Dermis-fat Graft Research Articles

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.

Exposed Porous Orbital Implants Treated With Simultaneous Secondary Implant and Dermis Fat Graft

To describe a technique for simultaneous secondary orbital implantation and dermis fat graft placement for exposed porous implants with significant conjunctival insufficiency. Retrospective review of 4 consecutive cases. Charts were reviewed for type and size of exposed porous implant, size of conjunctival defect, history of previous reconstruction for exposure, size and type of implant placed, follow-up interval, complications, ability to retain prosthesis, and cosmesis. Four patients underwent simultaneous dermis fat graft placement and secondary implantation for exposed and completely avascular orbital implants. The rectus muscles were advanced over the new implant to act as the host bed for the dermis fat graft. All patients tolerated a new prosthesis well, with adequate motility and cosmesis. Simultaneous secondary implantation and dermis fat graft placement may adequately address avascular porous implant exposure with significant conjunctival insufficiency.

Quality-of-Life Survey Comparing Patients Before and After Discectomy of the Temporomandibular Joint

The aim of this study was to assess the quality-of-life (QoL) outcomes of patients who had undergone temporomandibular joint (TMJ) discectomy with dermis-fat grafting compared with a cohort of closely matched patients who had not had surgery. A cross-sectional study of 61 patients was undertaken. All patients completed a TMJ surgery-specific QoL questionnaire. They were divided into 2 groups according to whether they had undergone TMJ discectomy (postsurgical group, n = 32) or not (presurgical group, n = 29). The 2 groups were closely matched for age, gender, clinical presentation, and radiologic diagnoses of Wilkes stage IV TMJ internal derangement. Post-TMJ surgery patients showed statistically significant decreases in pain levels (P < .05), diet and chewing (P < .01), mood (P < .01), anxiety (P < .01), and general health (P < .05) compared with the presurgical patients. However, there were no statistically significant differences between the pre- and post-TMJ surgery groups in terms of speech, level of activity, recreation, and general well-being. The results of this study suggest that TMJ discectomy with dermis-fat grafting appears to have a positive QoL effect in terms of reducing pain levels and improving diet and chewing, mood, anxiety, and general health in patients with Wilkes stage IV TMJ internal derangement.

Congenital Pigmented Nevi of the Auricle: Clinical Experience and Approach to Treatment

Congenital pigmented nevi of the auricle are uncommon. The authors' approach is to excise these nevi and perform reconstruction because of the risk of malignant transformation and the aesthetic and psychological effects these nevi can have on the child. This study presents the authors' experience in treating congenital nevi of the ear and suggests treatment principles and guidelines for the reconstructive surgeon. Fourteen patients with congenital nevus of the ear were treated from October of 1992 to September of 2008 by the senior surgeon (B.S.B.). Nevi involving the more stable areas such as the concha can be resected and grafted early; the antihelix, scapha, and triangular fossa area can be resected and grafted next; and the helical rim, having the most easily distorted cartilage, should be treated last. Lobule reconstruction requires combined flaps and a dermal fat graft or a postauricular fascial fat flap. Successful reconstruction was achieved in 10 patients. Three patients require final revision procedures (lobule reconstruction). One patient, early in our series, developed a deformed helical rim resulting from skin grafting at age 16 months, before the cartilage was firm enough to withstand the contraction forces of the skin graft. All subsequent patients with helical rim involvement had treatment delayed until the ear was at or near completion of its growth. Congenital nevi of the ear present a challenging reconstruction surgeon. The authors developed a treatment plan that breaks the ear down to aesthetic units and considers the location of the nevus, patient age, and the firmness of the cartilage.

Delayed Complications of Gel Injection for Penile Girth Augmentation

Penile girth augmentation is a domain of extensive controversy and debate. A variety of methods is available for the choice of the surgeon including dermal-fat grafts and flaps. The need for a simple procedure with minimal donor site has lead to proposing injection therapy for penile augmentation, whether by fat or synthetic materials. This work reports on a male patient suffering a deforming subcutaneous mass in the penis following penile girth augmentation by injection therapy using synthetic material, and describes its management, and pathologic analysis of the extracted tissue. The mass was excised through a circumferential subcoronal incision while maintaining skin vascularity and integrity of the corpora. The excised tissue was microscopically examined. Cosmetic and functional results of surgical correction. Cosmetic and functional outcome were acceptable. Pathology examination revealed features of foreign body granuloma. Injection of fillers for girth augmentation of the penile shaft may result in delayed complications including migration, granulomatous reaction, and resorption that may occur beyond the follow-up span of the currently available study that recommends its use.

