Pedicled Fat Research Articles

Adjustable Fat Repositioning With Intraoral Anchoring

Prominent tear trough deformity and midfacial depression are the first priority in periorbital rejuvenation. To achieve harmonious lower eyelid improvement, we developed a novel approach to reposition infraorbital fat using intraoral anchoring in transconjunctival lower eyelid blepharoplasty. Fourteen patients were included. Blepharoplasty involved infraorbital fat repositioning by intraoral anchoring via a transconjunctival incision to address depression and grooves deformities. Optimal fat repositioning can be achieved by intraorally manipulating suture tension. Photographs were taken both preoperatively and postoperatively. Time of operation, complications, recovery time, and postoperative outcomes were evaluated. Fourteen patients underwent blepharoplasty between August of 2018 and December of 2018. Their mean age was 36.9 ± 6.1 years. Grooves deformities and depression were eliminated, and the periorbital contour significantly improved. All patients were satisfied with postoperative outcomes. There were no major complications observed. Intraoral anchoring of the infraorbital fat pedicles yields a significantly improved lower eyelid appearance and requires minimum clinic visits and an extremely short recovery time. In addition, the maneuverable intraoral anchoring allows for customization of patient aesthetics. This approach can be regarded as a true alternative for lower lid rejuvenation, and the outcome is straightforward and predictable.

Pedicled Fat Transposition vs Free-Fat Grafting for Lower Blepharoplasty With Volume Preservation.

Pedicled Fat Transposition vs Free-Fat Grafting for Lower Blepharoplasty With Volume Preservation.

Pedicled Fat Transposition vs Free-Fat Grafting for Lower Blepharoplasty With Volume Preservation-Reply.

Pedicled Fat Transposition vs Free-Fat Grafting for Lower Blepharoplasty With Volume Preservation-Reply.

Fat necrosis after breast-conserving oncoplastic surgery.

Fat necrosis is a subjective early as well as delayed complication, which sometimes mimics local recurrence and ruins the quality of life by pain and poor cosmetic result. While, the frequency and severity of fat necrosis are important issues that breast surgeons should explain to the patient, these data are not revealed well. A total of 1476 patients who underwent breast surgery from January 2000 to December 2012 were enrolled in the present study. We assessed fat necrosis by mammographic and physical findings and created grading criteria: Grade (G) 0, no fat necrosis; G1, no symptomatic fat necrosis (mammographic dystrophic calcification); G2, mild symptomatic necrosis (mammographic dystrophic necrosis with tumor); G3, severe symptomatic necrosis (mammographic dystrophic necrosis with pain or skin change); and G4, symptomatic necrosis requiring surgical intervention. Of the 1476 patients enrolled, 393 (27%) underwent mastectomy, and 1083 (73%) underwent breast-conserving surgery. We achieved a high rate of breast-conserving surgery at a total rate of 73% over the study period and maximum rate of 88% in 2010, using oncoplastic procedures. We mainly adopted a pedicled fat flap (417/1083; 39%) and a free dermal fat flap (40/1083; 3.7%). Among the 626 patients who underwent partial resection with no replacement for the defect, G1-G2 fat necrosis was seen in 29/626 (4.6%). While, the incidence of fat necrosis with pedicled fat flap and free dermal fat graft was 68/417 (16%) and 40/40 (100%), respectively, showing a significant difference (p < 0.01). Furthermore, the incidence of G3-G4 fat necrosis was significantly higher with free dermal fat grafts (25%; 10/40) than with pedicled flap (2.9%; 12/417) (p < 0.01). Among pedicled flaps, the incidence of fat necrosis with inframammary adipofascial flaps was 56% (14/25) which was higher than that with lateral epidermal fat flaps (12%; 33/276) (p < 0.01), and rotation of surrounding breast tissues (8%; 21/116) (p < 0.01). The incidence of G3 fat necrosis was also high at 20% (5/25) in inframammary adipofascial flaps. Breast-conserving oncoplastic surgery carries a risk of fat necrosis as a delayed complication. The incidence rate and severity of fat necrosis with each procedure should be assessed. We should select fat grafts with a good blood supply to replace defects of breast-conserving therapy.

