Free Fat Graft Research Articles

Modified Transanosphincteric (York Mason) Repair of Nonradiated Rectourinary Fistulae: Patient-reported Fecal Continence Outcomes

To review our experience with the modified York Mason (MYM) procedure in the treatment of rectourinary fistulas (RUFs) and to assess fecal continence using patient-reported measures. A retrospective review was performed of patients who underwent MYM repair of nonradiated RUF with gluteal free fat graft from 2008 to 2016 at a single institution. Success was defined as resolution of the fistula without need for further surgery. The Cleveland Clinic-Florida Wexner Fecal Incontinence Score (CCFFIS) and the Patient Global Impression of Improvement (PGI-I) surveys were administered by phone. Of 17 patients who underwent MYM repair with a mean age of 61.8 years old, the most common fistula etiologies were prostatectomy in 11 patients (65%), cryoablation in 2 patients (12%), and transanal tumor excision (12%). Three patients (18%) failed prior perineal repairs. The mean fistula size was 10.1 mm (range 2-25), the median operative time was 231 minutes (range 151-365), and the median length of stay was 2.0 days (range 1-13). At the median follow-up of 39.4 months, 16 of the 17 patients (94%) had successful primary closures. The condition of the 10 patients who responded to the phone survey was "much better" (median PGI-I score 2), with 89.5% mean improvement. The mean CCFFIS was 1.4 (range 0-5) on a scale of 0 (total continence) to 20 (complete incontinence). Two patients (20%) reported rare (<1 per month) fecal incontinence, and 2/10 (20%) reported frequent flatal incontinence, but none reported significant lifestyle change or sought further treatment for bowel symptoms. The MYM technique has a high success rate in the treatment of nonradiated RUF with negligible impact on fecal continence.

Skull Base Erosion Resulting From Primary Tumors of the Temporomandibular Joint and Skull Base Region: Our Classification and Reconstruction Experience

We sought to introduce our classification and reconstruction protocol for skull base erosions in the temporomandibular joint and skull base region. Patients with neoplasms in the temporomandibular joint and skull base region treated from January 2006 to March 2017 were reviewed. Skull base erosion was classified into 3 types according to the size of the defect. We included 33 patients, of whom 5 (15.2%) had type I defects (including 3 in whom free fat grafts were placed and 2 in whom deep temporal fascial fat flaps were placed). There were 8 patients (24.2%) with type II defects, all of whom received deep temporal fascial fat flaps. A total of 20 patients (60.6%) had type III defects, including 17 in whom autogenous bone grafts were placed, 1 in whom titanium mesh was placed, and 2 who received total alloplastic joints. The mean follow-up period was 50months. All of the patients exhibited stable occlusion and good facial symmetry. No recurrence was noted. Our classification and reconstruction principles allowed reliable morpho-functional skull base reconstruction.

Prospective Randomized Comparative Study to Evaluate Epidural Fibrosis and Surgical Outcome in Patients Undergoing Lumbar Laminectomy with Epidural Autologous Free Fat Graft or Gelfoam: A Preliminary Study.

Introduction:Epidural fibrosis (EF) contributes to unsatisfactory relief of symptoms and failed back syndrome after spine surgery. EF around the nerve root can be more refractory to treatment than the original disc herniation itself. Reoperation on the scar can produce more scarring. Few studies have been conducted regarding the type of material to be used for decreasing EF.Materials and Methods:The prospective randomized comparative study was conducted in the Department of Neurosurgery and Radiodiagnosis, of a tertiary care hospital. Informed and written consent was obtained. Patients previously unoperated with symptoms and radiological features of lumbar spinal canal stenosis were included in the study. Fifteen patients were assigned to Group A (free fat graft) and 15 patients in Group B (Gelfoam group). Postoperatively, at 3 and 6 months, clinical outcome was evaluated and EF was assessed on CE-MRI.Results:Age and sex were comparable in both groups. The pain relief at 3 and 6 months was more in Group A as compared to Group B. In Group A, on CEMRI at 3 months, 87% of patients had none to mild fibrosis, with none had extensive fibrosis. The CEMRI at 6 months showed no increase in fibrosis. In Group B, 80% of patients had none to mild fibrosis at the end of 3 months. At 6 months, 13.3% patients had extensive fibrosis. The extent of EF was found to be statistically significant at 6 months postsurgery.Conclusion:Use of free fat graft at laminectomy site helps in reducing EF.

