Autologous Fat Transplantation Research Articles

Evaluating the Efficacy of Dedifferentiated Fat Cells (DFATs) vs Adipose-Derived Stem Cells (ASCs) in Enhancing the Viability of Fat Grafts.

Enhancing graft fat survival remains a paramount challenge in autologous fat transplantation surgeries. Dedifferentiated fat cells (DFATs) and adipose-derived stem cells (ASCs) represent 2 pivotal cells with potential to improve fat graft survival rates. In this study we aimed to compare the effectiveness of DFATs and ASCs in promoting fat graft survival, emphasizing their adipogenic and angiogenic capabilities. Both in vitro and in vivo experiments were conducted. In vitro assessments compared adipogenesis, angiogenesis, osteogenesis, chondrogenesis, cell migration abilities, and surface markers. For in vivo evaluation, a cell-assisted lipotransfer animal model was employed to gauge graft volume retention and histological morphology. Analysis techniques included hematoxylin and eosin staining, Western blotting, and real-time polymerase chain reaction. In vitro findings suggested a slight superiority of DFATs in adipogenesis and angiogenesis compared to ASCs. In vivo tests demonstrated both cell types surpassed the control in terms of graft volume retention, with the DFATs group marginally outperforming in retention rates and the ASC group presenting a slightly enhanced graft tissue structure. Our study underscores the distinct advantages of DFATs and ASCs in bolstering fat graft survival, offering potentially novel insights for plastic surgeons aiming to elevate fat graft survival rates.

Retracted: The Application and Efficacy Evaluation of Autologous Fat Transplantation in Antiaging of the Face: Systematic Review and Meta-Analysis.

[This retracts the article DOI: 10.1155/2022/5744123.].

Retracted: Aesthetic Effect of Autologous Fat Transplantation on Frontotemporal Depression Filling and Its Influence on SCL-90 and SES of Patients.

[This retracts the article DOI: 10.1155/2022/3374780.].

Correction of Sunken Upper Eyelid in Asian Blepharoplasty Based on Anatomical and Histological Study of Orbital Fat Fascia Flap.

To explore the clinical application of orbital fat fascia flap in the correction of sunken upper eyelid in Asian blepharoplasty based on anatomical and histological research. Observe the histological structure of the orbital fat and its fascia vascularity through cadaver anatomy and histological sections of 10 cadavers. Based on the anatomical and histological characteristics of orbital fat, 36 patients with mild to moderate sunken upper eyelids were corrected by transposition of orbital fat fascia flap with preservation of fascia vascular pedicle. During the operation, the lateral part of the central cellulite of orbital fat was separated longitudinally and transferred to the sunken place to correct the sunken upper eyelid. Anatomy and histology show that the orbital fat was located between the anterior layer of the levator aponeurosis and the posterior layer of the orbital septum and was separated into fat lobules by many fibrous septa. The blood vessels move forward from back to front along the orbital fat interlobular septum, and the blood vessels in the capsule below the orbital fat are abundant. Clinical results showed that the shape of the sunken upper eyelid was significantly improved in 35 cases after correction with this method during the postoperative follow-up from 9 months to 18 months. The mean sunken depth improved from 6.2mm (±1.0 mm) preoperatively to 2.2mm (±0.9 mm) at the last follow-up with a statistical significance. And only 1 case had partial depression in the unilateral eyelid and received autologous granular fat transplantation with satisfactory postoperative results. The transposition of orbital fat fascia flap with longitudinal separation and preservation of fascia vascular pedicle can better correct the sunken upper eyelid during blepharoplasty, and the long-term effect is stable, which is worthy of clinical promotion. 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 .

Ferroptosis in Autologous Fat Transplantation: A New Hypothesis.

Autologous adipose tissue transplantation is widely used for cosmetic and reconstruction of various areas in the body, often to repair soft tissue volume loss or contoured deformation. However, the application of fat transplantation is limited by unstable and unpredictable volume retention rates. At present, promoting adipose tissue survival and inhibiting its death is the key to improve the effect of autologous fat transplantation. In this paper, we propose a hypothesis that ferroptosis exists in fat transplantation. The bases of this hypothesis include the following: (1) the association between ferroptosis and other programmed cell death; (2) the association between ferroptosis and ischemia-reperfusion injury; and (3) the use of ferroptosis inhibitors in the field of fat transplantation.

Application of infraorbital rim augmentation with pocket fat filling to correct tear trough deformity.