Functional Outcomes of Local Pedicle Graft Interpositional Arthroplasty in Adults With Severe Freiberg's Disease.

Conservative treatment or debridement is generally sufficient for Freiberg's disease grades I and II but operative intervention for the late stages of the disease process (III-V) is more challenging. Debridement alone is not sufficient and various forms of arthroplasty have been put forward. We have evaluated the outcomes of patients treated with an interpositional arthroplasty technique using a pedicle graft of periosteum and fat made into a "Rollmop" spacer for severe Freiberg's disease. No results have previously been reported for this technique. Twenty-five consecutive cases (23 patients) were performed from February 2009 to September 2016 (20 females, 5 males). Mean age at surgery was 52.6 years (range 19-70.5 years) with 92% affecting the second metatarsal. Twenty-three were primary cases and 2 were revision cases. Five cases were stage III, 12 were stage IV, and 8 were stage V. All patients underwent interpositional arthroplasty using a periosteum and fat pedicle graft from the affected metatarsal shaft as described by Myerson. Patients were evaluated using Manchester-Oxford Foot Questionnaire (MOXFQ) and American Orthopaedic Foot & Ankle Society Questionnaire (AOFAS). Mean follow-up was 3.5 years (0.6-7.6 years). Paired 2-tailed Student t tests were used to assess clinical significance. Surgery allowed 8 patients to return to normal footwear, 10 patients returned to fashion footwear/heels, and 5 returned to sports. Nineteen cases (17 patients) were assessed with patient-reported outcome measures and all showed a clinically and statistically significant improvement in their scores. Mean pre- and postoperative VAS pain scores were 6.2 (range 4-9) and 1.8 (range 0-6) ( P < .05). Mean perioperative AOFAS scores were 45.6 (range 15-73) and 82.7 (range 57-100) ( P < .05). Mean perioperative MOXFQ scores were 60.0 (range 23-89) and 18.1 (range 0-80) ( P < .05). This novel interpositional arthroplasty technique using a "rollmop" of periosteum and fat for severe Freiberg's disease produced significant improvements in pain, functional outcome, and patient satisfaction without donor site morbidity. Furthermore, it allowed patients to return to desired footwear and sporting activities. The functional outcome and joint range of motion was superior after a K-wire was no longer placed across the joint, and we believe it is essential to avoid this to permit early range-of-motion exercises. Level IV, retrospective case series.

Arthroscopic Repair of Chronic Tears of the Anterior Horn of the Lateral Meniscus That Includes Covering the Lesion With an Infrapatellar Pedicle Fat Flap.

This study analyzed the efficacy and safety of arthroscopic outside-in repair of the anterior horn of the lateral meniscus that includes covering the lesion with an infrapatellar pedicle fat flap in patients with chronic tears. This retrospective study reviewed 87 patients with chronic tears of the anterior horn of the lateral meniscus who underwent arthroscopic outside-in repair, which included covering the lesion with an infrapatellar pedicle fat flap (group A, n=45) or not (group B, n=42). The 2 groups were similar in terms of age, sex, body mass index, and disease duration. Patient results were assessed with Tegner, Lysholm, and visual analog scale scores; healing criteria; magnetic resonance imaging; and complication rates. Mean follow-up was 38.2 months. Tegner and Lysholm scores improved postoperatively in both groups (all P<.01) and were similar for the 2 groups (all P>.05). Visual analog scale scores were reduced postoperatively in both groups (P<.01) and similar for the 2 groups (P>.05). Healing rates and complication rates did not differ between the 2 groups (all P>.05), but healing on magnetic resonance imaging was better in group A than group B (P<.05). The repair of chronic tears of the anterior horn of the lateral meniscus can lead to good clinical outcomes and a satisfactory success rate. Covering the repair site with an infrapatellar pedicle fat flap may improve meniscal healing and does not increase the complication rate. [Orthopedics. 2018; 41(3):e360-e364.].