Clinical application of combined platysma-fascial flap with free dermis fat graft to fill sunken cheek deformity

Objective To explore the method of treatment of sunken cheek deformity.Methods The longitudinal platysma-faseial flap was overturned 180 degree upward,the flap's pedicle located in the margin of mandible,and then combined with abdominal dermis fat graft to form as a sandwich,which filled in the sunken area of face.Results Five patients were treated with this method from 2003 to 2007,and satisfactory results were gained but only mild absorption was found in the transplanted tissue area during followed up for 3 months to 3 years.Conclusion Platysma-fascial flaps survive easily with rich blood supply and strong anti-infection,and are also easy to incise and operate as well,which,together with free abdominal dermis fat flap,could increase the amount of the needed tissue.It is a better approach to repair the sunken cheek deformity and in particular suitable for the more serious deformity in patients with sunken cheek. Key words: Sunken cheek deformity; Platysma-fascial flap; Dermis fat graft

The Use of Dermal Fat Grafts for the Correction of Secondary Cleft Lip Deformities

Sir: Surgeons who treat patients with cleft lip deformities face a wide array of challenges, both in the initial repair of the distorted anatomy and in the frequent “touch-up” procedures to improve secondary deformities. Common local techniques include V-Y vermilion advancement, Z-plasties, elliptical excision, Abbé flaps, and Kapetansky flaps.1,2 When local tissues are inadequate for volumetric correction, a wide range of grafting material is frequently used with variable results.3,4 Eight patients underwent cleft lip revision performed by a single surgeon using our dermal fat grafting technique at our facility between 1997 and 2001. The defect was outlined with a surgical marker, and the vertical incision placed on the posterior (oral) aspect of the marking. A subcutaneous pocket was dissected while staying within the markings of the defect, and the dermal graft was harvested. The size and shape of the graft were slightly larger than those of the outlined lip defect, to allow for trimming and slight overcorrection of the defect, since 10 to 15 percent resorption is expected (Fig. 1). The skin to be used was de-epithelialized in situ and excised full thickness with a thin layer of fat on the undersurface of the dermis. The graft was placed on the lip externally and trimmed to fit the defect optimally (Fig. 2). The graft was then drawn inside the pocket using two U stitches of 5-0 chromic gut suture, with the dermis side inward and the mucosal incision closed.Fig. 1.: Defect outlined on lip.Fig. 2.: Dermal fat graft overlying defect, trimmed to fit defect optimally with slight overcorrection.The charts were reviewed along with the standardized preoperative and postoperative photographs. Of the eight patients who underwent cleft lip revision, five had unilateral cleft deformities and three had bilateral deformities. All but one of the patients had a concomitant cleft palate. The average follow-up was 22 months. The average age at the time of operation was 12 years. Two of the patients, both with unilateral deformities, were noted to have a “slight excess fullness” on the grafted side but did not require a repeated operation. The initial patient in the series developed a palpable nodule of fat necrosis that required removal in addition to excision of excess vermilion. No other patients required repeated procedures for their cleft lip deformities (Table 1).Table 1: Patient DataThe method we have described has yielded consistent and durable results. The technical aspect of harvesting and placing the graft is straightforward and has a shallow learning curve. Our method differs from that reported in another recently published article5 and features a precisely dissected pocket to define the deficit to be augmented. We prefer to place our grafts with the dermis side down, believing the outwardly placed fat has a softer feel and graft take is better with the dermis adjacent to the labial muscle layer. Grafting can be combined with other procedures, such as V-Y advancement. In addition, the majority of these patients do not require the creation of any other scars, due to the harvest of tissue in the iliac region from bone-graft-harvest donor sites. In the event of incomplete correction, the procedure can be easily repeated for further focused augmentation. Craig Staebel, M.D. Charles N. Verheyden, M.D., Ph.D. Department of Surgery Division of Plastic Surgery Scott & White Memorial Hospital and Clinic The Scott, Sherwood, and Brindley Foundation The Texas A & M Health Science Center College of Medicine Temple, Texas DISCLOSURES There were no sources of funding supporting the work, and there is no financial interest to declare on behalf of either author.

