have been used for preoperative planning for autologous reconstruction to evaluate available perforators. In this study, we report our experience using CT angiography for preoperative volumetric assessment for autologous contralateral breast augmentation in the setting of unilateral autologous breast reconstruction. Twelve patients underwent autologous augmentation during the study period. The average reconstruction flap weight was 561.2±253.6 grams, while the average augmentation flap weight was 218.0±133.7 grams. No patients experienced flap loss and we demonstrate that the predicted volumes for the augmented and reconstructed breasts were comparable to the actual respective flap volumes. Additionally, post-operative patient-reported outcome measures demonstrate high levels of satisfaction across multiple BREAST-Q subscales. This study demonstrates the utility of using CT angiography to estimate reconstructive volumes to help preoperative planning and achieve predictable postoperative breast volumes. It also supports that contralateral autologous augmentation is a good option for patients who would like to avoid implants and are interested in a small to moderate increase in size.

Autologous islanded breast enhancement by reversed abdominoplasty (AIBERA) flap

We present a surgical technique of recuperating tissue from the upper abdominal wall, based on the superior epigastric artery perforators, thereby providing tissue for autologous augmentation of the breasts in combination with reversed abdominoplasty in patients after massive weight loss. A 20-year-old woman was seen in the outpatient clinic with a large residual skin laxity of the superior abdomen following circular abdominoplasty after weight loss of 55 kg. She was dissatisfied with the appearance of her breasts and superior abdomen. Bilaterally, pedicled SEAP flaps were harvested from the epigastric region. In addition, a reversed abdominoplasty was performed. The flaps were secured in a retroglandular pocket superiorly to the anterior chest wall in order to augment the breasts. The islanded pedicled SEAP flap in combination with reversed abdominoplasty is a useful and safe technique for autologous breast augmentation following massive weight loss. In addition, the potential risk of implant-related complications is eliminated as implants are replaced by autologous tissue. Level of evidence: Level V, therapeutic study.

Mastopexy with Autologous Augmentation in Women After Massive Weight Loss: A Randomized Clinical Trial.

Breast reshaping or mastopexy following massive weight loss can be challenging. The LOPOSAM (lower pole subglandular advancement mastoplasty) technique has shown promising results for correction of ptotic, wide, lateralized and deflated breasts following massive weight loss. We compared the LOPOSAM technique to the mastopexy technique after massive weight loss described by Rubin JP, in a randomized trial. The main outcome measure was the total operative time. Secondary outcomes measures were socio-economic factors; length of hospital stay, numbers of sutures used, secondary corrective procedures, post-operative sick leave and surgeon- and patient-reported appearance of the breasts. We included 22 women: 11 operated on by the LOPOSAM technique and 11 by the technique described by Rubin JP. The total operative time was 84.8 (SD 12.2) minutes in the LOPOSAM group and 99.1 (SD 23.5) in the Rubin JP group (p = 0.074). There were no differences related to days with drains, length of hospital stay or sick leave between the two groups. The surgeon- and the patient-reported appearance of the breasts changed significantly between the pre-operative and the 12-month post-operative assessments. The LOPOSAM technique is a safe and quick surgical procedure for correction of ptotic, wide, lateralized and deflated breasts following massive weight loss and seems to provide results comparable to the better-known Rubin JP's technique. There was a trend that the LOPOSAM technique was faster to perform, however, not significant. The breast appearance improved significantly using both techniques when assessed by both surgeons and patients. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Combined Mastopexy and Augmentation with Autologous Fat Grafting: First Results with Lipopexy.