The Reliability of Free Buccal Fat Graft for Treatment of Severe Gingival Recessions at Mandibular and Maxillary Exposed Roots.

Introduction:The occurrence of gingival recessions (GRs) is multifactorial, mainly due to trauma induced by traumatic toothbrushing, orthodontic tooth movement, as well as anatomical factors such as bone dehiscence, teeth malposition, and muscle pull. Fat tissue in the oral cavity is widely available and easily accessed. The use of pedicled buccal fat pad (BFP) graft is well known in maxillofacial surgery and has been shown promising results, becoming safe and effective graft for several clinical applications. However the use of fat tissue harvested from the buccal fat pad as a free graft (BFFP) is less common, but recently, it has been described by the author for different intraoral clinical applications. The aim of this study is to present additional application using the BFFG for coverage of severe muco-GRs and to discuss the promising outcomes of this procedure.Patients and Methods:A technique for harvesting intraoral BFFG for the use in mucogingival surgery is presented. A total of 10 patients (age: 38.3 ± 6.8 years) with 17 teeth presenting severe GRs (4.8 ± 1.8 mm) were included in the study. Recessions treated using BFFGs were recorded at baseline and 12 months after surgery.Results:A total of 17 GRs were treated using BFFG. At 12 months, significant reduction of recession occurred. Initial recession was reduced from 4.8 ± 1.8 mm to 1.7 ± 0.9 mm. A mean of 3.1-mm reduction in GR was achieved compared to baseline.Conclusions:The new, simple, technique for treatment of severe GRs using BFFG resulted in significant reduction of GRs.

Erratum to immediate breast volume replacement using a free dermal fat graft after breast cancer surgery: multi-institutional joint research of short-term outcomes in 262 Japanese patients.

[This corrects the article on p. 179 in vol. 4, PMID: 26005649.].

Efficiency and Safety of Autologous Fat Grafts in Reconstructing Skull Base Defects After Resection of Skull Base Meningiomas

Reconstruction of the skull base after resection of skull base meningiomas is of paramount importance. Here we describe a safe and effective method of skull base reconstruction using autologous free fat grafts. In this retrospective analysis of patients operated for skull base meningioma from 2007 to 2014. We analyzed the surgical technique, efficiency and safety as well as the graft-related complications. Autologous free fat grafts were used in 55 patients, including 39 patients with posterior fossa meningiomas related to the petrous bone and 16 patients with anterior fossa meningiomas related to the paranasal sinuses. Three patients experienced postoperative cerebrospinal fluid (CSF) leak and were managed with temporary continuous lumbar drainage. One patient developed pneumocephalus and required revision. The occurrence of CSF leak was related to aggressive resection with resulting large skull base defects, especially in anterior skull base meningiomas. There were no donor site-related complications. The use of autologous free fat grafts is an effective and safe technique for reconstructing skull base defects after microsurgical resection of skull base meningiomas.

Correction of whistle deformity using autologous free fat grafting: first results of a pilot study and review of the literature.

Whistle deformities are frequent sequelae after surgical correction of cleft lip, trauma, or tumor excision. The aim of this study was to examine the role of autologous free fat grafting in the reconstruction of whistle deformity. Fifteen patients with whistle deformity were enrolled in this pilot study. The mean follow-up period was 19months. Liposuction was done followed by the replantation of an average of 2.2ml autologous fat per patient (range 0.7-4ml). An overcorrection was performed in all patients. All the patients showed improvements in whistle deformity. The mean resorption rate was 53% (range 30-80%). Three patients (20%) were not satisfied with the postoperative result. Six complications were assessed (4× feeling of pressure [27%], one hematoma [7%], one recurrent pain [7%]), but a major complication did not occur. We also present a review of the literature with different techniques that were described in the last 20years. Autologous free fat graftings for reconstruction of whistle deformity represent a reliable method with a low complication rate. However, the resorption rate is unpredictable. If necessary, several autologous fat transplantations should be conducted at an interval of at least 6months.

