Autologous Free Fat Graft Research Articles

Long‐Term Cosmetic Outcomes of Parotidectomy Reconstruction: AlloDerm versus Free Dermal Fat Graft

Objective: Parotid neoplasms generally require surgical resection with adequate margins. Cosmetic contour deformities resulting from parotidectomy can cause significant postoperative dissatisfaction. Therefore, we seek to compare the functional and cosmetic success of 2 postparotidectomy reconstructive modalities: autologous free dermal fat grafting (FDFG) and AlloDerm implantation. Method: We conducted a retrospective review of all patients who underwent a parotidectomy with either AlloDerm or autologous FDFG reconstruction by a single surgeon since January 1997. Complications were identified and patients from both cohorts were contacted by telephone to assess cosmetic satisfaction using a novel analogue scale. Results: Sixty-five patients who received AlloDerm reconstruction and 35 patients who received FDFG reconstruction were analyzed. The incidence of complications following FDFG was 3% (n = 1) compared with 5% (n = 3) after AlloDerm implantation ( P = 1.000). Both cohorts rated their reconstruction on symmetry (1-worst to 5-best), degree of change (1-least to 5-most), and overall satisfaction (1-worst to 5-best). Patients with FDFG reconstruction reported favorable cosmesis with respect to symmetry (4.5 ± 0.7) and overall appearance (4.8 ± 0.4), while indicating mild changes in their appearance over time (2.0 ± 1.2). At the time of this writing, cosmetic assessment of AlloDerm patients was underway but incomplete. Conclusion: FDFG and AlloDerm are cosmetically and functionally viable options to reconstruct the post-ablative parotid bed. Both modalities demonstrated similarly low complication rates ( P = 1.000), and an assessment of long-term patient satisfaction with AlloDerm will determine how it compares to the cosmetically efficacious FDFG.

Immediate breast reconstruction using autologous free dermal fat grafts provides better cosmetic results for patients with upper inner cancerous lesions

Although breast-conserving therapy (BCT) is the standard form of treatment for early-stage breast cancer, in patients with small breasts cosmetic results can be poor, especially when the lesion is located on the inner upper quadrant area. This study analyzes our use of autologous free dermal fat grafts (FDFGs) for immediate breast reconstruction. A total of 23 patients who received a partial mastectomy for an inner upper quadrant lesion from 1992 to 2006 at Kagoshima University Hospital were retrospectively divided into three groups according to the reconstructive procedure that was used for the defect after partial mastectomy: immediate reconstruction using an autologous FDFG from the lower abdomen (group FDFG); patients receiving only rotation and fixation of the parenchymal adipose tissue or gland to repair the defect (group GL); and a third group who underwent immediate reconstruction using a miniflap of the latissimus dorsi (group LD). The total duration of surgery in group FDFG was significantly shorter than in group LD (P < 0.01). The mean volume of blood lost in group FDFG was significantly lower than in group LD (P < 0.01). The breast retraction assessment (BRA) of group FDFG was significantly better than for the patients in groups GL and LD (P < 0.01). The total score using the ABNSW system for cosmetic assessment was significantly better in group FDFG than in group GL (P < 0.01). Similarly, the total score in group FDFG using the assessment by the Japanese Breast Cancer Society was significantly higher than that in group GL (P < 0.01). Immediate breast reconstruction for a defect after a partial mastectomy of an upper inner quadrant malignant lesion using FDFG can be especially useful for patients with small breasts.

Effect of rhVEGF gene transfection on survival of grafts after autologous free granular fat transplantation in rats

Objective To investigate the effect of recombinant human vascular endothelial growth factor (rhVEGF) on autologous free granular fat grafts in rats. Methods Forty-eight Sprague Dawley (SD) rats, weighing 190-280 g and regardless sex, were randomly divided into three groups, sixteen in each. After fat transplantation, the rats were treated with plasmid DNA encoding rhVEGF protein (the experimental group), plasmid DNA (the negative group) and normal saline (the blank control group), respectively. At 3, 7, 15 and 30 days after transplantation, the rats were killed and the grafts were weighed, respectively. Histopathological changes were evaluated. Microvessel density and the expression of VEGF were examined by immunohistochemical staining and Western blotting. Results The weights of the negative and blank control groups were significantly reduced on the 7th, 15th and 30th days compared with those of the experimental group. The expression of VEGF and the microvessel density in the experimental group were significantly higher than the other two groups during the latter periods. Conclusion The plasmid encoding VEGF can induce expression of VEGF and angiogenesis in fat grafts and reduce the absorption of free fat grafts.

