Free Fat Graft Research Articles

The Serial Free Fat Transfer in Irradiated Prosthetic Breast Reconstructions

This study investigated the effects of lipofilling on both the functional and the aesthetic aspects of breast reconstruction. Sixty-one consecutive patients with irradiated reconstructed breasts (62 breasts) were offered free fat transfer to enhance the results and correct the defects. Twenty patients were enrolled (active branch) and underwent multiple sessions of lipofilling, while the others were considered controls. The fat was harvested by syringe and processed by saline washing only (no centrifugation). Three months after the last session the functional outcome was evaluated using the LENT-SOMA scoring system and the aesthetic outcome was evaluated using a visual 5-point scale. A significant improvement in all the LENT-SOMA scores after free fat grafting was observed; the scores after treatment were all significantly lower than those before it and were also significantly lower than those of untreated breasts. These results also were confirmed by comparing homogeneous subgroups of breasts with similar LENT-SOMA ranks before treatment. Similarly, the cosmetic outcomes were significantly enhanced after serial lipofilling. The four cases in the active branch with severe flap thinning resolved with no implant exposure (mean follow-up = 17.6 months), while implant exposure occurred in the two cases with the same problem in the control group. In one case, a Baker 3-4 capsular contracture was downgraded to Baker 1 after only one session of lipofilling. No complications occurred in the treated cases. Free fat transfer is a safe and reliable technique in improving the outcomes of irradiated reconstructed breasts with implants.

Correction of Nasojugal Groove With Tunnelled Fat Graft

Pronounced nasojugal sulcus (tear trough deformity) is a frequent and distressing symptom in aesthetic palpebral surgery. The sliding fat technique using the transcutaneous or transconjunctival approach has proven to be considerably useful in patients with clinically evident fat bags. In the absence of fat bags, commonly used techniques can lead to unpredictable (and frequently less than optimal) results. The authors report their experience with correcting the nasojugal groove in the absence of palpebral fat bags by use of a one-piece, free fat graft as an alternative to autologous fat injections or the placement of alloplastic materials. The authors conducted a retrospective study of a consecutive series of 34 patients (33 women and one man) between 42 and 57 years of age. In all cases, small, free fat grafts harvested from the medial fat compartment of the upper eyelid were placed precisely under the depression through two stab incisions in the suborbicularis plane, filling in the groove. Results were considered excellent in 24 out of the 34 patients. Results in the remaining 10 patients were rated as good, in most cases because of mild undercorrection. All patients expressed a high degree of satisfaction. Recovery time was very short and no eye or eyelid complications were observed. Correction of the nasojugal groove with a tunnelled fat graft causes minimal tissue trauma and allows exact placement of the graft. The upper palpebral fat has unique characteristics that render it an ideal graft material for correction of the nasojugal groove in patients with no concomitant lower fat bags. This procedure offers more predictable results and a lower incidence of adverse effects than more commonly used techniques.

Bilateral Microphthalmos With Cyst: Excision With Orbital Free Fat Graft

Bilateral microphthalmos with cyst was diagnosed in a 4-month-old female term infant who presented with bilateral lower eyelid cysts and the right eye displaced beneath the upper eyelid. Imaging of the orbits revealed bilateral microphthalmic globes with large orbital cysts. Treatment consisted of bilateral cyst removal and free fat grafts for volume replacement, which yielded good cosmetic results with reduction of right globe displacement.

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

Experimental study of the effect of adipose tissue derived stem cells on the survival rate of free fat transplantation

To investigate the feasibility of using adipose tissue derived stem cells (ASCs) to promote neovascularization and survival rate of free fat transplantation. ASCs were isolated from aspirates from human liposuction and cultured in vitro. The cells were incubated in adipogenic, osteogenic, and chondrogenic medium for 2-4 weeks to induce adipogenesis, osteogenesis and chondrogenesis, respectively. ASCs were labelled by DiI. ASCs (A group), Insulin (B group), Medium (C group) were respectively mixed with free fat graft from aspirates. The mixtures were injected subcutaneously at the three random points on the back of eighteen 4- 6-week-old nude mice. Transplanted fat tissue was harvested after 6 months. The grafts were assessed by morphological observation, HE staining and immunohistochemistry. ASCs can be easily harvested from liposuction aspirates and differentiate into adipogenic, osteogenic, chondrogenic lineages. The wet weight of transplanted fat tissue in ASCs group was (165.97 +/- 5.51) mg, significantly higher than that in the insulin group (93.42 +/- 5.12) mg and control group (67.64 +/- 5.09) mg (P = 0.000). The rate of fibrosis and steatonecrosis in ASCs group was( 152.2 +/- 9.8)/10HF, significantly lower than that in the Insulin group (743.9 +/- 20.4)/10HF and control group (892.2 +/- 16.5)/10HF (P = 0.000). DiI labelled ASCs were found between adipocytes and in the connective tissue in free transplanted fat tissue, and some of these cells were immunopositive for antihuman CD31 and FITC, suggesting differentiation into vascular endothelial cells. ASCs can differentiate into vascular endothelial cells and contribute to angiogenesis in free transplanted fat tissue. ASCs can increase the survival rate and decrease the rate of fibrosis and steatonecrosis of free transplanted fat tissue. These findings suggest that ASCs-assisted transplantation may be an ideal cell therapy.