Untethering physiolysis for delta phalanx (longitudinally bracketed diaphysis) combined with free fat interposition graft

We report the results of physiolysis of the epiphyseal bracket combined with free fat grafting for the treatment of delta phalanx. Thirteen cases (five patients) were included. Mean patient age was 6.6years (range, 4–9). The patients underwent physiolysis in which the epiphyseal bracket was cut and replaced with a free fat graft. The angle between the long axis of the proximal and distal phalanges and the ratio between the width and length of the affected middle phalanx were evaluated on plain radiographs. The range of motion in the fingers was also evaluated. The mean follow-up period was 42.2months (range, 25–61). The mean correction angle was 17.1° (range; 13–23). The mean width-to-length ratio of the affected phalanx was improved from 0.6 to 0.47. The range of motion was maintained at the previous level. Physiolysis by untethering the bracketing epiphysis and free fat grafting can alleviate the angulation of clinodactyly, especially in growing children. It also allows catch-up growth in the middle phalanx.

Our Experience of Rejuvenation of Atrophied Web Spaces in Leprosy Patients with Fat Grafting

Atrophied web spaces are a common finding in the hands of leprosy affected hands and decreases the aesthetic appearance of the hands. Autologous fat transfer is an option for restoring the contour of the atrophied web spaces as it based on the principle “replace like with like”. Free fat graft harvested from abdomen/thigh/buttock. Derma fat harvested from the groin crease was also used to correct web space atrophy. Study included the reabsorption quantification using high-resolution ultrasound and patient/surgeon satisfaction scale. Keywords: Web spaces, Fat Grafting, Atrophy, HRUS.

Predictors of Autologous Free Fat Graft Retention in the Management of Craniofacial Contour Deformities.

Autologous free fat graft outcomes are not always predictable, and variables that can potentially influence fat graft retention are still not well understood or investigated. The purposes of this study were to assess fat graft retention in the management of craniofacial contour deformities and to identify possible predictive factors of this retention. A prospective analysis was conducted using consecutive patients with unilateral craniofacial contour deformities who underwent autologous free fat grafting between 2012 and 2015. Standardized ultrasonographic craniofacial soft-tissue thickness measurements were adopted to determine the fat graft retention. Bivariate and multivariate analyses were performed to identify independent predictors of 12-month postoperative fat graft retention. One hundred forty-two patients were enrolled. There was significant (all p < 0.05) and progressive reduction in fat graft retention within the first 3 postoperative months, and the retained fat graft was maintained (all p > 0.05) from 3 to 12 months postoperatively, with a 12-month fat graft retention rate of 67.7 percent. Age, Parry-Romberg syndrome, previous craniofacial bone surgery, grafted volume, and forehead unit were independently negative (all p < 0.05) predictors of fat graft retention, whereas cheek unit was an independently positive (all p < 0.05) predictor of retention. Craniofacial fat graft retention is achievable but remains somewhat unpredictable, with age, Parry-Romberg syndrome, previous bone surgical intervention, grafted volume, and recipient sites affecting retention. Risk, III.

Micro Free Orbital Fat Grafts to the Tear Trough Deformity during Lower Blepharoplasty.