The efficacy of retroperitoneal laparoscopic deroofing of simple renal cyst with perirenal fat tissue wadding technique: A retrospective study.

Treatment options for simple renal cyst (SRC) include open surgery, laparoscopy with decortication, or percutaneous aspiration with or without sclerotherapy. Though laparoscopic unroofing achieves better results than percutaneous sclerotherapy, the reported recurrence rate is still up to 19%. Thus, it is necessary to find methods to reduce the recurrence rate.To investigate whether the perirenal pedicled fat tissue wadding technique during retroperitoneal laproscopic deroofing (RLD) of SRC affects the incidence of recurrence.A retrospective analysis was carried out on clinical data of 254 patients with SRC treated by RLD in our hospital from 2008 to 2016. Among these patients,119 had a simple retroperitoneal deroofing (SRD) and 135 received a retroperitoneoscopic deroofing with wadding of the cyst using perirenal fat tissue (RDCW). The recurrence rate and variables, as well as perioperative complications, were compared. To further explore the potential variables influencing cyst recurrence rate, univariate and multivariate regression analyses were applied.A total of 251 patients were included in the analysis. The operation was successfully completed laparoscopically in all cases with no conversion to open surgery. No mortality or significant complication occurred in both groups. After a median follow-up of 38.67 months, we noted 41 recurrences. According to the univariate and multivariate regression analyses, patients managed with the wadding technique had superior recurrence-free survival (RFS), compared with patients in SRD group (log-rank P = .03 and P = .04, respectively). Moreover, patients with single renal cyst had a lower recurrence rate, compared with patients with multiple renal cysts (log-rank P < .01). Regarding the operation time, blood loss, and hospital stay, no statistically significant difference was found between 2 groups (P values .13, .30, and .75, respectively). However, less postoperative drainage and shorter postoperative interval until tube removal (P = .04) were observed in RDCW group.The perirenal pedicled fat tissue wadding technique can decrease the cyst recurrence rate and RCDW represents an effective and safe treatment option in the management of renal cysts.

New Internal Fixation Technique for Transconjunctival Fat Repositioning.

To treat tear trough deformities in young patients, transconjunctival orbital fat repositioning has been widely used. Although internal fixation of transposed fat enables more secure and stable fixation than the externalized percutaneous suture method, the latter is used more commonly because of the narrow operation field and consequent technical difficulty of the internal fixation method. We describe a novel technique using a newly devised needle (Chang's needle) that facilitates internal fixation of transposed fat pedicles.

The no-touch saphenous vein for coronary artery bypass grafting maintains a patency, after 16 years, comparable to the left internal thoracic artery: A randomized trial

ObjectivesThis study investigates whether the no-touch (NT) vein graft, at a mean time of 16 years, maintains a significantly higher patency rate than conventional (C) vein grafts and still has patency comparable to that of the left internal thoracic artery (LITA). MethodsA total of 156 patients accepted for coronary artery bypass grafting were randomly allocated to 1 of 3 groups. In the C group, the saphenous vein (SV) was stripped and distended. In the intermediate group, the SV was stripped but not distended. In the NT group, the SV was neither stripped nor distended, but rather harvested with a fat pedicle. This study is an angiographic follow-up of the C and NT groups, at a mean time of 16 years postoperatively. ResultsFifty-four patients were included (C group = 27; NT group = 27). In all, 72 and 75 vein grafts were completed in groups C and NT, respectively. Crude SV graft patency was 64% in the C group versus 83% in the NT group (P = .03), which was similar to the patency of the LITA (88%). The harvesting technique had a major impact on the patency with a hazard ratio for occlusion of 1.83 for the C group (P = .04). ConclusionsHarvesting the SV with the NT technique conferred, at a mean time of 16 years, a significantly higher patency than the conventional technique that was still comparable to that of the LITA.

