Dermis-fat Graft Research Articles

P2-15-03: Nipple-Sparing Mastectomy for Breast Cancer in Japanese Experience: An Assessment from Long Follow-Up Data of Complication and Cancer Control in 806 Patients.

Abstract [Introduction] Mastectomy has been conducted in general for cases in which breast conservation is inapplicable. Since Nipple-sparing Mastectomy (NSM) conserves nipple-areola, it is not only more advantageous in an aspect that nipple-areola reconstruction isn't required in case of breast reconstruction compared with mastectomy but also significantly meaningful because the sensation of nipple-areola is preserved in about 70% cases by skin flap preparation based on thick flap method we have adopted. On the other hand, NSM is controversial relating to complication of surgery and recurrence as well. [Objective] We've made (1) review of safety in NSM surgical technique, (2) discussion over recurrence and prognosis comparing with those in mastectomy, and (3) consideration of performance in immediate reconstructions. [Result] (1) Of all cases of NSM, the number of cases in stage 0, 1, 2A, 2B, 3 and 4 was 21, 305, 239, 123, 112 and 6 respectively. During 104 months of follow-up period in average, total of seven complication cases (0.9%) were observed, including two flap necrosis cases and five postoperative bleeding cases, but no nipple necrosis case was recorded. Although nipple-areola recurrence rate (%) in stage 0, 1, 2A, 2B and 3A was 0, 2.9, 4.6, 2.4 and 5.3 respectively, prognosis of nipple-areola recurrence cases was good showing no difference between stages (OS: 60M; 93%, 100M; 84%). Skin flap recurrence rate (%) in stage 0, 1, 2A, 2B and 3 was 0, 3.2, 3.3, 4.0 and 14.2 respectively, and prognosis of skin flap recurrence cases was significantly worse in stage 2B and 3 compared with that in stage 1 and 2A (p < 0.001). (2) We analyzed local recurrence rate, recurrent free survival and overall survival between 806 of NSM cases and 200 of mastectomy cases which had been performed during the same period, and the result showed no significant difference in those rates between NSM and mastectomy cases. (3) Infectious complication was observed in one out of 18 immediate reconstruction cases using free dermal fat graft. Among 124 immediate reconstruction cases using implant, complications were observed in five postoperative bleeding. [Conclusion] NSM was excellent in cosmetic aspect showing equivalent results in local recurrence rate and prognosis compared with those in mastectomy cases. Besides, patient's satisfaction was also higher in those who had had NSM alone without reconstruction. Our long term follow-up data shows that NSM may be considered as an alternative option for mastectomy in cases in which breast-conserving surgery is inapplicable in breast cancer patients. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-15-03.

Use of Various Free Flaps in Progressive Hemifacial Atrophy

Romberg disease is an uncommon condition manifested by progressive hemifacial atrophy of the skin, soft tissue, and bone. Facial asymmetry with soft tissue deficiency in Romberg disease causes a significant disability affecting the social life and can bring about many psychological problems. The aim of surgical treatment is cosmetic amelioration of the defect. Several conventional reconstructive procedures have been used for correcting facial asymmetry. They include fat injections, dermal fat grafts, filler injections, cartilage and bone grafts, and pedicled and free flaps. We report our experiences with 11 patients involving 11 free flaps with a minimum 1-year follow-up. All patients were classified as having moderate to severe atrophy. The average age at disease onset was 4.5 years; the average duration of atrophy was 5.2 years. No patients were operated on with a quiescent interval of less than 1 year. The average age at operation was 20.1 years, ranging from 10 to 55 years. Reconstruction was performed using 4 groin dermofat free flaps, 4 latissimus dorsi muscle free flaps, and 3 other perforator flaps. To achieve the finest symmetrical and aesthetic results, several ancillary procedures were performed in 4 patients. These procedures included Le Fort I leveling osteotomy, sagittal split ramus osteotomy, reduction malarplasty and angle plasty, rib and calvarial bone graft, correction of alopecia, and additional fat graft. All patients were satisfied with the results. We believe that a free flap transfer is the requisite treatment modality for severe degree of facial asymmetry in Romberg disease.