Tear trough deformity is one of the most common complaints in clinical settings. The correction of this groove is challenging in facial rejuvenation. The lower eyelid blepharoplasty varies with different conditions. A novel approach of using orbital fat in the lower eyelid to increase the volume of the infraorbital rim with granule fat injection has been applied in our institution for more than 5 years. This article aims to describe the detailed steps of our technique and verify its effectiveness by a cadaveric head dissection after surgical simulation. In this study, a total of 172 patients with tear trough deformity underwent lower eyelid orbital rim augmentation with fat filling in the sub-periosteum pocket. According to Barton's grades, 152 patients underwent lower eyelid orbital rim augmentation with orbital fat filling, 12 patients had it combined with autologous granule fat from other body parts, and 8 patients received only transconjunctival fat removal to correct tear trough. The modified Goldberg score system was used to compare preoperative and postoperative photographs. Patients were satisfied with the cosmetic results. Excessive protruding fat was released, and the tear trough groove was flattened by using autologous orbital fat transplantation. The lower eyelid sulcus deformities were well-corrected. To further illustrate the anatomical structure of the lower eyelid area and injection layers, six cadaveric heads were used for surgical simulation and demonstrated the effectiveness of our technique. This study indicated that the infraorbital rim could be increased by transplanting orbital fat to the pocket, which was dissected under the periosteum, and the procedure has been verified as reliable and effective. Level II.

Three-Dimensional Volumetric Analysis of the Effect of Interval Time in Autologous Fat Graft Breast Augmentation.

Autologous adipose tissue has become increasingly popular in cosmetic and plastic reconstructive surgery, especially breast augmentation surgery. However, the volume retention rate after transplantation significantly varies and may be unsatisfactory. Many patients need two or more autologous fat graft breast augmentations to achieve the expected effect. There are currently no studies on optimal timing between fat injections. We identified target patients with secondary or multiple autologous fat transplantations by inclusion and exclusion criteria and used three-dimensional scanning technology to calculate the volume retention. Patients were divided into two groups according to the dates of the first and second operations (group A: interoperative time < 120 days, group B: interoperative time ≥ 120 days). We used SPSS 26 for statistical calculations. We included 161 patients in this retrospective study, with an average volume retention rate of 36.56% in group A (n = 85) and 27.45% in group B (n = 76). The independent sample t test showed that the volume retention rate in group A was higher than that in group B (P < 0.001). And the paired t test showed there is a significant improvement of volume retention rate after the second fat graft session (P < 0.001). Multivariate regression analysis showed that the interval time was an independent factor affecting the postoperative volume retention rate. The interval time between autologous fat transplantation for augmentation mammaplasty was an independent factor affecting the postoperative volume retention rate. The postoperative volume retention rate of the < 120 days group was higher than that of the ≥ 120 days group. 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 .

Male Pectoralis Major Muscle Augmentation with Autologous Fat Transplantation Using VASER Lipoaspirate: Evaluation with MRI.

This is a prospective examination of 20 male patients (40 breasts) who underwent VASER-assisted liposuction and fat grafting surgery, and long-term fat graft viability was evaluated by magnetic resonance imaging scans. Participants had an average age of 34.85 ± 7.37 years with a mean BMI of 26.73 ± 2.63 kg/m2. The mean fat graft volume injected was 542.63 ± 144.78 mL on the right, and 548.95 ± 140.36 mL on the left side. On the magnetic resonance imaging follow-up, the mean intrapectoral adipose tissue thickness was 20.34 ± 6.31 mm on the right, and 18.94 ± 8.27 mm on the left sides and tissue viability was preserved in all cases. The mean follow-up duration was 22 ± 9.8 (range 14-44) months. VASER-assisted lipoaspiration and autologous fat grafting of the major pectoralis muscle provide a satisfactory outcome and long-term maintenance of the grafted adipose tissue.

Deferoxamine Mesylate Improves the Survival Rate of Transplanted Fat by Promoting Angiogenesis.