Repair of Oroantral Communications by Use of a Combined Surgical Approach: Functional Endoscopic Surgery and Buccal Advancement Flap/Buccal Fat Pad Graft

The purpose of this study was to evaluate the efficacy of a combined surgical approach for repair of oroantral communications. This retrospective study evaluated the effectiveness of the combined surgical approach of functional endoscopic sinus surgery and buccal advancement flap or buccal fat pad grafting. Forty-three patients with chronic sinusitis from 2007 to 2013 were evaluated after combined functional endoscopic sinus surgery and closure of oroantral communication with a buccal fat pad graft or buccal advancement flap for persistent oroantral communication. Treatment included preoperative computed tomography, antibiotic therapy, exploration and removal of sinus pathologic tissues, rotation of a pedicled fat pad graft into the oral opening, repair and closure of oral mucosa, exploration of involved sinuses with excision of sinus and nasal tissues necessary for establishment of osteomeatal drainage, and follow-up to evaluate the success or failure of treatment. The results were overwhelmingly positive, with 17 of 19 buccal advancement flaps showing no dehiscence or chronic sinusitis and all 24 buccal fat pad grafts showing no dehiscence, with no continued sinus complaints. Complications ranged from a sensation of tightness in the graft area to paresthesia of nerve V2. There was no statistical difference in results between buccal fat pad grafts and buccal advancement flaps. The results of this study infer that a combined approach to the multifactorial disease process results in a very successful and predictable outcome.

Comparison of $LigaSure^{TM}$ and Bipolar Vessel Sealing System for Laparoscopic Ovariectomy in Cats

The aim of this study was to investigate and compare technique, surgical time, and complications of laparoscopic ovariectomy using LigaSure TM and bipolar vessel sealing system in cats. Laparoscopic ovariectomy was performed under general anesthesia on 10 healthy female cats admitted for elective ovariectomy. Surgery was performed through three midline portals. Each ovary was randomly-assigned to removal by use of either LigaSure TM or bipolar vessel sealing system. Duration of predetermined surgery intervals and complications were compared. Bipolar OVE (2:16 ± 1:14 minutes) took significantly longer surgical time compared to the LigaSure TM OVE (1:24 ± 0:59 minutes, P = 0.021). The ovarian pedicle fat and obesity did not influence surgery duration. Intraoperative hemorrhage occurred with bipolar OVE in three cats, but had no significant influence on surgical time. The results suggest that both LigaSure TM and bipolar devices appear to be effective, but LigaSure TM can be used as a stand-alone device that decreases surgical time and complication compared with bipolar vessel sealing system.

Fat transposition with a single subdermal stitch for the treatment of deep tear trough

Goal: To describe a fixation technique of the medial and central fat pads in the subperiosteal pocket for transconjunctival fat transposition, using a single subdermal, non-removable, non-absorbable stitch.Materials and methods: Retrospective study of 19 patients with bilateral deep tear through treated by means of transconjunctival fat transposition. Charts and photographic records were reviewed.Results: Photographical and clinical improvement of the deep tear through and fat prolapse was observed in all patients in variable degrees. There were no intraoperative complications. Significant periocular hematoma occurred in 1 patient and solved without complications. Two patients presented transitory fat pedicle hardening and one patient presented a conjunctival inferior fornix granuloma, surgically removed. All patients were satisfied.Conclusions: Transconjunctival subperiosteal fat transposition with single subdermal stitch to fix the medial and central fat pads, for the treatment of deep tear trough and fat prolapse demonstrated high patient satisfaction, good aesthetic results with no significant or permanent complications.

Preliminary treatment of microscopic purse-string suture and pedicle fat tamponade in symptomatic sacral canal cyst