The tear trough deformity is challenging in lower eyelid rejuvenation. Surgical treatment has evolved, with more modern techniques preserving orbital fat and using autologous fat transposition. The senior author (M.A.C.) reviewed his own experience in targeting the tear trough in lower lid blepharoplasty and presents a new technique that incorporates the addition of micro free fat grafts that adds direct volume to the underlying anatomical depression using a transcutaneous skin-muscle approach. Medical records of lower lid blepharoplasty patients performed from February of 2011 to February of 2016 were reviewed. Patients who had tear trough deformities with the addition of micro free fat grafts were included. Standard patient characteristics were collected, complications were identified, and assessment of postoperative results was performed. There were 32 patients included in the study, with a median follow-up of 392 days (range, 45 to 1709 days). Scleral show requiring operative correction occurred in one patient (3 percent). Additional complications included chemosis in four patients (13 percent), which resolved in all patients. No patients had infections, ectropion, lid retraction, or palpable or visible grafts. The use of micro free orbital fat grafts is an effective and safe technique to treat the tear trough deformity without increased complication rates and good patient and surgeon satisfaction and should be considered a surgical adjunct during an open blepharoplasty technique. Therapeutic, IV.

Quantifying Long-Term Retention of Excised Fat Grafts: A Longitudinal, Retrospective Cohort Study of 108 Patients Followed for Up to 8.4 Years.

Predicting the degree of fat graft retention is essential when planning reconstruction or augmentation with free fat grafting. Most surgeons observe volume loss over time after fat grafting; however, the portion lost to resorption after surgery is still poorly defined, and the time to reach steady state is unknown. The authors compiled a retrospective, longitudinal cohort of patients with vestibular schwannoma who had undergone ablative surgery and reconstruction with excised fat between the years 2006 and 2015. Fat volume retention was quantified by computed tomography and magnetic resonance imaging and used to model a graft retention trajectory and determine the volumetric steady state. In addition, the authors evaluated the association between graft retention and secondary characteristics, such as sex and transplant volume. A total of 108 patients were included. The average baseline graft volume was 18.1 ± 4.8 ml. The average time to reach steady state was 806 days after transplantation. By this time, the average fat graft retention was 50.6 percent (95 percent CI, 46.4 to 54.7 percent). No statistically significant association was found between baseline graft volume and retention. Fat graft retention over time was significantly higher in men than in women (57.7 percent versus 44.5 percent; p < 0.001). The authors' data provide evidence that the time to reach fat graft volumetric steady state is considerably longer than previously expected. Fat grafts continue to shrink long after the initial hypoxia-induced tissue necrosis has been cleared, thus indicating that factors other than blood supply may be more influential for fat graft retention. Therapeutic, IV.

Systematic Endoscopic Endonasal Approach to Pituitary Adenomas. Reconstruction of Skull Base with Pedicle Mucoperichondrial Flap versus Free Abdominal Fat Graft for Patients with Incidental Rupture of Sellar Diaphragma

Systematic Endoscopic Endonasal Approach to Pituitary Adenomas. Reconstruction of Skull Base with Pedicle Mucoperichondrial Flap versus Free Abdominal Fat Graft for Patients with Incidental Rupture of Sellar Diaphragma

P.3.014 - Cytochrome P450 polymorphisms moderate pharmacokinetics and pharmacodynamic effects of MDMA in healthy subjects

Reconstruction of the skull base after resection of skull base meningiomas is of paramount importance. Here we describe a safe and effective method of skull base reconstruction using autologous free fat grafts.In this retrospective analysis of patients operated for skull base meningioma from 2007 to 2014. We analyzed the surgical technique, efficiency and safety as well as the graft-related complications.Autologous free fat grafts were used in 55 patients, including 39 patients with posterior fossa meningiomas related to the petrous bone and 16 patients with anterior fossa meningiomas related to the paranasal sinuses. Three patients experienced postoperative cerebrospinal fluid (CSF) leak and were managed with temporary continuous lumbar drainage. One patient developed pneumocephalus and required revision. The occurrence of CSF leak was related to aggressive resection with resulting large skull base defects, especially in anterior skull base meningiomas. There were no donor site–related complications.The use of autologous free fat grafts is an effective and safe technique for reconstructing skull base defects after microsurgical resection of skull base meningiomas.