The treatment of breast ptosis and gland hypoplasia in a single surgery is a challenging procedure and the result is less predictable. In this surgery, the complications mainly concern the prosthesis, such as implant deflation, capsular contracture, palpability, or malposition. We, therefore, propose a different and new technique that avoids breast prosthesis, combining mastopexy and autologous augmentation with fat grafts. Combined mastopexy and autologous fat graft augmentation (lipopexy) was performed in women affected by breast ptosis and asymmetric breast or hypomastia. The breast lift technique was determined due to the ptosis level. The process of fat grafting was executed according to the PureGraft and, in some cases, to GID System, to Celution System or Carraway's techniques. Thirty-four patients affected by breast ptosis and hypomastia underwent lipopexy from January 2010 to May 2017. The mean volume of adipose tissue injected for each breast was 225.98 ml. After surgery, the patients were followed for an average of 22.8 months. A mild ptosis relapse with partial fat absorption was observed in 4 cases (11.76%) and the presence of oily cysts was diagnosed in 2 patients (5.88%). One severe complication was recorded (hematoma drainage). All the patients healed uneventfully in 2 weeks. This technique allows the surgeon to distribute the desired fat volume along the breasts, avoids implants, and displayed stable results. This treatment has been demonstrated not to interfere with follow-up breast imaging. We, therefore, consider lipopexy a valuable and safe alternative to mastopexy and mild to moderate breast volume augmentation.

A Technique Utilizing GraftNet to Fill Graft Donor Sites in Bone-Patellar-Bone Anterior Cruciate Ligament Reconstruction

Anterior knee pain and patella fracture are 2 potential complications of bone-patellar-bone autograft anterior cruciate ligament reconstruction. Techniques have been developed to minimize the risk of these complications, including filling the defects with autologous bone fragments and augmenting with biologic agents. We have developed a technique that uses a graft collection device to collect the autologous bone graft generated during surgery. This graft augments the larger bone graft derived from the bone plugs. This autologous augmentation provides a complete biologic strategy to potentially reduce the risk of anterior knee pain and potential patella fracture.

The Influence of Thrust Force on the Vitality of Bone Chips Harvested for Autologous Augmentation during Dental Implantation.

Bone drill chips that are collected during implant site preparation can be reused as autologous bone-grafting material for alveolar ridge augmentation. This study characterized five market-leading implant drill sets regarding their geometric properties and ability to produce vital bone chips. The drill geometry of each tool of five commercial implant drill sets was characterized while using optical profile projector devices and SEM. Bone chips were collected during the in vitro preparation of porcine jaw bone with the various drill sets. Produced bone chip masses were measured. The bone chips were cultured in vitro and the number of outgrown cells was determined and measurand for vitality. Furthermore, the thrust force and cutting torque were recorded to examine the mechanical loads of the manual drilling process. The tool geometry and set configuration of one out of five implant drill sets appears to be superior regarding chip mass, vitality, and thrust force. It could be proven that there is a correlation between vitality and thrust force. The thrust force is influenced by the cutting behavior of the tool, which in turn depends on the geometry of the tool. The tool geometry has an influence on the vitality of the augmentation material due to this relationship.

Utilizing the lateral excess for autologous augmentation in massive weight loss patients

The number of patients in need of a mastopexy with autologous augmentation after massive weight loss (MWL) increases along with the increasing number of bariatric surgeries. The primary aim of this paper was to visualize how we utilize the lateral excess of the breast for auto augmentation. The secondary aim was to assess the outcome using the LOPOSAM technique in a larger study population. This retrospective study included 72 MWL patients aged 40±9 years undergoing a bilateral LOPOSAM procedure, between March 2015 and April 2018. All patients had undergone a weight loss of more than 15 BMI units, had a BMI of less than 30 kg/m2 at the time of surgery and functional problems due to excess or lax skin. Patient demographics, comorbidities, cause of MWL, operative time and complications were recorded. The mean weight loss was 58±18 kg or 21±6 BMI units. The mean operative time was 97±39 minutes. The surgical goal was achieved in all patients. Three patients (4%) experienced hematomas requiring surgical intervention. The utilization of the lateral excess of the breast for auto augmentation in MWL patients is visualized. The long term results using the LOPOSAM mastopexy technique shows that the technique is quick, safe and with a low rate of complications.

Utilizing the lateral excess for autologous augmentation in massive weight loss patients.