Is V-Y plasty necessary for penile lengthening? Suspensory ligamentolysis and dermal-fat graft placement solely through circumcision

Is V-Y plasty necessary for penile lengthening? Suspensory ligamentolysis and dermal-fat graft placement solely through circumcision

Clinical and pathologic evaluation of implanted free dermal fat grafts after breast cancer surgery: A retrospective analysis

The efficacy of immediate breast reconstruction using a free dermal fat graft (FDFG) was evaluated clinically. A total of 22 breasts in 21 patients who underwent partial mastectomy for early breast cancer involving mainly the inner upper quadrant were enrolled in this study. The defect was reconstructed immediately by filling it with an autologous FDFG. At 6 months and 1, 2, 3, 4, and 5 years postoperatively, the width (horizontal length) and thickness (distance perpendicular to skin) of the FDFG on computed tomography (CT) scans were measured. Histologic samples from the implanted FDFG were collected by core needle biopsy (CNB). The correlations between clinical findings and volume of the FDFG on CT and the proportion of fatty tissue in the CNB were examined statistically. Cosmetic results were also evaluated. On CT, the mean width of the FDFG was 95%, 81%, 79%, 73%, 68%, and 47% and the mean thickness were 125%, 121%, 120%, 115%, 104%, and 103% at 6 months, and 1-5 years postoperatively, respectively. In the CNB samples, the mean fatty tissue distribution was 76%, 63%, and 54% at 1 year, 1-4 years, and >4 years postoperatively, respectively. The percent change in the width of the FDFG at 6 months after the operation displayed a significant negative correlation with the postmenopausal period and a significant positive correlation with the maximum surgical margin. On CT, thickness was negatively correlated with the size of the resected breast tissue, and thickness of the implanted FDFG. No clinicopathologic factors or technical factors were related to FDFG outcome and the proportion of fat tissue in the CNB sample, except for axillary dissection. Nineteen of 21 patients had good to excellent cosmesis. FDFG implanted into breast defects after partial mastectomy undergo mild resorption and degeneration to fibrous tissue, but most patients have good to excellent cosmesis.

Congenital anophthalmia

The introduction of hydrogel socket and orbital expanders has modified the approach towards the rehabilitation of congenital anophthalmia. This study highlights the most recent advances for the treatment of congenital anophthalmia based on personal experience and the review of recent literature. Hydrogel socket expanders may be positioned as an out-patient procedure with topical anaesthesia, using cyanoacrylate glue as opposed to temporary tarsorraphy. Increased orbital volume has been confirmed by computed tomography (CT) scan or magnetic resonance imaging (MRI) following early dermis-fat graft in children with congenital anophthalmia. An orbital tissue expander made of an inflatable silicone globe sliding on a titanium T-plate and secured to the lateral orbital rim appears to be effective to stimulate orbital bone growth and development. Congenital anophthalmia has a complex cause with both genetic and environmental factors involved. The ideal treatment is simultaneous expansion of the eyelids, socket and orbital bones, and it should begin after birth as soon as possible. Socket expansion with self-inflating expanders is a useful technique, although custom-made conformers may produce similar results. Dermis-fat grafts are another reasonable option as an orbital implant, following adequate lid and socket expansion.

Temporary cosmetic painted prostheses in anophthalmic surgery: an alternative to early postoperative clear conformers

To evaluate the use and safety of temporary, cosmetic, painted prostheses as an alternative to clear conformers immediately post removal of eye or socket surgery in children and adults. A 2-year, two-centre, retrospective audit of 54 patients undergoing enucleation, evisceration, secondary implant or socket reconstruction receiving a temporary painted prosthesis as an alternative to clear conformers immediately post surgery. Patient questionnaire and review of clinical notes was conducted for all patients. We reviewed 54 consecutive patients (22 females, 32 males, mean age 18.6 years, range 6 days to 82 years) who received cosmetic painted prostheses from January 2009 to December 2010. Procedures included: evisceration with primary implant (5), enucleation with primary implant (37), secondary implant (9), dermis fat graft (2) and fornix reconstruction with buccal graft (1). Complications included: pyogenic granuloma (2), mucous discharge (2) and exposure (2). All adults found their prosthesis comfortable, and no problems were reported by the parents of the children included in this study. In all, 46 patients (88% of respondents) returned to normal activities within 2 weeks. The temporary prosthesis fell out at least once in 25% of cases. In all, 90% of respondents expressed a definite preference towards the painted shell over a clear shell. Temporary cosmetic painted prostheses placed immediately after removal of the eye or socket surgery are well tolerated and preferred to standard clear shells. Painted prostheses, matched to the contralateral iris are a valuable option in anophthalmic surgery as an alternative to traditional clear conformers.

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.