Effect of an Autogenous Free Fat Graft on Hemilaminectomy Defects in Dogs

The purpose of this study was to evaluate the effect of an autogenous free fat graft (FFG) on hemilaminectomy defects. Hemilaminectomy was performed at three levels in three beagles, and each defect was designated as a control site or a site treated with one of two different sizes of FFG. Subsequently, longitudinal computed tomography scanning and histopathological examination were performed. As a result, no postoperative dural adhesion was recognized at the sites where FFGs were placed regardless of the size of the FFG. Moreover, there was no compression of the spinal cord by the FFG. Therefore, it appears that postoperative dural adhesion was controlled by the FFG and that the possibility of FFG migration into the spinal canal is low in hemilaminectomy. In conclusion, placement of an FFG over the defect was considered useful for preventing complications in hemilaminectomy.

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.

Platelet-rich plasma has no effect on increasing free fat graft survival in the nude mouse

Free fat grafts have an unpredictable survival rate, which may be dependent on host bed vascularity. Therefore, the authors hypothesized that the presence of growth factors in platelet-rich plasma (PRP), may enhance free fat graft survival. Free fat grafts and autologous PRP were harvested from a healthy female and processed using the Coleman technique and the Medtronic Magellan system respectively. The experiment comprised two groups of 12 nude mice each with injection of free fat grafts into the scalp. The experimental group comprised the combination of 0.8 ml of free fat graft and 0.2 ml of PRP. The control group comprised the combination of 0.8 ml of free fat graft and 0.2 ml of normal saline. The mice were euthanized after 16 weeks and the fat grafts explanted and measured for weight and volume. Histology was performed with Oil Red O stain. Statistical analysis of the weight and volume in between groups was performed using the independent samples T-test (SPSS v11). The Mann-Whitney test was used to compare the ranking of six histological parameters between the two groups. The mean weight and volume for the experimental arm were 0.503 g and 0.545 ml respectively. The mean weight and volume for the control arm were 0.500 g and 0.541 ml respectively. The weight, volume and histological parameters between the two groups were not statistically significant. A mouse from each group died of unknown causes. PRP did not enhance free fat graft survival in the nude mouse.

The Effect of Meperidine-impregnated Autogenous Free Fat Grafts on Postoperative Pain Management in Lumbar Disc Surgery

Prospective, randomized, double-blind clinical study. To examine the effect of meperidine-impregnated autogenous free fat grafts (AFFGs) on postoperative pain management after 1-level, first-time lumbar disc surgery. Uncontrolled postoperative pain impedes patient recovery. Insufficient control of postoperative pain makes it difficult to convince new patients to undergo the lumbar disc surgery. Twenty-seven patients scheduled to undergo lumbar microdiscectomy for the first time were divided into 2 groups by a randomized double-blind method. Group 1 patients received a meperidine-impregnated AFFG in the epidural area. Group 2 received the graft without meperidine impregnation. Both groups were asked to use a Patient Controlled Analgesia device to deliver tramadol, and at 1, 4, 12, and 24 hours postoperatively, the amounts of tramadol used and pain severity on the 10-cm Visual Analog Scale (VAS) were recorded. The VAS scores and total tramadol use were both lower in group 1 compared with the control group (P<0.05). The first hour of VAS scores were significantly lower in group 1 than in the control group (P<0.05). In this study, we helped patients, who underwent 1-level, first-time lumbar microdiscectomy have a postoperative pain-free and comfortable period by using epidural meperidine-impregnated AFFGs.

CT image of a free fat graft (FFG) within hemilaminectomy space (author's transl)

To prevent scarformation after hemilaminectomy many authors (1, 2, 6, 8) use free autologous fat grafts. CT scanning reveals vitality or death if the transplant. CT enables to control intra vitam whether FFG diminishes postnucleotomy syndrome caused by scar formation.