The number of patients in need of a mastopexy with autologous augmentation after massive weight loss (MWL) increases along with the increasing number of bariatric surgeries. The primary aim of this paper was to visualize how we utilize the lateral excess of the breast for auto augmentation. The secondary aim was to assess the outcome using the LOPOSAM technique in a larger study population. This retrospective study included 72 MWL patients aged 40±9 years undergoing a bilateral LOPOSAM procedure, between March 2015 and April 2018. All patients had undergone a weight loss of more than 15 BMI units, had a BMI of less than 30 kg/m2 at the time of surgery and functional problems due to excess or lax skin. Patient demographics, comorbidities, cause of MWL, operative time and complications were recorded. The mean weight loss was 58±18 kg or 21±6 BMI units. The mean operative time was 97±39 minutes. The surgical goal was achieved in all patients. Three patients (4%) experienced hematomas requiring surgical intervention. The utilization of the lateral excess of the breast for auto augmentation in MWL patients is visualized. The long term results using the LOPOSAM mastopexy technique shows that the technique is quick, safe and with a low rate of complications.

Utilizing the lateral and inferior excess for autologous augmentation in massive weight loss patients

Utilizing the lateral and inferior excess for autologous augmentation in massive weight loss patients

Upper body lift and breast reshaping with lateral chest wall perforator propeller flap following massive weight loss

After massive weight loss (MWL), female patients often develop upper trunk laxity and severe breast deformities. Usually several procedures are required to address upper body contouring issues. To achieve better breasts and improve upper body contour, the authors employed a combined approach, associating lateral chest wall perforator propeller flaps with an upper bodylift (UBL). Between September 2015 and March 2017, nine post-bariatric patients underwent simultaneously an UBL and autologous augmentation breast reshaping with lateral chest wall perforator propeller flaps. The authors analyzed the clinical indications, results and complications of this procedure. Eighteen lateral perforator propeller flaps for autologous breast augmentation-mastopexy associated with an UBL were performed successfully. Mean pre-MWL body mass index (BMI) was 54.3±10.9kg/m2, with a mean preoperative pre-UBL BMI of 28.7±3.6kg/m2. The average weight loss before surgery was 67.7±22.4kg. The flaps were harvested on intercostal and/or lateral thoracic arteries. All donor sites had been closed primarily. Following the classification of Dindo and Clavien, four minor complications (I, II), and two major complications (IIIb), including two hematomas requiring reoperation, were reported. No flap necrosis occurred. Follow-up averaged 27.9±8.4months. The patients' satisfaction with their improved breast shapes and chest wall contours was "good", with an aesthetic outcome mean ranked 3.8±0.8 (out of 5). After MWL, upper body deformities can be treated safely and reliably by a combined approach, associating an UBL and autologous lateral chest wall perforator flaps to provide more natural and durable breast shapes, as well as an upper circumferential reshaping.

Autologous augmentation gluteoplasty with local inverted flap

Autologous augmentation gluteoplasty with local inverted flap

Latissimus Dorsi and Immediate Fat Transfer (LIFT) for Complete Autologous Breast Reconstruction.

Despite the popularity of latissimus dorsi (LD) flap in breast reconstruction, a breast implant is often necessary to achieve sufficient volume. Prior reports describe fat grafting to the LD flap as a secondary procedure to correct contour deformities and improve volume. Our institution has instituted autologous breast reconstruction with an LD flap and immediate fat transfer (LIFT). A retrospective review of all patients undergoing the LIFT procedure was undertaken. Patient age, total volume of fat transfer, length of follow-up, need for adjuvant therapy, and complications were recorded. The procedure begins with harvest of the LD flap and fat. Prior to disorigination of the latissimus muscle, fat is injected into the flap. Flap harvest is then completed and inset to create a breast mound. Eighteen patients underwent LIFT procedures over 3 years with an average follow-up of 8.7 months (range, 2-24). Four breasts (22.2%) had previously received adjuvant radiation therapy. The mean total fat grafting volume was 515.5 mL (range, 325-730) per breast. The average estimated fat graft take was 66.8% (range, 50-80%). Four patients (22.2%) experienced complications. Autologous augmentation of the LD flap with lipotransfer has been used to avoid placement of an implant. We improve the technique by performing lipotransfer during index reconstruction. Furthermore, we perform lipotransfer prior to disorigination of the LD muscle to minimize trauma to the flap and increase the efficiency of fat grafting. Our experience demonstrates that this technique is a viable autologous alternative to microsurgical breast reconstruction.