Objective To explore the clinical features and microsurgical treatment of symptomatic sacral canal cyst.Methods 18 cases with symptomatic sacral canal cyst were operated through different surgical modes according to the classifications.According to the relationship with communicating foramen,these cysts were divided into two types:perineural cyst and nerve root sleeve expansion.While the latter was divided into two subtypes:simple communicating and the sleeve of the nerve root.For perineural cyst,we performed subtotal or total resection of the cyst wall under the protection of nerve roots.For the simple communicating cyst,we performed purse-string suture in the neck of cyst.For the cyst with sleeve of the nerve root,we performed partial cyst excision,plication of the cyst wall,purse-string suture in the neck of cyst and remodel the sleeve of the nerve root.The residual cavity area was tamped by a fascial fat with pedicle.Results 18 patients were followed-up for 6-36 months (an average of 18 months) and there was no cyst recurrence.16 out of 18 patients experienced complete or substantial resolution of the preoperative local and radicular pain.Two patients still complained of mildly pain and numbness but could be tolerated without influence on their daily life.Conclusions Microsurgical treatment should be selected for patients with symptomatic sacral canal cysts according to the different types of cysts,including total or partial cyst excision combined with direct dural closure,purse-string suture in the neck of cyst,remodeling the sleeve of the nerve root and pedicled fat filling the cavity under the protection of nerve roots.Effective and safe treatment of symptomatic sacral canal cyst with low recurrence could be achieved. Key words: Sacrococcygeal region; Arachonid cyst; Microsurgery ; Suture techniques

Breast reconstruction with pedicle fat dermal layer associated pectorallis muscle flap

A Revista Brasileira de Cirurgia Plástica é o órgão oficial de divulgação da Sociedade Brasileira de Cirurgia Plástica (SBCP), tem como objetivo registrar a produção científica em Cirurgia Plástica, fomentar o estudo, aperfeiçoamento e atualização dos profissionais da especialidade.

Effacing the Orbitoglabellar Groove With Transposed Upper Eyelid Fat

An age-related depression can develop over the superonasal orbital rim, which the authors have called the "orbitoglabellar groove (OGG)." It is, in part, related to volume loss over the rim as is seen at the lower eyelid/cheek interface (nasojugal groove). An upper eyelid fat pedicle can be transposed over the OGG during standard upper blepharoplasty surgery to reduce this depression. The charts of patients who underwent fat transposition to the OGG during upper blepharoplasty over a 20-month period (2010-2012) are retrospectively reviewed. Only primary eyelid surgery patients are included in the study. The procedure, its results, and complications are presented. Seventeen patients are included in this study. Eleven patients (65%) are women and 6 (35%) patients are men. The average patient age is 56 years (range 47-80 years), and the average follow up is 10 months (6-14 months). Two patients (12%) developed a transient induration over the transposed fat pedicle in the postoperative period which resolved with a combination 5-fluorouracil/kenalog injection. There were no cases of postoperative infection, prolonged swelling, motility disturbance, diplopia, or eyelid malposition. Clinical effacement of the OGG was noted in all cases, and physician and patient assessment of surgical results are equally good. The OGG is an involutional periorbital hollow present over the superonasal orbital rim. The depression can be reduced with native eyelid fat transposition during upper blepharoplasty in a similar way that lower blepharoplasty with fat repositioning effaces the nasojugal groove. The learning curve for the procedure is quick, especially for those who have experience with its lower eyelid counterpart.

Interpolated subcutaneous fat pedicle melolabial flap for large nasal lining defects

Full-thickness nasal deformities are a reconstructive challenge. Restoration of a reliable internal lining is critical for a successful reconstruction. Septal hinge flaps are the workhorse for internal lining defects. However, these and other intranasal mucosal flaps are sometimes unavailable due to prior harvest or previous oncologic resection. We present the two-stage interpolated subcutaneous fat pedicle melolabial flap for lining large defects when traditional intranasal flaps are unavailable. This approach is particularly useful when one forehead flap has already been expended, preserving the patient's remaining forehead tissue for external cover.