Free dermal fat graft reconstruction of the head and neck: An alternate reconstructive option

ObjectivesAblative procedures of the head and neck often result in significant facial and cervical irregularities and cosmetic asymmetry. The deformity resulting from ablative procedures of the head and neck is a significant source of cosmetic morbidity and postoperative dissatisfaction. Reconstruction of post-ablative defects in the head and neck can employ a broad range of techniques, ranging from primary closure to free tissue transfer. The free dermal fat graft (FDFG) is one such option and has been used to repair volume defects of varying sizes after common head and neck procedures such as parotidectomy. However, its use is largely undocumented in the literature. We seek to further illustrate the FDFG as an alternate method of reconstruction of head and neck defects. Study designNon-randomized retrospective analysis. MethodsThe medical records of all patients who underwent primary autologous abdominal FDFG reconstruction of head and neck defects by a single surgeon at Vanderbilt University Medical Center from January 1997 to August 2010 were reviewed. All patients were called in order to assess their post-operative cosmetic satisfaction. ResultsSixty-two patients were analyzed. Only three patients were found to have post-operative complications directly related to the FDFG. No complications were found at the donor site. Based on a telephone survey, the majority of patients were satisfied post-operatively with their cosmetic outcomes in the primary site and donor site. ConclusionsFrom our experience the FDFG is a cosmetically and functionally advantageous option for reconstruction of ablative procedures of the head and neck.

Clinical features and surgical outcomes of patients with skull base chordoma: a retrospective analysis of 238 patients

OBJECTIVE Skull base chordoma is relatively rare, and a limited number of reports have been published regarding its clinical features. Moreover, the factors associated with extent of resection, as well as the value of marginal resection for long-term survival, are still in question for this disease. The objective of this study was to investigate these factors by evaluating their clinical features and surgical outcomes. METHODS A retrospective analysis of 238 patients with skull base chordomas, who met the inclusion criteria, was performed. This study summarized the clinical features, selection of approaches, degree of resection, and postoperative complications by statistical description analyses; proposed modified classifications of tumor location and bone invasion; studied the contributions of the clinical and radiological factors to the extent of resection by Pearson χ2, ANOVA, rank test, and binary logistic regression analysis; and estimated the differences in overall survival and progression-free survival rates with respect to therapeutic history, classification of tumor location, extent of bone invasion, and extent of tumor resection by the Kaplan-Meier method. A p value < 0.05 was considered statistically significant. RESULTS The study included 140 male and 98 female patients with a mean age of 38.1 years. Headache and neck pain (33.2%) and diplopia (29%) were the most common initial symptoms. Sphenoclival type accounted for the largest proportion of tumor location (59.2%); endophytic chordoma was the more common type of bone invasion (81.5%). Lateral open approaches were performed in two-thirds of the study population (78.6%). The rate of marginal resection was 66%, composed of gross-total resection (11.8%) and near-total resection (54.2%). Meningitis (8%) and CSF leakage (3.8%) were the most frequent complications. The mean follow-up period was 43.7 months. The overall survival and progression-free survival rates at 5 years were 76% and 45%, respectively. Recurrent tumor and larger tumor volume (≥ 40 cm3) were identified as risk factors of marginal resection. Patients who presented with recurrent tumor and underwent intralesional resection had a worse long-term outcome. CONCLUSIONS The classifications of both tumor location and bone invasion demonstrated clinical value. Marginal resection was more likely to be achieved for primary lesions with smaller volumes (< 40 cm3). The rate of CSF leakage declined due to improved dura mater repair with free fat grafts. Marginal resection, or gross-total resection when possible, should be performed in patients with primary chordomas to achieve better long-term survival.