Early experience of immediate reconstruction using autologous free dermal fat graft after breast conservational surgery

Breast conservational therapy (BCT) has become a standard strategy for breast cancer, and ensures that local control with acceptable cosmetic results [Fisher B, Anderson S, Redmond CK, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1995;333:1456-61] and immediate reconstruction after BCT has become increasingly popular even for early-stage breast cancer [Berrino P, Campora E, Santi P. Post-quadrantectomy breast deformities: classification and techniques of surgical correction. Plast Reconstr Surg 1987;79(4):567-72; Cooperman AM, Dinner M. The rhomboid flap and partial mastectomy. Surg Clin North Am 1978;58:869-73]. The breasts of Japanese women are sometimes too small to maintain symmetry, even after partial resection, and an insufficient resection margin may increase local recurrence if too much attention is paid to cosmesis. Use of an autologous free dermal fat graft (FDFG) for defect reconstruction has proven popular for some areas of the body [Lexer E. Free transplantation. Ann Surg 1914;60:166-94; Peer LA. The neglected free fat graft. Plast Reconstr Surg 1956;18:233-50]. Immediate reconstruction of the surgical defect was performed in seven Japanese women using autologous free dermal fat graft (FDFG) from the lower abdomen after breast-conserving surgeries for six malignant lesions and two benign masses located in the medial or central area of the breasts. The mean amount of resected tissue was 56.4 g (range, 28-108 g), while mean FDFG weight was 78.3g (range, 35-148 g). We obtained symmetry in the size of the whole breast, the position and level of the nipple, and shape. Autologous FDFG was useful for reconstruction, with a good cosmetic effect. This technique achieves better cosmetic results than the transposition of residual breast tissue, is more convenient than muscle flap grafting, and safer than implantation of foreign materials. This report documents our early experiences with seven patients who underwent BCT and immediate breast reconstruction using autologous FDFG.

Experimental study on the prevention of epidural scar adhesion with polycaprolactone/polylactic acid membrane

To evaluate the ability of a polycaprolactone/polylactic acid (PCL/PLA) membrane to inhibit epidural scar adhesion after laminectomy, and observe the responsive changes of the pain media in the spinal cord. L(1), L(3) laminectomies were performed on 96 Wistar rats. The rats were divided into 3 groups: None-implant Control Group (NC), Autologous free fat graft group (AFFG) and PCL/PLA membrane group (PCL/PLAm). The rats were killed at 1, 3, 6, and 12 weeks postoperatively. Epidural scar formation and adhesion were observed grossly and histologically. Reverse transcription polymerase chain reaction (RT-PCR) were used to analyses the expression of Transforming growth factor beta (TGF-beta) in the epidural scar. Immunohistochemistry stain and RT-PCR were performed to evaluate the expression of the substance P and the c-fos gene in the relevant spinal cord, and the results were analyzed statistically. Gross evaluation and histological evaluation showed that in the NC lamina defect site had much scar tissue and had wide and tight adhesions to the dura; in the AFFG, with the fat degrading gradually, the adhesions were increased; whereas in the PCL/PLAm group, there were slightly adhesions to the dura. RT-PCR showed that the expression of the TGF-beta was much less in the PCL/PLAm group than in the NC group. The insertion of the PCL/PLA membrane and the fat patch reduced the expression of the substance P and the c-fos gene in the spinal cord. The insertion of the PCL/PLA membrane reduces scar formation and separates fibrosis tissue from the dura, the results indicate that PCL/PLA membrane is an effective way of reducing peridural scar formation and preventing the failed back surgery syndrome.

Problem-solving, decision-making, and critical thinking: How do they mix and why bother?