Use of dermal fat graft for augmentation of the labia majora

Dermal fat grafts have been utilized in plastic surgery for both reconstructive and aesthetic purposes of the face, breast, and body. There are multiple reports in the literature on the male phallus augmentation with the use of dermal fat grafts. Few reports describe female genitalia aesthetic surgery, in particular rejuvenation of the labia majora. In this report we describe an indication and use of autologous dermal fat graft for labia majora augmentation in a patient with loss of tone and volume in the labia majora. We found that this procedure is an option for labia majora augmentation and provides a stable result in volume-restoration.

Reconstruction de l’orbite anophtalme

Evaluate different surgical techniques in the management of the contracted anophthalmic socket. A retrospective study including 12 patients with acquired anophthalmic socket presenting inadequate fornices and/or orbital volume loss. The surgeries performed were conjunctival suture to the periosteum (mild fornix contraction), buccal mucosa graft (moderate fornix retraction), auricular cartilage graft (severe fornix retraction), and dermis-fat graft (loss of orbital volume). Fornix retraction was mild in two patients, moderate in three patients, and severe in two patients. We observed five patients with loss of orbital volume. Successful correction was achieved in all patients with fornix retraction who were able to wear an external prosthesis. One patient with orbital volume loss developed graft atrophy. Autologous grafts are useful in the rehabilitation of the contracted socket.

Dermis-Fat Graft for Treatment of Exposed Porous Polyethylene Implants in Pediatric Postenucleation Retinoblastoma Patients

To demonstrate the use of the autogenous dermis-fat graft for the treatment of porous polyethylene implant exposure and volume augmentation in postenucleation retinoblastoma children. Retrospective, interventional case series. Ten children who received a dermis-fat graft at Seoul National University Hospital between July 1, 2005 and January 31, 2010 were included in this study. The patients had undergone unilateral enucleation for retinoblastoma, and received a subconjunctival dermis-fat graft to repair implant exposure and simultaneously correct enophthalmos. The clinical characteristics of the patients, rate of graft survival, and complications were analyzed. The cosmetic outcome was assessed using a grading system. All patients had enucleation using porous polyethylene implant as a primary orbital implant. The average time to exposure was 89.1 ± 22.4 months and the median size of defect was 2 × 3 mm. With a mean follow-up of 28 months, 9 of 10 patients showed well-survived graft without re-exposure. One patient who experienced a graft failure managed with implant rotation and a scleral graft. Seven patients showed significant improvement of enophthalmos. Implantation of an autogenous dermis-fat graft is a procedure that can be effectively used to treat porous polyethylene implant exposure and simultaneously correct enophthalmos. Use of this procedure can be particularly advantageous for pediatric postenucleation patients.

Auricular reconstruction and correction of mild hemifacial microsomia with dermal fat graft in one stage

To evaluate the effect of auricular reconstruction and correction of mild hemifacial microsomia with dermal fat graft in one stage. 28 cases with microtia and grade I and II hemifacial microsomia were treated. The tissue expander was implanted under the skin of mastoid at the first stage. At the second stage, the auricular reconstruction was performed with autologous rib cartilage framework. The remained dermal fat tissue from the donor site was inserted subcutaneously to correct the asymmetric face of microsomia. 20 cases, who underwent auricular reconstruction only, were used as control group. The facial asymmetry was greatly improved after operation in the 28 cases. The complications happened in 7% (2/28) of the patients, including one case of infection and one case of framework exposure. While it was 5% (1/20) in control group, showing no significant difference between the two groups (P > 0.05). The satisfactory rate was 93% (26/28) in one-staged group and 80% (16/20) in control group (P < 0.05). The dermal fat graft which should be abandoned in the traditional auricular reconstructions could be used to correct mild hemifacial microsomia with satisfactory appearance improvement.

Macroscopic and Histologic Analysis of Abdominal Dermis-Fat Grafts Retrieved From Human Temporomandibular Joints