Remote Cauda Equina Syndrome Due to Overgrowth of Epidural Free Fat Graft: Case Report

Lumbar discectomy is being done in increasing frequency worldwide where formation of epidural scar formation has been known as a common cause of its failure. Application of a free fat graft despite controversies has been widely used to prevent further adhesion and post-laminectomy scarring. Single nerve root compression and cauda equina syndrome due to compressive effect of free fat graft with a few days to weeks after laminectomy is well known early complication of lumbar discectomy. However, late neurological deficit as the result of significant increase of fat graft volume has been not addressed previously in the literature. Herein, the authors present a middle-age man who was admitted with cauda equina syndrome for one day duration developing 11 years after a redo laminectomy for recurrent disc herniation and local stenosis. The MRI obtained urgently revealed significant overgrowth of the free fat graft that had been already used for prevention of scar formation. Piecemeal surgical removal of fat with clearance of the theca and the corresponding nerve roots result in steady but good recovery within a few weeks. To our knowledge, although overgrowth of fat has been reported in other locations, but this is the first example occurring after its application at the site of laminectomy. Therefore, overgrowth of free fat graft should be added to all previously describe unusual complication of lumbar discectomy.

Epidural scarring after lumbar disc surgery: Equivalent scarring with/without free autologous fat grafts.

Background:To limit epidural fibrosis and prevent scar formation/nerve tethering that may contribute to chronic postoperative pain; some surgeons have utilized epidural autologous fat grafts following lumbar microdiscectomy.Methods:We investigated the correlation between post-microdiscectomy epidural scarring [including select magnetic resonance imaging (MRI) studies] and clinical outcomes in 36 patients operated for symptomatic. MRI documented L4-L5 and L5-S1 disk herniations with (18 patients) and without (18 patient) the application of free fat grafts. In addition, histological evaluation of the original fat grafts was performed in 4 patients requiring additional surgery.Results:We found no clear association between the use of autologous graft fats and the clinical outcomes in this study.Conclusion:In this preliminary study involving only 36 patients, the prospective randomized use of free autologous fat grafts did not appear to influence outcomes following microdiscectomy.

A Ｃase Report of the Fatty Necrosis of Free Dermal Fat Graft Mimicking Local Recurrence after Breast Ｃonserving Surgery for Breast Cancer

A Ｃase Report of the Fatty Necrosis of Free Dermal Fat Graft Mimicking Local Recurrence after Breast Ｃonserving Surgery for Breast Cancer

Evaluation of Use of Adipose Cells in Various Procedures of Plastic Surgery and its Volumetric Quantification using High Resolution Ultrasound.

Autologous fat transfer is based on one of the principles of plastic surgery, replace like with like. It is used in wide variety of aesthetic procedures such as lip, facial augmentation and reconstructive procedures such as involutional disorders, post traumatic defects etc. This prospective study was on the use of adipose cells in various procedures of plastic surgery, the role of high resolution ultrasound in estimating the volume of the grafted fat, comparison of the results based on the different donor sites of the harvested fat and comparison of the effectiveness of grafted fat in extremities and craniofacial region. In this prospective study a total of 34 patients underwent fat grafting procedure at various sites of the body from May 2012 till November 2013. After noting the details of the patient, details of the defect, laboratory and radiological investigations, the consent for the fat grafting procedure was taken. Clinical photographs and High Resolution Ultrasound (HRUS) volume estimation was done on a regular basis as per the protocol. Out of 34 patients, 29 patients underwent free fat grafting and five patients underwent derma fat grafting. HRUS at six months revealed a mean 73.5% and 63.5% of the injected fat remained in contour deformity in extremities and craniofacial region respectively. HRUS at one year revealed a mean 57.4% and 41.4% of the injected fat remained in contour deformity in extremities and craniofacial region respectively. HRUS is an excellent handy modality for serial volume estimation, cost-effective, non-invasive, multi planar modality, does not require any preparation, and easily done outdoor procedure. Follow up is a practical proposition. Autologous fat grafting is a safe procedure with no significant complications other than fat reabsorption and it can be done under local anaesthesia in contour deformity of smaller areas. Disadvantage of autologous fat grafting is the fat reabsorption needing multiple sittings.