Autologous free-fat grafting (AFG) has emerged as an attractive proposition for soft-tissue reconstruction of various contour defects because it obviates more complex reconstructive options and reduces operative times and donor-site morbidity. Nonetheless, a common complication of this procedure is the resorption of the engrafted fat. Cell-assisted lipotransfer (CAL) is now a well-regarded technique where adipose-derived stem cell (ASC)-rich stromal vascular fraction is admixed with lipoaspirate, increasing the volumetric outcome of fat grafts in light of its potent angiogenic and adipogenic properties. Criticisms, however, remain regarding this modality especially for the treatment of post-oncologic defects. Laboratory data has attested to its propensity to perpetuate tumor cells as a result of its paracrine effects on the host microenvironment. This review article aims to present the underlying facts behind ASC therapy and provide meaningful discourse as to its utility in post-oncologic soft tissue reconstruction.

Facial contour reconstruction using an autologous free fat graft: A case report with 18-year follow-up

Facial contour reconstruction using an autologous free fat graft: A case report with 18-year follow-up

The use of autologous free fat tissue in prevention of calvarial bone regeneration: an experimental study

Autologous free fat grafts have been successfully used to limit ingrowth of postlaminectomy fibrous tissue and to prevent reossification after bone resection in long bones. This study was designed to test the effect of placing autologous adipose tissue in standardized craniotomy defects and also to determine the effect of the presence of periosteum and dura in the area of the fat augmented defects. In 18 immature rabbits, aged 18–21 days, two identical full-thickness defects were made bilaterally in the parietal bone. An autologous free fat graft was placed in one of the defects, the second being an internal control. The study groups were as follows: Group I: dura and periosteum left intact; Group II; periosteum removed; dura left intact; Group III; periosteum and dura removed. The animals were sacrificed after ten weeks. Histological examination of all groups demonstrated prevention of bone regeneration at the margins of the defect with some variations. In the first and second groups, new bone formation appeared over the dura, creating an incomplete plate of bone. On the periosteal side of the graft, a smaller amount of bone formation appeared close to the osteotomy line. The third group demonstrated a total prevention of bone regeneration. The use of free fat tissue graft can prevent calvarial bone regeneration and may be a useful adjunct for the treatment of craniosynostosis. Measures should be taken regarding the new bone formation over the dura, since this may cause reoccurrence of craniosynostosis.

Autologous free dermal fat graft. Reconstruction of facial contour defects.

To examine the use of autologous free dermal fat grafts (FDFGs) in the reconstruction of soft-tissue facial contour defects, an 8-year, retrospective, computerized medical chart review was conducted for 21 patients who underwent reconstruction with FDFGs. Section of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology, Oregon Health Sciences University, Portland, or affiliated hospitals. Twenty-one patients identified in the chart review were included in the retrospective evaluation. Follow-up periods ranged from 11 to 94 months. Five patients were unavailable for follow-up at the chart review, but all five had satisfactory results at their last evaluation. Soft-tissue augmentation was performed using autologous FDFGs harvested from the abdomen following in situ de-epithelialization with a high-speed dermabrader. Facial contour defects resulted from tumor extirpation, congenital deformity, trauma, or degenerative disease. Outcome was considered satisfactory when the patient and the surgeon were pleased with the long-term results at the last evaluation. Complications, including graft resorption (five patients) and epithelial cyst formation (two patients), were observed in seven patients and resulted in an unsatisfactory outcome. The remaining 14 patients demonstrated satisfactory results as determined by the patient and the surgeon at the last evaluation. Successful long-term augmentation of facial contour defects may be achieved with autologous FDFGs in an appropriate patient population. Careful patient selection and proper surgical technique are essential for satisfactory long-term results. Guidelines are provided for the augmentation of facial contour defects with autologous FDFGs.

The effect of preoperative needle abrasion of the recipient site on survival of autologous free fat grafts in rats.

Pads of fat ranging from 670-1758 mg in weight were taken from the right groins of 20 rats and implanted subcutaneously over their right pectoral muscles. One week previously the recipient site on the thorax had been abraded with a needle in 10 of the rats. After three months the transplanted fat was taken out, weighed, and examined histologically by light microscopy. Regional tissue blood flow in the transplanted fat and in the fat from the left groin was measured by the microsphere technique. The amount of surviving fat and blood flow in the fat transplanted to an abraded recipient site was significantly higher than in the control group after three months. We conclude that preoperative needle abrasion of the recipient site may increase the chance of revascularisation and survival of the transplanted fat in rats.