Effect of autologous platelet adhesives on dermal fat graft resorption following reconstruction of a superficial parotidectomy defect: A double‐blinded prospective trial

Dermal fat grafts are used to reconstruct facial contour defects but may undergo variable resorption. Application of autologous platelet adhesive may improve outcomes. The primary objective was to compare resorption of dermal fat grafts for parotidectomy defects, between patients receiving autologous platelet adhesive versus controls. This was a double-blinded prospective cohort at a tertiary care center. Volumetric analyses of dermal fat graft measured by MRI scans. Resorption was determined by comparing 1- and 6-month MRIs in each patient. Complications, Frey's Syndrome, and patient satisfaction were also assessed. Twelve patients completed the study. A significant reduction in graft resorption was seen in the treatment group (57% vs. 31%, p = .01). Three patients in the control group developed fat liquefaction. Patient perceived significant differences in scar and contour. Application of autologous platelet adhesives improved graft viability and patient satisfaction at 6 months.

Addition of Dermis-Fat Graft to Diminish Cable Visibility in Frontalis Suspension for Patients With Pre-Existing Deep Superior Sulci

To propose and demonstrate a technique modification for frontalis suspension to simultaneously address ptosis and diminish abnormalities related to deep superior sulcus defect. Six patients underwent simultaneous frontalis suspension and placement of a superior sulcus dermis-fat graft. Postoperative visibility of the cables, anticipated in patients with deep superior sulci, was prevented in these 6 patients. Dermis-fat grafting may be added to improve cosmesis after frontalis suspension in patients at risk for postoperative cable visibility.

Correction of progressive hemifacial atrophy using dermis-fat graft and Medpor implant shaped by reverse engineering technique

To evaluate the therapeutic effect of dermis-fat graft combined with Medpor implant shaped by reverse engineering technique in the correction of the progressive hemifacial atrophy. A skull model was made by rapid prototyping and the bony deficiency model was acquired with reverse engineering technique. The Medpor implant was shaped precisely based on the deficiency model and implanted with dermis-fat graft at the same stage. 11 cases were treated successfully without infection, necrosis and rejection. The patients were followed up for six months to one year with satisfactory cosmetic improvement. The dermis-fat graft survived without obvious absorption. The technique can correct both the bony and soft tissue deficiency for progressive hemifacial atrophy. It is very practical and easily performed with reliant results and less morbidity.

Role of Trichloroacetic Acid in Treating Posterior Conjunctival Cyst in an Anopthalmic Socket

Orbital cysts in anophthalmic socket are infrequent. Most of the cysts reported are anterior and the inability to retain a formerly well-fitted prosthesis is the most common symptom. We present a posterior conjunctival cyst developed after a dermo-fat graft reconstruction in an eviscerated socket. Eleven years after evisceration surgery due to irreparable ocular trauma an extrusion of the orbital implant occurred. Removal of the orbital implant and a socket reconstruction with dermis fat graft was done. Three years later, the patient again returned back to the treating ophthalmologist with complaint of an inability to retain the formerly well-fitted artificial prosthesis. A detailed ophthalmic examination failed to reveal any abnormality. The CT scan showed a posteriorly located conjunctival cyst in the right orbit. Tricholoroacetic acid (TCA) was injected intracystically into the conjunctival cyst. Ten months of follow-up did not show any recurrence of the conjunctival cyst and allowed complete tolerance of the prosthesis. This case report highlights the role of tricholoacetic acid in treating a posteriorly located conjunctival cyst in an anophthalmic socket.