The volume retention rate after autologous fat transplantation is unpredictable and unstable. Deferoxamine mesylate (DFO) is a drug approved by the FDA that is safe, has antioxidant effects, and can promote angiogenesis. The aim of this study was to transplant DFO-pretreated fat granules into nude mice to observe the proangiogenic effect of DFO and to evaluate whether this treatment could also improve the retention rate of fat transplantation. A total of 24 nude mice were transplanted with human adipose tissue that had been pretreated with different concentrations of DFO (0.5, 1, and 4 mM). Samples were collected at 1 and 3 months. After sampling, weight/volume retention rate, immunohistochemistry, and polymerase chain reaction were analyzed. The effects and mechanisms of DFO-pretreated fat grafts were evaluated. The in vivo experimental results showed that DFO-pretreated adipose fat significantly improved the postoperative weight/volume retention rate. The results of the immunohistochemical staining indicated that the integrity and activity of the adipocytes in the DFO-pretreated groups were better than in the control group. The polymerase chain reaction results were consistent with the immunohistochemistry results (CD31), suggesting that DFO promoted angiogenesis in the grafts. The results of this study indicate that preconditioning fat grafts with DFO can improve the effect of fat transplantation by promoting vascular regeneration.

Treatment of mild hemifacial microsomia in children by autologous nano-fat mixed granule fat transplantation

To investigate the effectiveness of autologous nano-fat mixed granule fat transplantation in the treatment of facial soft tissue dysplasia in children with mild hemifacial microsomia (HFM). A total of 24 children with Pruzansky-Kaban type Ⅰ HFM were admitted between July 2016 and December 2020. Among them, 12 children were treated with autologous nano-fat mixed granule fat (1∶1) transplantation as study group and 12 with autologous granule fat transplantation as control group. There was no significant difference in gender, age, and affected side between groups ( P>0.05). The child's face was divided into region Ⅰ(mental point-mandibular angle-oral angle), region Ⅱ (mandibular angle-earlobe-lateral border of the nasal alar-oral angle), region Ⅲ (earlobe-lateral border of the nasal alar-inner canthus-foot of ear wheel). Based on the preoperative maxillofacial CT scan+three-dimensional reconstruction data, the differences of soft tissue volume between the healthy and affected sides in the 3 regions were calculated by Mimics software to determine the amount of autologous fat extraction or grafting. The distances between mandibular angle and oral angle (mandibular angle-oral angle), between mandibular angle and outer canthus (mandibular angle-outer canthus), and between earlobe and lateral border of the nasal alar (earlobe-lateral border of the nasal alar), and the soft tissue volumes in regions Ⅰ, Ⅱ, and Ⅲ of healthy and affected sides were measured at 1 day before operation and 1 year after operation. The differences between healthy and affected sides of the above indicators were calculated as the evaluation indexes for statistical analysis. At 1 year after operation, the parents, the surgeons, and the nurses in the operation group made a self-assessment of satisfaction according to the frontal photos of the children before and after operation. The study group and the control group were injected with (28.61±8.59) and (29.33±8.08) mL of fat respectively, with no significant difference ( t=0.204, P=0.840). After injection, 1 child in the control group had a little subcutaneous induration, and no related complications occurred in the others. All children in both groups were followed up 1 year to 1 year and 6 months, with an average of 1 year and 4 months in the study group and 1 year and 3 months in the control group. At 1 year after operation, the asymmetry of the healthy and affected sides improved in both groups; the satisfactions of parents, surgeons, and nurses in the study group were all 100% (12/12), while those of the control group were 100% (12/12), 83% (10/12), and 92% (11/12), respectively. The differences between healthy and affected sides in mandibular angle-oral angle, mandibular angle-outer canthus, earlobe-lateral border of the nasal alar, and the soft tissue volume in 3 regions of the two groups after operation were significantly smaller than those before operation ( P<0.05). There was no significant difference in the above indexes between the two groups before operation ( P>0.05). After operation, all indexes were significantly lower in study group than in control group ( P<0.05). Autologous nano-fat mixed granule fat transplantation and autologous granule fat transplantation can both improve the facial soft tissue dysplasia in children with mild HFM, and the former is better than the latter.

Efficacy and Safety of Transplantation of Autologous Fat, Platelet-Rich Plasma (PRP) andStromal Vascular Fraction (SVF) in the Treatment of Acne Scar: Systematic Review and Meta-analysis.