Die Ribeiro-Technik bei Gigantomastie – Review von 294 Reduktionsplastiken in 8 Jahren

Reduction mammaplasty in patients with gigantomastia is challenging even to very experienced plastic surgeons. Extremely elongated pedicles impair the vascular supply of the nipple-areola complex. Breast shaping and effective reduction are difficult due to the severely stretched skin envelope. The Ribeiro technique is the standard technique for reduction mammaplasty in our clinic. The aim of this study is to review our approach in patients with gigantomastia in comparison to the current literature. From 01/2009 to 12/2016, we performed 1247 reduction mammaplasties in 760 patients. In 294 reduction mammoplasties (23.6 %), resection weight was more than 1000 g per breast corresponding to the definition of gigantomastia. The Ribeiro technique with a superomedial pedicle and inferior dermoglandular flap for autologous augmentation of the upper pole was implemented as standard procedure. In cases with a sternal notch-nipple distance > 40 cm, free nipple grafting was performed. The outcome parameters complication rate, patient satisfaction with the aesthetic result, nipple sensitivity and surgical revision rate were obtained and retrospectively analysed. In 174 patients, 294 reduction mammaplasties were performed with a resection weight of more than 1000 g per breast. Average resection weight was 1389.6 g (range, 1000-4580 g). Average age was 43.5 years (range, 18-76 years), average body mass index (BMI) was 29.2 kg/m2 (range, 19-40 kg/m2), average sternal notch-nipple distance was 34.8 cm (range, 27-52 cm), average operation time was 117 minutes (range, 72-213 minutes). A free nipple graft was necessary in 30 breasts. Overall complication rate was 7.8 %; secondary surgical revision rate was 16 %. 93 % of the patients were "very satisfied" and "satisfied" with the aesthetic result. Nipple sensitivity was rated "very good" and "good" in 88 %. The Ribeiro technique is a well established, versatile standard technique for reduction mammaplasty, which helps to create high-quality reproducible results with longterm formstable shape. In gigantomastia, this procedure is also very effective to achieve volume reduction and aesthetically pleasing results with a low complication rate.

Autogenous bone grafts in oral implantology\u2014is it still a \u201cgold standard\u201d? A consecutive review of 279 patients with 456 clinical procedures