The purpose of the present study was to examine the fate of the abdominal dermis-fat grafts that were implanted into human temporomandibular joints (TMJ) at the macroscopic and histologic levels. The clinical records of 123 patients who underwent TMJ discectomy with dermis-fat grafting during a 10-year period (2000 to 2009) were reviewed, and 8 patients were identified who had had the dermis-fat graft surgically removed from their TMJ at a subsequent operation. The retrieved grafts were assessed at the macroscopic and histologic levels for size, consistency, and cellular composition. The dermis-fat grafts were retrieved after a period of 8 to 46 months (mean, 22.3) after initial implantation into the TMJ. The graft material was a rubbery consistency and filled the entire joint space between the condylar head and glenoid fossa/articular eminence. The average size of the retrieved grafts was 16 mm × 14 mm × 7 mm, with a mean volumetric dimension of 1.57 ± 0.38 cm(3). The interpositional tissue retrieved from all joints demonstrated clear histologic evidence of mature adipose tissue interspersed with dermal elements such as sweat glands and hair follicles that were atrophied. The ratio of fat/nonfat tissue was significantly (P < .01) less (mean, 31.3% ± 5.7%) than in the original (mean, 90.2% ± 6.3%) graft. No evidence was found of dermoid cysts or necrotic fat in any of the specimens examined. The results of the present study showed that abdominal dermis-fat grafts transplanted to the TMJ do thrive and adapt well to the confines of the joint cavity, allowing functional movement of the joint. However, in the present study, the dermis-fat graft failed to protect the condyle against additional deterioration in 6.5% of patients who went on to have total joint replacements.

Application of autologous dermal-fat flap in repair of collapsed nasal dorsum

Objective To investigate the feasibility, rationality and efficacy of the autologous dermal-fat composite tissue used as filling materials in the repair of nasal dorsum collapse.Methods The dermal fat composite tissue block (7.0 cm× 1.0 cm × 1.0 cm) was removed from the buttocks or abdoman as filling materials. 13 cases of nasal dorsum and nasal-shaped misfits were treated by using an umbrella graft of the auricular cartilage plus dermal-fat composite tissue graft to reconstruct natual shape of nasal dorsum and tip. Results The nasal dorsum and tip were repaired in 13 patients with collapsed nasal dorsum. The dermal-fat composite tissue survived well, and the incisions were healed in stage Ⅰ and the incision trace was not obvious. After follow-up for one year, the shape of nose was much satisfactory. Conclusion It is a well-accepted and easy-going procedure to repair collapsed nasal dorsum with autologous dermal-fat or a combination of composite ear cartilage tissue graft, with satisfactory effect and no rejection reactions. Key words: Dorsum collapse; Repair; Dermal-fat composite tissue; Auricular cartilage

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.

“En-Glove” Lysis of Lower Eyelid Retractors With AlloDerm and Dermis-Fat Grafts in Lower Eyelid Retraction Surgery

To describe a minimally invasive surgical technique using AlloDerm or dermis-fat grafts for lower eyelid retraction. A retrospective review of all patients undergoing lower eyelid retraction surgery via a minimal invasive, "en-glove" technique from 2005 through 2009. Charts were reviewed for the type of graft (AlloDerm or dermis-fat) used, the etiology of lower eyelid retraction, and the follow-up time. Outcome measures included lower eyelid height (measured from the corneal light reflex to the lower eyelid margin, or MRD2), reduction of lagophthalmos, cosmetic appearance, complications, and need for further surgery. Presurgery and postreconstruction photographs were reviewed and graded for functional and cosmetic outcome. A total of 8 patients underwent successful lower eyelid retraction surgery using this minimally invasive technique. Etiologies included thyroid eye disease and cicatricial paralytic lower eyelid retraction. Mean improvement in MRD2 was 1.5 mm for the AlloDerm group (4 patients, 7 eyelids) and 1.0 mm for the dermis-fat group (4 patients, 4 eyelids) after a minimum of 3 months' follow-up. The cosmetic result was satisfactory in all cases. "En-glove" lower eyelid retraction surgical technique offers a minimally invasive approach for the release of the lower eyelid retractors and allows for volume augmentation using either AlloDerm or dermis-fat spacer graft.

Dermis fat graft after enucleation in children with retinoblastoma

Purpose: Enucleation is the only true cure for retinoblastoma. It's performed in children with tumors that are not possible to treat with thermotherapy/chemotherapy. This surgery can result in retarded orbital growth and facial hypoplasia. The common management is a porous orbital implant that is placed to provide volume. This implant is a fixed-diameter sphere that results too big for the orbit of these children. Another disadvantage is the price. Complications associated with orbital implants include discharge, conjunctival dehiscence, infection, granuloma, potential implant exposure.

Free Dermal Fat Graft Reconstruction of the Head and Neck: A Cosmetically Appealing Reconstructive Option

Methods: Patients who underwent FDFG reconstruction of the head and neck between 1997 and 2010 were identified. Of 205 patients identified, 62 met inclusion criteria. The pathology, surgical technique, long term imaging, cosmetic outcome, and complications were analyzed. Postoperative cosmetic results were assessed by a novel patient based numerical grading scale. Three of 62 patients with extensive photographs and imaging are presented in greater detail.