The efficacy and safety evaluation of the transplantation of autologous fat, platelet-rich plasma (PRP) and stromal vascular fraction (SVF) in acne scars has not been completely unified. This article will analyze and process the data of the included studies through evidence-based medicine to evaluate the efficacy and safety of autologous fat grafting, PRP and SVF for acne scar treatment, so as to provide treatment basis and strategy for the clinical treatment of acne scars. We searched the PubMed, Embase, Cochrane Library databases, CNKI, Wanfang and CQVIP databases for studies published during the time between the establishment of the databases through October 2022. We included studies that report autologous fat grafting, SVF and PRP for patients with acne scars. We excluded repeated publication, researches without full text, incomplete information or inability to conduct data extraction and animal experiments, case report, reviews and systematic reviews. STATA 15.1 software was used to analyze the data. The findings showed that fat grafting had excellent improvement, marked improvement, moderate improvement and mild improvement rates of 36%, 27%, 18% and 18%, respectively, PRP had excellent improvement, marked improvement, moderate improvement and mild improvement rates of 0%, 26%, 47% and 25%, respectively, and the SVF had excellent improvement, marked improvement, moderate improvement and mild improvement rates of 73%, 25%, 3% and 0%, respectively. Additionally, the pooled results showed that there was no significant difference between PRP treatment and pre-treatment in Goodman and Baron scale score. However, Shetty et al. reported that Goodman and Baron scale score after fat grafting was significantly lower than pre-treatment. The results also showed that after fat grafting treatment, incidence of pain after fat grafting was 70%. After PRP treatment, in addition to pain (17%), there is a higher probability of postinflammatory hyperpigmentation (17%) and hematoma (6%). After SVF treatment, the incidence of postinflammatory hyperpigmentation and hematoma was all 0%. Autologous fat grafting, PRP and SVF are effective for the treatment of acne scars, and the safety of autologous fat grafting, PRP and SVF is acceptable. Autologous fat grafting and SVF may be a better treatment for acne scars than PRP. However, this hypothesis still needs to be tested in the future large randomized controlled trials. 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 .

High-Frequency Ultrasound-Guided Temporal Fat Transplantation: A Safe and Visualized Approach.

Autologous fat injection is one of the most popular methods for the treatment of temporal depression; however, accurate puncture into the target layer without vascular compromise is hard to achieve. With the aid of high-frequency ultrasonography, the authors performed autologous fat transplantation after visualization in five cases, with satisfactory results. The authors observed the course of superficial temporal vessels, the orbitozygomatic artery, and sentinel veins preoperatively, and used high-frequency ultrasonography to guide lipotransfer into the desired layer intraoperatively, to avoid intravascular injection. With the aid of high-frequency ultrasonography, the authors can easily prevent vascular complications and personalize surgical procedures, as anatomical variations of vasculature can also be detected by means of this method.

Evaluation of Patient Satisfaction Following the Grafting of Autologous Fat Tissue Obtained by VASER-Assisted Liposuction

Aim: Autologous fat transplantation, also known as fat grafting or fat injection, is an increasingly popular technique in reconstructive surgery with minimal complications and low morbidity rates. The aim of this study is to evaluate the satisfaction of patients after the injection of autologous adipose tissue obtained by the Vibration Amplification of Sound Energy at Resonance (VASER)-assisted lipoplasty method due to aesthetic concerns or deformity. Materials and Methods: The study includes 20 patients who underwent VASER-liposuction-guided autologous fat injection between 2014 and 2021 in a single center. Patients were invited for follow-up approximately three years after the surgical intervention, and patient satisfaction and complications were evaluated with a semi-structured questionnaire. Results: Patient and surgeon satisfaction received the highest score at discharge. Sensory changes and tissue stiffening were found to be the most common complications. Overall satisfaction and scar healing were identified as the parameters with the highest score. Conclusion: VASER- assisted liposuction and autologous fat transplantation is a technique associated with high patient satisfaction and minimal complications. The method is an ideal technique for whole body contouring and facial operations.

HIF-1α-Induced Mitophagy Regulates the Regenerative Outcomes of Stem Cells in Fat Transplantation

Hypoxia is a crucial factor with type diversity that plays an important role in stem cell transplantation. However, the effects of hypoxia on adipose-derived stem cells (ADSCs) are largely unclear in the autologous fat transplantation (AFT) model, which shows a special type of “acute-progressively resolving hypoxia.” Here, an AFT model in nude mice and a hypoxic culture model for ADSCs were combined to explore the link between hypoxia-inducible factor-1 α subunit (HIF-1α) and mitophagy under hypoxic conditions. The results showed that the activity of ADSCs in the first 7 days after grafting was the key stage for volume retention, and the expression of HIF-1α, light chain 3 beta (LC3B), and Beclin1 in ADSCs increased during this period. We also found that hypoxia for longer than 48 h damaged the differentiation and mitochondrial respiration of ADSCs in vitro, but hypoxia signals also activate HIF-1α to initiate mitophagy and maintain the activities of ADSCs. Pre-enhancing mitophagy by rapamycin effectively improves mitochondrial respiration in ADSCs after grafting and ultimately improves AFT outcomes.