BackgroundThis study assessed the clinical outcomes of graft success rate and early implant survival rate after preprosthetic alveolar ridge reconstruction with autologous bone grafts.MethodsA consecutive retrospective study was conducted on all patients who were treated at the military outpatient clinic of the Department of Oral and Plastic Maxillofacial Surgery at the military hospital in Ulm (Germany) in the years of 2009 until 2011 with autologous bone transplantation prior to secondary implant insertion. Intraoral donor sites (crista zygomatico-alveolaris, ramus mandible, symphysis mandible, and anterior sinus wall) and extraoral donor site (iliac crest) were used. A total of 279 patients underwent after a healing period of 3–5 months routinely computer tomography scans followed by virtual implant planning. The implants were inserted using guided oral implantation as described by Naziri et al. All records of all the consecutive patients were reviewed according to patient age, history of periodontitis, smoking status, jaw area and dental situation, augmentation method, intra- and postoperative surgical complications, and surgeon’s qualifications. Evaluated was the augmentation surgical outcome regarding bone graft loss and early implant loss postoperatively at the time of prosthodontic restauration as well a follow-up period of 2 years after loading.ResultsA total of 279 patients underwent 456 autologous augmentation procedures in 546 edentulous areas. One hundred thirteen crista zygomatico-alveolaris grafts, 104 ramus mandible grafts, 11 symphysis grafts, 116 grafts from the anterior superior iliac crest, and 112 sinus lift augmentations with bone scrapes from the anterior facial wall had been performed. There was no drop out or loss of follow-up of any case that had been treated in our clinical center in this 3-year period. Four hundred thirty-six (95.6%) of the bone grafts healed successfully, and 20 grafts (4.4%) in 20 patients had been lost. Fourteen out of 20 patients with total graft failure were secondarily re-augmented, and six patients wished no further harvesting procedure. In the six patients, a partial graft resorption was detected at the time of implantation and additional simultaneous augmentation during implant insertion was necessary. No long-term nerve injury occurred. Five hundred twenty-five out of 546 initially planned implants in 259 patients could be inserted into successfully augmented areas, whereas 21 implants in 20 patients due to graft loss could not be inserted. A final rehabilitation as preplanned with dental implants was possible in 273 of the 279 patients. The early implant failure rate was 0.38% concerning two out of the 525 inserted implants which had to be removed before the prosthodontic restoration. Two implants after iliac crest augmentation were lost within a period of 2 years after loading, concerning a total implant survival rate after 2 years of occlusal loading rate of 99.6% after autologous bone augmentation prior to implant insertion.ConclusionsThis review demonstrates the predictability of autologous bone material in alveolar ridge reconstructions prior to implant insertion, independent from donor and recipient site including even autologous bone chips for sinus elevation. Due to the low harvesting morbidity of autologous bone grafts, the clinical results of our study indicate that autologous bone grafts still remain the “gold standard” in alveolar ridge augmentation prior to oral implantation.

Cartilage Scales Embedded in Fibrin Gel.

Multiple techniques have been described for dorsal nasal augmentation in rhinoplasty. In this article, we review common surgical techniques for raising the dorsum or eliminating dorsal irregularities, by highlighting inherent advantages and disadvantages of each method. Within the past few years, the use of diced cartilage grafts has become the workhorse in this field of interest. To overcome drawbacks of methods based on diced cartilage, we present a new concept for autologous augmentation, using regenerative medicine protocols. A mix of cartilage scales with cartilage pâté was embedded in platelet-rich fibrin (PRF). Since December 2015, a total of 48 patients were treated with this technique. Based on our preliminary results, cartilage scales in PRF appear to be a promising and reliable alternative to existing procedures for dorsal nasal augmentation.

Evolution of a safe and effective management protocol for velopharyngeal incompetence: Seeking good speech without airway compromise

Objective: To document an evidence based evolution of VPI management over an 18 year period with the goal of optimizing speech while minimizing complications and need for re-operation. Design: An institutional review board approved, retrospective 18-year single surgeon, single-center series of 370 patients undergoing surgery for velopharyngeal incompetence (VPI). Methods: A review of our database between the years of 1997 and 2015 identified 370 patients who underwent surgical procedures for VPI. Records were reviewed for types of procedures performed each year. Procedures were evaluated for safety and efficacy as regards to speech outcome. The study population was divided into an earlier period (1997–2009) and a later period (2010–2015). Results: We demonstrated a reduction in the use of airway obstructive procedures such as sphincter pharyngoplasty from 25.2% of VPI surgeries in the early period to 10.4% in the late period. There has been a progressive shift toward more physiologic procedures such as re-repair with intravelar veloplasty (IVVP). The extent of IVVP has become more aggressive over the time period of the study. In our re-repair population, 89.7% of patients had improvement of the speech scores with 64.5% of all the re-repair patients achieving normal speech postoperatively. Autologous fat augmentation of the palate was introduced in the second period and represents about half of the procedures in the later period. Focused autologous fat augmentation of the palate resulted in statistically significant improvement in speech in 75.7% of cases. Conclusion: This study demonstrates an evidence-based evolution in management, shifting away from potentially airway obstructive procedures and toward a more physiologic approach to velopharyngeal competence. We outline the steps taken to reach the author's current approach to VPI management based on periodic outcome audits, specific anatomic findings, and goal-directed surgical interventions. With correct diagnosis and patient selection, VPI can be safely eliminated in over 70% of patients with a single procedure. We believe that this anatomic and physiologic approach improves safety while minimizing risks of airway obstruction.