A critical review of interpositional grafts following temporomandibular joint discectomy with an overview of the dermis-fat graft

The aim of this critical review is to determine what constitutes an ideal disc replacement material and whether any of the existing materials reported in the literature satisfy the requirements of an effective disc substitute following temporomandibular joint (TMJ) discectomy. Over the last half century a myriad of interpositional materials have been used in the TMJ but nearly all have been less than successful. The disasters that followed the early use of alloplastic interpositional implants in the 1980s prompted the increased use of autogenous grafts in the 1990s. Whilst studies by the author on the use of dermis-fat grafts have been largely positive, there are still concerns that make the dermis-fat graft a less than ideal interpositional material for use in discectomized joint cavities. In reviewing the literature, it is clear that there is still no ideal interpositional material that satisfies all the criteria for replacement of a missing articular disc following TMJ discectomy.

Condylar Morphology After Temporomandibular Joint Discectomy With Interpositional Abdominal Dermis-Fat Graft

The purpose of this study was to look at the morphology of the condylar head after temporomandibular joint (TMJ) discectomy with interpositional abdominal dermis-fat grafts by using the orthopantograph (OPG) as the basis for investigation. This retrospective study involved 28 patients (1 male patient) who had undergone TMJ discectomy with an interpositional abdominal dermis-fat graft for the management of severe internal derangement. The age range of the patients was 15 to 68 years, with a mean age of 51.5 years at the time of their TMJ surgery. A total of 33 operated joints were examined, including 5 cases of bilateral TMJ discectomy with dermis-fat grafts. Sixteen joints underwent additional surgery to the condylar head, whereas the remaining 17 joints had no condylar surgery. OPG radiographs were taken from 12 months up to 7 years after surgery, with a mean follow-up period of 32 months. The condyles of the operated joints were visually assessed on OPG and graded according to the condylar morphology scale (CMS), where 0 indicates normal, 1 indicates remodeling, and 2 indicates resorption of the condylar head. By use of the CMS grading system, 9 of 33 joints (27.3%) were found to be normal (CMS = 0). Remodeling (CMS = 1) was found in 14 joints (42.4%) after TMJ discectomy with dermis-fat graft. Radiologic evidence of resorption was present in 10 joints (30.3%) with a CMS score of 2. Remodeling (CMS = 1) was found in 3 joints (17.6%) where no condylar surgery was performed compared with 11 joints (68.8%) where condylar surgery was undertaken. Resorption (CMS = 2) was measured in equal numbers of 5 joints in each group regardless of whether condylar surgery was undertaken (31.2%) or not (29.4%). The findings of this study suggest that in cases where additional condylar surgery was undertaken, over two thirds of the joints (68.8%) showed evidence of remodeling on postoperative OPGs. The interpositional dermis-fat graft failed to prevent significant condylar changes (CMS = 2) in about one third of patients who underwent TMJ discectomy, with the youngest (mean, 30.2 years) and the oldest (mean, 55.6 years) patients being most susceptible to condylar resorption.

Histological fate of abdominal dermis–fat grafts implanted in the temporomandibular joint of the rabbit following condylectomy

The histological fate of abdominal dermis-fat grafts implanted into the temporomandibular joint (TMJ) following condylectomy was studied. 21 rabbits underwent left TMJ discectomies and condylectomies; 6 were controls (Group A; no graft used); 15 (Group B) had autogenous abdominal grafts transplanted into the left TMJ. Animals were killed after 4, 12 and 20 weeks. Specimens of the TMJ were histologically and histomorphometrically evaluated. At 4 weeks, fat necrosis was clear in all specimens. The dermis component survived and formed cysts with no necrosis. By 12 weeks, viable fat deposits appeared with no evidence of necrotic fat. At 20 weeks, large amounts of viable fat were present in Group B specimens. Group A had no fat, although the missing condyles regenerated. In the presence of viable fat, Group B showed little condyle regeneration 20 weeks after condylectomy. Non-vascularised fat grafts do not survive transplantation, but stimulate neoadipogenesis. The fate of the dermis component of the graft is independent of the fat component. Fat in the joint space disrupts the regeneration of a new condylar head. Neoadipogensis inhibits growth of new bone and cartilage. This has clinical implications for TMJ ankylosis management and preventing heterotopic bone formation around prosthetic joints.