Cauda equina syndrome without mechanical cauda compression: a report of 2 cases

Study design Case report. Objective To highlight the concept of Cauda Equina Syndrome without cauda compression. Summary of background data Cauda equina syndrome (CES) is a rare disorder. CES occurs usually due to direct physical compression of the cauda nerve roots, most often from the extruded nucleus pulposus; other rare causes reported in the literature include compression by tumour, infection, fracture, penetrating trauma, chiropractic manipulation, free epidural fat graft, postoperative haematoma, ankylosing spondylitis, metastatic invasion, schwnnoma, Paget’s disease and laminar hook compression. All these causes of CES physically compress the cauda. Chemical irritation of the root can cause radicular pain but this has not been noted to cause CES before. We present two cases of Cauda Equina Syndrome was brought on by non-physical compression of the cauda. Annular tears can induce CES by chemical irritation of the cauda by inXammatory mediators. Conclusion The idea of presenting this paper is to highlight that cauda equina syndrome can be caused by nonmechanical cauda compression; in our cases it was due to chemical irritation and caudal epidural steroid injection has produced satisfactory outcome. Awareness of non-physical cauda equina syndrome is essential to identify and to initiate appropriate treatment, and the outcome seems to be

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.

Surgical Treatment of Partial Closure of Growth Plate - Physeal Bar Resection and Free Fat Graft -

Purpose: To evaluate the results of physeal bar resection and free fat graft as a treatment method for partial epiphyseal closure. Materials and Methods: Thirteen cases of partial epiphyseal closure (4 of the distal femur, 8 of the distal tibia and one of the distal radius) were subjected to physeal bar resection. All of the cases were caused by trauma. The physeal bar was central in 3 cases, peripheral in 9, and mixed (central-peripheral) in 1. Mean patient age at surgery was 10.7 years and mean follow-up period was 47 months. Final results were evaluated by a modified Williamson-Staheli classification. Results: Results at final follow-up were as follows: 6 satisfactory (3 excellent and 3 good) and 7 unsatisfactory (5 fair and 2 poor). Satisfactory results according to location and region of the physeal bar were as follows: distal tibia, 5 of 8 cases; distal femur, 1 of 4; central, 1 of 3; peripheral, 4 of 9; and mixed, 1 of 1. When considered by areal extent, physeal bars occupying 30% or less of the bone's cross-sectional area showed satisfactory results in 5 of 7 cases, while in 6 cases with the physeal bar over 30%, 5 were unsatisfactory. Conclusion: Accurate preoperative evaluation of the size and type of the physeal bar, and meticulous surgical technique, are important predictors of satisfactory outcome of physeal bar resection. Cases where the physeal bar extent exceeded 30% had mostly unsatisfactory results.

Fat Grafting to the Breast Revisited: Safety and Efficacy

A 1987 American Society of Plastic and Reconstructive Surgeons position paper predicted that fat grafting would compromise breast cancer detection and should therefore be prohibited. However, there is no evidence that fat grafting to breasts is less safe than any other form of breast surgery. As discussions of fat grafting to the breast are surfacing all over the world, it is time to reexamine the opinions of the 1987 American Society of Plastic and Reconstructive Surgeons position paper. This is a retrospective examination of 17 breast procedures performed using fat grafting from 1995 to 2000. Indications included micromastia, postaugmentation deformity, tuberous breast deformity, Poland's syndrome, and postmastectomy reconstruction deformities. The technique used was the Coleman method of fat grafting, which attempts to minimize trauma and place grafted fat in small aliquots at many levels. All women had a significant improvement in their breast size and/or shape postoperatively and all had breasts that were soft and natural in appearance and feel. Postoperative mammograms identified changes one would expect after any breast procedure. Given these results and reports of other plastic surgeons, free fat grafting should be considered as an alternative or adjunct to breast augmentation and reconstruction procedures. It is time to end the discrimination created by the 1987 position paper and judge fat grafting to the breast with the same caution and enthusiasm as any other useful breast procedure.

Effect of VEGF on weight maintenance rate of free fat-graft in rabbit

目的 观察血管内皮生长因子(vascular endothelial growth factor,VEGF)对移植脂肪质量保持率的影响.方法 收取兔腹股沟脂肪并剪成颗粒状,在动物背部中线两侧各做一腔隙,将VEGF随机注射入一侧腔隙深筋膜下,再注入脂肪颗粒至腔隙,对侧仅注入脂肪颗粒作为对照,在术后40 d、3个月和6个月,分别收集移植组织,进行肉眼大体观察、测重和组织学观察.结果 在术后40 d与对照组比较,VEGF组移植脂肪局部的血管增生较明显(P＜0.05),脂肪质量保持率增高(P＜0.05),在术后3个月,实验组与对照组之间血管数及移植物大小未见明显差异(P＞0.05),6个月后两组移植物几乎全被吸收.结论 VEGF局部注射早期可促进移植脂肪局部的血管增生,增加脂肪的质量保持率,但其作用不持久.其使用方式及剂量有待于进一步探讨。

The Fate of Autogeneous Free Fat Grafts after Skull Base Surgery

The Fate of Autogeneous Free Fat Grafts after Skull Base Surgery

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.