Retracted: Hyperbaric Oxygen Improves the Survival and Angiogenesis of Fat Grafts after Autologous Fat Transplantation.

[This retracts the article DOI: 10.1155/2022/6738959.].

Clinical, ultrasonic, and histopathologic evaluation of autologous fat transplantation plus platelet-rich plasma with versus without fractional carbon dioxide laser in the treatment of aging hands

Background Aging hands show soft tissue atrophy with prominent bones, tendons, and visible veins as well as pigmented changes and skin rhytids. Autologous fat grafting (AFG) combined with platelet-rich plasma (PRP) sessions can be used in hand rejuvenation for improvement of cutaneous and subcutaneous defects with long lasting results. Objective To evaluate the efficacy, tolerability, and possible side effects of AFG plus PRP with versus without fractional carbon dioxide (CO2) laser in hand rejuvenation. Patients and methods This comparative randomized study included 60 apparently healthy participants in need for hand rejuvenation who were divided into two groups: group I, two hands of 30 participants were treated by AFG with PRP and fractional CO2 laser. Group II, two hands of 30 participants were treated by AFG with PRP. The evaluation was done by clinical evaluation, ultrasound scanning, histopathology, and patient satisfaction. Participants were followed up for 6 months. Results Significant improvement was detected on both groups after treatment with no significant difference between both sides by clinical evaluation, ultrasound scanning, histopathologic evaluation, and patient satisfaction that persisted for 6 months. However, addition of fractional CO2 laser produced significant improvement in skin pigmentation and improvement with nonsignificant difference in wrinkling. Conclusion The enriched AFG with PRP was very effective and safe in the treatment of hand aging especially in volume restoration and disappearance of visible underlying structures. Moreover, fractional CO2 laser produced more improvement in skin pigmentation.

Aesthetic Effect of Autologous Fat Transplantation on Frontotemporal Depression Filling and Its Influence on SCL-90 and SES of Patients.

Objectives This study aimed to study the aesthetic effect of autologous fat transplantation in frontotemporal depression filling as well as the influence on the Symptom Checklist 90 (SCL-90) and the Rosenberg Self-Esteem Scale (SES) score of patients. Methods A total of 100 patients with frontotemporal depression admitted to the outpatient department of burn and plastic surgery in our hospital were selected as the observation group, and all of them received autologous fat transplantation. The filling effect of patients in the observation group was discussed. Simultaneously, 50 volunteers were selected as the control group to compare the SCL-90 and SES scores of the observation group and the control group. Result ① A total of 100 patients with frontotemporal depression were treated with autologous fat transplantation, and the secondary autologous fat transplantation rate was 10%; two cases of fat absorption occurred during the 12-month follow-up after surgery; on the 7th day, 6 months, and 12 months after the operation, the satisfaction rate of the patients who visited the doctor was 96.00%, 97%, and 92.00%; the satisfaction rate of the plastic surgeon was 94.00%, 96%, and 90.00%; the satisfaction rate of the third party was 96.00%, 98%, and 92.00%. ② The preoperative scores of somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, terror, paranoia, and psychotic factor scores in the observation group were higher than those in the control group (P < 0.05). The scores of somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, terror, paranoia, and psychotic factor scores in the observation group at 6 months after the operation were lower than those before operation (P < 0.05). The preoperative SES score of the observation group (28.51 ± 9.81) was significantly lower than that of the control group (32.47 ± 5.39) (P < 0.05). The SES score (34.17 ± 9.81) in the observation group at 6 months after the operation was significantly higher than that before the operation (P < 0.05). Conclusion The aesthetic effect of autologous fat transplantation in frontotemporal depression filling is good and safe. Simultaneously, it can improve the mental health and self-esteem of patients and has high clinical value.

Effect of Hyperbaric Oxygen Therapy on the Survival Rate of Autologous Fat Transplantation.