Treatment of Lower Eyelid Malposition with Dermis Fat Grafting

Treatment of Lower Eyelid Malposition with Dermis Fat Grafting

Reply

Sir: We thank Dr. Malaviya for sharing his opinion and commentary on autologous lip augmentation. Palmaris longus tendon is a soft, thin, autologous implant that does restore volume in a hypoplastic or scarred lip. It is a valuable and versatile soft-tissue filler that has taken the place, in certain circumstances, of other autologous options, such as microfat grafting and dermal fat grafts. The donor-site incision is small, inconspicuous, and well tolerated. We doubt the options presented by Dr. Malaviya, including the fascia lata and gracilis, could have the same small donor site and longevity objectively demonstrated in our article. We agree that lip augmentation has no one answer, as Dr. Malaviya has commented. In the reconstructive lip, the palmaris longus tendon is readily available and form-stable, with the ability to contour with stacking to fill the specific void after a stable soft-tissue envelope has been created. A multimodal approach should be applied to the lip and should include volume augmentation, combined with skin resurfacing or scar revision, and alteration of the orbicularis oris, either surgically or through chemodenervation. These principles hold true for both the cosmetic and the reconstructive patient. We believe that the palmaris longus tendon does play a role in this multimodal approach. It is presented as a viable, safe addition to the lip algorithm and not as a single solution, as Dr. Malaviya suggested. Plastic surgery has been plagued by subjective opinions and dogma; this article offers objective data that support our technique. The author has obviously missed the point of the article and, ironically, fallen into the trap of subjective opinion in his letter. Andrew P. Trussler, M.D. University of Texas Southwestern Medical Center Dallas, Texas James P. Bradley, M.D. UCLA Division of Plastic and Reconstructive Surgery Los Angeles, Calif.

Micro-cleft lip repair thrugh intraoral incision and combined with dermo-fat graft

Objective To explore a method of repairing microform cleft lip.Methods Reconstruet orbicularis oris muscle through intraoral incision opposite to the affected philtral ridge;Augment the depressed deformity using postauricular dermis fat graft though the canal of the upper lip;Correct the notching of the Cupid's bow through Z-plasty and dermis fat graft;Lift and fix the alar cartilage,and advance the alar base medially to reduce the cleft-site nostril.Results 8 patients were operated with this method,in which 7 patients were followed-up with satisfactory results.Conclusion It is a useful method to repair microform cleft lip using dermis fat graft through the intraoral incision. Key words: Cleft lip; Intraoral incison; Dermis fat graft

Le greffon dermohypodermique pour la couverture du nerf médian au poignet : résultats cliniques et paracliniques

We wished to evaluate the effectiveness of a free dermal fat graft for covering the median nerve in order to improve function after failure of carpal tunnel release. Eight patients with nine failures of carpal tunnel release were reviewed for this retrospective study. They all had significant perineural fibrosis. We performed a free dermal fat graft harvested from the inguinal region on the same side. The mean follow-up was 37 months (range 6 to 112). All patients had a clinical examination, a disability arm and shoulder scoring (DASH) and magnetic resonance imaging (MRI). Five patients were satisfied or very satisfied with the procedure although only two patients returned to work. Mean grip strength was 13 kg (43% of non-operated hand) and the two-point discrimination test was normal or subnormal six times on the eight wrists tested. The mean DASH score was 43 out of 100. MRI scans on eight wrists showed a fat signal in all patients and enhanced signal with gadolinium contrast in six cases. Free dermal fat graft offers a good covering for the median nerve over the carpal tunnel in cases of failure of carpal tunnel release. MRI showed viability of the graft. Clinical results show improvement but symptoms of median nerve irritation persisted. Permanent intraneural changes may explain these limited results.

Autologous Serum Eye Drops Used to Treat an Ulcerated Dermis-Fat Graft

A 49-year-old woman with a contracted and keratinized anophthalmic socket underwent a dermis-fat graft for orbital augmentation. She presented with an early ulcer on the surface of the dermis, with inhibited conjunctival growth. There was no improvement after 1 month of conservative treatment. The authors applied autologous serum eye drops to accelerate epithelial repair, with resolution of the ulcer and reduction of surface keratin within 3 weeks. This is the first report of dermis-fat graft ulcer treated with autologous serum.