Management of Adhesion Using a Pretarsal Fibromuscular Flap or Graft in Secondary Blepharoplasty

In double eyelid operations, if the eyes have too little fat and soft tissue, or if too much of the orbital fat was removed during the operation, the double eyelid crease is placed too high and the supratarsal recess becomes hollow and adhesion of the eyelid crease occurs even in the orbital septum and levator muscle. A secondary double eyelid operation in response to these problems needs to correct the height of the eyelid crease by releasing the inadequately high eyelid fold and preventing readhesion. Moreover, in case the muscle and scar tissue are bulged below the incision line, the height of the double eyelid should be appropriately lowered and the bulky lower flap should be flattened. In cases where the adjacent tissue (e.g., preaponeurotic fat) was excessively removed during the primary double eyelid operation, a free fat or dermis fat graft was performed to correct supratarsal depression and readhesion. These graft materials are extracted from a distant donor site. Even if the adjacent tissue was not sufficient, the authors made the superiorly based local flap or graft of pretarsal scar-muscle tissue obtained after thinning the bulky lower flap. In these cases, the fibrous muscle flap or graft compensated tissue depletion with a proper mass around the double eyelid crease, thus helping to prevent readhesion. Of the 1225 patients with high placement of the supratarsal fold with a bulky lower skin flap, we used pretarsal fibromuscular flaps in 914 patients and pretarsal fibromuscular grafts in treating 311 patients between November of 1997 and October of 2004. In the authors' series, 425 of 1225 patients underwent follow-up ranging from 2 to 23 months. Most of these patients were satisfied; however, 33 patients (7.8 percent) expressed dissatisfaction with the postoperative results based on their subjective judgment; 29 patients (6.8 percent) had mild asymmetry, and surgical revision was required in only 17 patients (4 percent). The authors eventually found that the pretarsal fibromuscular flap or graft was successful in making a natural eye shape and preventing readhesion, with no requirement of a distant donor site. They also found that the operation was effective in reducing the operative time and lowering the risk of postoperative infection.

Dissemination of fat in CSF: a common finding following translabyrinthine acoustic neuroma surgery*

Following translabyrinthine craniotomy the temporal bone defect is commonly obliterated using a free autologous fat graft. In this series the dura was put back in place but not closed primarily. As the fat graft remains in direct contact with the cerebro spinal fluid (CSF) there is potential for dispersal of fat within the CSF space. This paper aims to determine the frequency of such CSF fat dissemination and its clinical significance. A retrospective review of translabyrinthine acoustic neuroma removal with free fat autograft obliteration of the temporal bone defect between the years 1997 and 2000. Tertiary referral oto-neurosurgical centre. Postoperative magnetic resonance (MR) imaging. All translabyrinthine patients who had postoperative MR imaging were included. Twenty-six cases were identified. Age range was 13-70 years. Fourteen were male patients. Evidence of CSF fat dissemination on MR and patients' clinical findings. Twenty-two of the 26 scans (85%) demonstrated evidence of fat dissemination into the subarachnoid CSF spaces in the form of microemboli. The cerebellopontine angle was the most common site involved. No evidence of ventricular dilation or any other abnormality was noted. There was no relationship between the presence or extent of fat microembolization and the patients' clinical course. This study suggests that free fat placed in temporal bone defects commonly migrate into the subarachnoid space and subsequently move around in these spaces. This is not associated with any complications such as hydrocephalus, meningitis or prolonged postoperative headache.

Parascapular Free Flap and Fat Grafts: Combined Surgical Methods in Morphological Restoration of Hemifacial Progressive Atrophy

Progressive hemifacial atrophy, widely referred to as Parry-Romberg syndrome or Romberg's disease, is a rare pathologic process characterized by an acquired, idiopathic, self-limited, unilateral atrophy of the face, variably involving skin, subcutaneous tissues, fat, muscle and, less frequently, the underlying bone structures. Restoration of contour and symmetry is the main challenge in cases of Parry-Romberg syndrome; there are several different reconstructive techniques directed at augmentation of deficient soft-tissue volume. The present study describes the authors' own experience with deepithelialized free parascapular flap transfer combined with Coleman's lipoinjection in treatment of four severe cases affected by Parry-Romberg syndrome. The free microvascular parascapular flap, harvested and transferred for facial contour reconstruction, provided large volumes of tissue at the location of the greatest contour defect. It also has proven useful in restoring atrophic tissues trophism. To achieve the finest reconstructive result, Coleman's lipoinjection technique was used for a modification of the free parascapular flap contour, to restore adjacent atrophic areas, and to treat the remaining small or moderate defects. Free parascapular flap transfer combined with Coleman's lipoinjection, according to the authors' results, is the procedure of choice for facial contour restoration. Together, they can provide an excellent reconstructive solution directed at restoration of facial morphology, in terms of natural appearance and long-lasting results, with minimal donor-site morbidity.