Long-Term Stability of Adipose Tissue Generated from a Vascularized Pedicled Fat Flap inside a Chamber

Numerous studies demonstrate the generation and short-term survival of adipose tissue; however, long-term persistence remains elusive. This study evaluates long-term survival and transferability of de novo adipose constructs based on a ligated vascular pedicle and tissue engineering chamber combination. Defined adipose tissue flaps were implanted into rats in either intact or perforated domed chambers. In half of the groups, the chambers were removed after 10 weeks and the constructs transferred on their vascular pedicle to a new site, where they were observed for a further 10 weeks. In the remaining groups, the tissue construct was observed for 20 weeks inside the chamber. Tissue volume was assessed using magnetic resonance imaging and histologic measures, and constructs were assessed for stability and necrosis. Sections were assessed histologically and for proliferation using Ki-67. At 20 weeks, volume analysis revealed an increase in adipose volume from 0.04 ± 0.001 ml at the time of insertion into the chambers to 0.27 ± 0.004 ml in the closed and 0.44 ± 0.014 ml in the perforated chambers. There was an additional increase of approximately 10 to 15 percent in tissue volume in flaps that remained in chambers for 20 weeks, whereas the volume of the transferred tissue not in chambers remained unaltered. Histomorphometric assessment of the tissues documented no signs of hypertrophy, fat necrosis, or atypical changes of the newly generated tissue. This study presents a promising new method of generating significant amounts of mature, vascularized, stable, and transferable adipose tissue for permanent autologous soft-tissue replacement.

A stand-up collar around the saphenous vein graft

We present a technique of a stand-up collar around the saphenous vein graft using a pedicled fat pad flap. This procedure is simple and effective to avoid kinking in a graft that was proximally anastomosed with an automatic device and to maintain the graft in its natural position.

Pedicled Fat Flap to Increase Lateral Fullness in Upper Blepharoplasty

The eyelid of a young person can be distinguished by the lateral fullness of the upper eyelid. With aging, lateral fullness decreases. Volume restoration in the periorbital area has been previously addressed by fat draping and grafting. More recently, techniques for regaining lateral fullness of the upper eyelid have focused on fat grafting, although effective graft take, reabsorption, and irregularities have been a concern. To address these issues, the concept of pedicled fat draping in the upper eyelid was explored. In a retrospective study from June 2006 to August 2008, 31 patients underwent upper blepharoplasty with augmentation of the lateral fullness with a pedicled fat flap from the central fat pad. The fat from the central compartment was elevated, dissected, and then transposed to the lateral upper eyelid below the orbicularis muscle. All patients were women ranging in age from 43 to 68 years. Pre- and postoperative picture comparison demonstrated a more youthful appearance with increased lateral fullness of the upper eyelids. There were no cases of fat necrosis encountered. Increased volume remained stable over an average of one-year follow-up. No complications were recorded. Transposing a pedicled fat pad from the central compartment laterally has proven to be an effective technique for achieving predictable upper lateral eyelid fullness and thus achieving a long-lasting, more youthful appearance.

Thymopericardial Augmented Encasement for Coronary Artery Bypass Graft Surgery

: A pedicled prepericardial fat flap was created to augment the pericardial cavity and applied for patients undergoing coronary artery bypass grafting. The efficacy and durability of this method were investigated. : Between July 2005 and November 2008, the present technique was applied for consecutive 245 patients (165 men and 80 women, aged 67 ± 8.3 years) undergoing isolated coronary artery bypass grafting in which 240 (98.0%) were off-pump cases. The left and/or right internal thoracic artery and the gastroepiploic artery were used in 244 and 160 patients, respectively, and the saphenous vein and the radial artery were used in 51 and 10 patients, respectively. Ninety-seven (40.0%) patients had been diabetic, 18 (7.3%) had had chronic renal failure, and three were redo cases. The prepericardial soft tissue, involving the pedicled thymic gland, was dissected en bloc and sewn with pericardiotomies to wrap the heart and the grafts. Angiography or three-dimensional computed tomography was used to assess the intrapericardial pathways of each graft and a long-term durability of the fat pad. : Early angiography or three-dimensional computed tomography proved that the graft pathways were unaffected by the encasements. Resternotomies in two patients and sternal treatments for infectious dehiscence in two patients were safely achievable. Five-year postoperative computed tomography showed the intact fat pad in the retrosternal space. : The present technique can encase the heart not the least jeopardizing each pathway of the grafts, and the durable fat pad functions protectively when the sternotomy is either reopened or infected.