To investigate whether hyperbaric oxygen therapy can improve the survival rate of fat transplantation and analyze the possible mechanisms. Ninety SD rats were randomly divided into 3 groups. All the rats were cut into pieces with about 5mL of fat from the abdominal cavity, rinsed with normal saline for 3 times, and cleaned with cotton pad adsorption method. Then, 3ml was removed, divided into 3 parts, and injected into three adjacent but not touching parts of the back. Group A received 1h/d hyperbaric oxygen therapy, group B received 2h/d hyperbaric oxygen therapy, and group C received no hyperbaric oxygen therapy. The hyperbaric oxygen therapy lasted for 10 consecutive days. Fat grafts from one site were randomly removed at 2, 4, and 6 weeks after surgery, respectively. ① the survival rate of fat transplantation in three groups was compared. ② observe the pathological section; ③ immunohistochemistry was used to detect and compare the expression of vascular endothelial growth factor. The survival rate of fat transplantation in group A was the highest. After subcutaneous transplantation of 1 ml of fat and 1 hour/day of continuous hyperbaric oxygen treatment for 10 days, the fat survival rates were 0.796 ± 0.071ml, 0.644 ± 0.151ml, and 0.473 ± 0.127ml at the second, fourth, and sixth weeks, respectively. The survival rate of fat transplantation in group B was the second. After subcutaneous transplantation of 1 ml of fat and 2 hour/day of continuous hyperbaric oxygen treatment for 10 days, the survival rate of fat was 0.624 ± 0.220ml, 0.494 ± 0.125ml, and 0.329 ± 0.153ml at the second, fourth, and sixth weeks, respectively. The survival rate of fat transplantation in group C was the lowest. After subcutaneous transplantation of 1 ml of fat and no hyperbaric oxygen treatment for 10 days, the fat survival rates were 0.461 ± 0.132ml, 0.290 ± 0.112ml and 0.169 ± 0.091ml at the second, fourth, and sixth weeks, respectively. We have made changes in the abstract of the article and marked in red color. Hyperbaric oxygen therapy is conducive to the survival of transplanted fat. Importantly, a short period of hyperbaric oxygen therapy (1h/d) can promote the survival of transplanted fat. 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 .

Large-Volume Fat Grafting: Identifying Risk Factors for Fat Necrosis.

Fat necrosis is a well-recognized complication following autologous fat grafting. The purpose of this study was to evaluate the incidence of fat necrosis after large-volume fat grafting and identify risk factors for fat necrosis. A retrospective review was performed on 83 consecutive patients who underwent large-volume fat grafting (>100 cc) to the breast performed by the senior author (L.P.B.) between September of 2011 and May of 2016. Fat necrosis was defined as palpable nodules, or nodules seen on imaging. A total of 148 breasts underwent 170 autologous fat transplantations. Indications included the following: 72 reconstructions after surgical therapy and 98 cosmetic augmentations. Mean age was 48 years, median graft volume was 300 cc, and median length of follow-up 423 days. Overall incidence of necrosis was 32.9 percent, with 47.8 percent in previously irradiated patients. Increased incidence of necrosis was associated with increasing fat graft volumes (OR, 1.002; p = 0.032), increasing body mass index (OR, 1.13; p = 0.04), and simultaneous implant exchange with fat ( p = 0.003). Fat grafting volumes greater than 450 cc in a single breast were also associated with an increase in fat necrosis ( p = 0.04). Within a group of six patients who had bilateral fat grafting with unilateral radiation therapy, there was a significant increase in necrosis on the irradiated side ( p = 0.015). In a cohort of non-BRAVA patients, reconstruction (compared to augmentation) was associated with fat necrosis ( p = 0.039). Increased rates of fat necrosis were associated with volumes greater than 450 cc, patients undergoing concurrent implant exchange with fat grafting, and fat grafting after a history of lumpectomy or mastectomy without preexpansion. In addition, radiation therapy may be associated with a higher rate of complications. Risk, III.

Application of dural suturing in the endoscopic endonasal approach to the sellar region.

The endoscopic endonasal approach (EEA) is widely used in the treatment of cranial base tumors. Skull base reconstruction is a crucial part of EEA, which has a great impact on patients' prognosis. In this study, we report our experience with sellar dural suturing in cranial base reconstruction and retrospectively analyze its effect. The clinical data of 134 patients who suffered intraoperative CSF leakage and underwent EEA surgery in the Department of Neurosurgery of the First Affiliated Hospital of Nanjing Medical University from October 2018 to November 2020 were retrospectively collected and analyzed. According to whether sellar dural suturing was performed during the operation, they were divided into a suture group (55 cases) and a control group (79 cases). The results showed that dural suturing of the sellar floor effectively reduced the postoperative hospitalization duration (p = 0.026) and the use rates of lumbar drainage (p = 0.047), autologous fat transplantation (p = 0.038), and pedicled nasoseptal flaps (p = 0.026). Sellar dural suturing under endoscopy is a promising and effective method for cranial base reconstruction in EEA surgery and is worthy of clinical application.