Abdominoplasty and gluteoplasty after massive weight loss: an all-in-one technique

Introduction: Patients requesting body-contouring surgery after massive weight loss often present with abdominal and lumbar skin excess as well as gluteal ptosis and loss of gluteal projection. In order to restore gluteal projection a circular abdominoplasty in combination with an autologous gluteal augmentation (all-in-one technique) can be performed.Objective: To compare outcomes for patients who underwent a circular abdominoplasty with or without autologous gluteal augmentation.Methods: In a retrospective study we analyse 24 patients who underwent a circular abdominoplasty between 2006 until 2014 at the University Hospital of Ghent, Belgium. Fourteen patients underwent a classic circular abdominoplasty (4 men and 10 women). Ten patients underwent the all-in-one technique (all women). Mean age was 43 in the classic abdominoplasty group and 41 in the all-in-one technique group. All the patients endured massive weight loss after bariatric surgery. Gluteal augmentation was performed using lumbar dermal fat rotation flaps based on perforators of the 4th lumbar artery. For statistical analysis a Fisher exact tests was used.Results: Postoperative photographs showed that gluteal projection had been increased in patients who underwent the all-in-one technique. The mean operation time in this group was 3h49min versus 2h47min in the group who underwent a classic circular abdominoplasty. The mean hospital stay in both groups was 6 days. Complication rate was comparable between both the groups.Conclusion: The all-in-one technique is an efficient method to improve both abdominal and gluteal body contour in patients who endured massive weight loss.

Autologous augmentation of hiatal hernia repair with filtered platelet concentrate improves tissue remodeling in a swine model.

Autologus augmentation of wound remodeling with platelet concentrate is a burgeoning field with promising results. We hypothesized that the addition of filtered platelet concentrate (fPC) to an acellular biologic graft would improve crural healing and tissue integrity in hiatal hernia repair. Sixteen healthy Yorkshire female pigs were divided into three groups: hiatus repair (HR) (n=7), HR with biologic graft (HRM; n=8, and HR with biologic graft and fPC (fPC; n=9). Surgeries were performed by a single surgeon. Animals were euthanized at 8weeks, and the distal esophagus with hiatus was harvested en-block. Tissue was graded by a histopathologist on collagen deposition, vascularization, and inflammation at the graft-hiatal interface. Tensile strength testing was performed using the Teststar IIs (MTS), coupled with a strain extensometer (Epsilon). Samples of equal dimensions were preloaded to 1N and deformed at a constant rate of 0.2mm/s. Statistical analysis was performed via Kruskal-Wallis one-way analysis of variance. Aspirate analysis revealed a mean platelet count of 3million platelets/1mL of aspirate. Animals in the fPC group had significantly increased mean chronic inflammation (3.1±1.1 vs. 1.8±1.6, 1.2±1.2, p=0.04) compared to HR alone and HR+biologic graft. Vascular deposition did not differ between groups (p=0.8). A trend toward increased collagen deposition was demonstrated for the fPC group (1.4±1.1 vs. 2.0±0.6 in HR group and 3.0±1.2 in HRM group, p=0.06). There was a statistically significant increase in tensile strength, yield force, and Young's modulus in the fPC group compared with HR and HR+biologic mesh (p<0.01). A trend toward increased collagen deposition and vascularity of the fPC group was demonstrated. In addition, there was an increase in tensile strength and yield force in the fPC group. Use of autologous fPC appears a safe and promising adjunct to wound remodeling and healing in a swine model.