Intraorbital Polyacrylamide Gel Injection for the Treatment of Anophthalmic Enophthalmos

To evaluate the use of orbital polyacrylamide gel injection for the correction of anophthalmic enophthalmos. Noncontrolled clinical trial of 21 patients (14 with ocular implants, 5 with phthisis bulbi, and 2 with dermis-fat graft). Orbital CT was performed to estimate the volume of polyacrylamide gel needed to restore orbital volume. Polyacrylamide gel was injected using a 22-gauge (30 x 0.7 mm) needle transcutaneously inserted in the lateral third of the lower eyelid, directed to the orbital muscle cone. A second injection was administered 15 days later, if necessary. CT was repeated 30 days after the last procedure. Exophthalmometry was performed before and 90 days after the procedure. The mean total volume injected per orbit was 2.4 +/- 0.7 ml (range, 1-3.5 ml). The volume of the enophthalmic orbit increased from 26.9 +/- 5.0 ml to 29.3 +/- 4.9 ml (p < 0.001). The mean difference in exophthalmometry readings was 3.3 +/- 1.6 mm (range, 1.5-8.0 mm) before the procedure and 1.0 +/- 0.9 mm (range, 0.0-3.0 mm) after 3 months (p < 0.001). Adjustment of the ocular prosthesis or fabrication of a new one was necessary in 11 patients (52.4%), and the mean volume of the ocular prosthesis was reduced from 2.0 +/- 0.6 ml to 1.6 +/- 0.6 ml (p = 0.003). All patients were satisfied with the aesthetic results. No serious adverse events were observed. The initial results were maintained 1 year after the procedure. Polyacrylamide gel injection in the orbital space effectively reduces enophthalmos in ocular prosthesis wearers.

P.440 Megacoronoid: a cause of temporomandibular joint dysfunction

To compare the outcomes achieved with eminectomy, discectomy alone, and discectomy with an abdominal dermis fat graft (D + ADFG) in the treatment of internal derangements (IDs) of the temporomandibular joint (TMJ), and to briefly discuss the failed cases in which a second operation was needed.This was a retrospective study of 31 patients (27 females, 4 males) who were unresponsive to conservative therapy and therefore underwent eminectomy (group A, n = 6), discectomy alone (group B, n = 8), or D + ADFG (group C, n = 17). All of the IDs of the TMJ were unilateral. Functional mandibular pain intensity on a visual analog scale (VAS) and maximum interincisal opening (MIO) were recorded preoperatively and at the latest postoperative examination (average, 30 months). The preoperative and postoperative results were compared between and within each group.Overall, patients in groups B and C had better outcomes than those in group A in terms of TMJ symptom relief. Postoperative increases in MIO were statistically significant in groups A, B, and C (P < 0.027, P < 0.017, and P < 0.000, respectively). Patients with discectomized joints (groups B and C) had significantly improved pain scores (P < 0.05) at the latest follow-up. In 6 of the 31 (19.3%) patients (3 eminectomy, 1 discectomy, and 2 D + ADFG), the procedure was deemed unsuccessful because of persistent symptoms and a second operation was performed.Discectomy with or without ADFG was clearly superior to eminectomy in reducing pain and improving joint function. But there were no significant differences in the two-discectomy groups with respect to symptom improvement.

Random control trial of dermis-fat graft and interposition of temporalis fascia in the management of temporomandibular ankylosis in children

Temporomandibular ankylosis is a disabling condition that affects hygiene and cosmetic appearance. Several interpositional grafts such as meniscus, muscle, fascia, skin, cartilage, fat, dura, alloplastic materials and xenografts have been used to prevent recurrence of ankylosis. We studied the advantages and disadvantages of dermis fat graft as an interposition material after arthroplasty and compared it with temporalis fascia interposition. Seventeen patients with temporomandibular ankylosis involving 20 joints were randomly divided into two groups; the first group had operations for interposition of dermis-fat graft that was taken from the groin. Patients in control group had operations to interpose temporalis fascia and muscle from the same surgical site. All were assessed by age, sex, etiology, clinical features and post surgical complications. The groups were matched in age and the male: female ratio was 0.89:1.The median duration of ankylosis was 7.3 (range 2–11) years. Postoperative and follow up interincisal mouth opening was satisfactory with good healing of the dermis-fat graft donor site. We conclude that the use of dermis fat grafts has minimal donor site morbidity, and is a safe and effective interposition material to prevent the recurrence of temporomandibular ankylosis.

Encasement of a Gold Weight with Dermal Fat Graft in the Management of Paralytic Lagophthalmos

Encasement of a Gold Weight with Dermal Fat Graft in the Management of Paralytic Lagophthalmos