Suction-assisted Lipectomy Research Articles

The Lymphedematous Limb as a Donor Site for Breast Fat Grafting

Summary: Breast cancer–related lymphedema results in chronic upper limb swelling with subcutaneous deposition of fluid and fibroadipose tissue. Morbidity includes psychosocial distress, infection, and difficulty using the extremity. Operative management includes excisional procedures such as suction-assisted lipectomy to reduce abnormal subcutaneous fibroadipose tissue to improve limb volume. Patients who have had postmastectomy breast reconstruction often benefit from fat grafting. This report introduces the concept of fat grafting the breast using the lymphedematous arm as a donor site. This technique improves the volume of the limb by removing the excess subcutaneous adipose, and at the same time reconstructs the breast without adding a donor site not related to the breast cancer–related lymphedema.

Direct Subscarpal Lipectomy Combined With Liposuction in Abdominoplasty: An Analysis of Safety and Efficacy in 200 Consecutive Patients.

Abdominoplasty procedures continue to evolve because combining techniques such as suction-assisted lipectomy or direct subscarpal lipectomy have proven to be powerful adjuncts to achieve optimal aesthetic results. However, concern has been expressed about combining techniques simultaneously given the potential to damage the vascularity of the abdominoplasty flap. The aim of this study was to assess the safety and efficacy of simultaneous direct subscarpal lipectomy combined with liposuction in abdominoplasty patients. A 4-year retrospective review of consecutive abdominoplasties (n = 200) performed by a single surgeon was conducted. Liposuction of the abdominal flap and flanks was performed in all patients. After raising the abdominoplasty flap, undermining was performed to just beyond the xyphoid, the lower rib margins superiorly, and the anterior axillary line laterally. Fat deep to Scarpa's fascia was then removed by direct tangential excision in all zones of the abdominal flap. The patients had a mean age of 42.19 years and BMI of 28.10 kg/m2; the mean follow-up time was 7 months. Seroma occurred in 13 patients (6.5%), superficial wound dehiscence treated with local wound care in 16 patients (8%), hypertrophic scarring in 16 patients (8%), partial umbilical necrosis in 1 patient (0.5%), and partial umbilical epidermolysis in 6 patients (3%). No patients experienced major or minor full-thickness tissue loss. No patients needed reoperation. Simultaneous direct excision of subscarpal fat with liposuction of the abdomen and flanks does not appear to subject any zone of the abdominoplasty flap to increased risks of vascular compromise. No flap necroses were observed. The technique described is safe and may provide superior abdominoplasty results.

Surgical Treatment for Primary Lymphedema: A Systematic Review of the Literature

AbstractThis is a retrospective review of surgical management for primary lymphedema.Data were extracted from 55 articles from PubMed MEDLINE, Web of Science, SCOPUS, and Cochrane Central Register of Controlled Trials between the database inception and December 2022 to evaluate the outcomes of lymphaticovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT), and outcomes of soft tissue extirpative procedures such as suction-assisted lipectomy (SAL) and extensive soft tissue excision.Data from 485 patients were compiled; these were treated with LVA (n = 177), VLNT (n = 82), SAL (n = 102), and excisional procedures (n = 124). Improvement of the lower extremity lymphedema index, the quality of life (QoL), and lymphedema symptoms were reported in most studies. LVA and VLNT led to symptomatic relief and improved QoL, reaching up to 90 and 61% average circumference reduction, respectively. Cellulitis reduction was reported in 25 and 40% of LVA and VLNT papers, respectively. The extirpative procedures, used mainly in patients with advanced disease, also led to clinical improvement from the volume reduction, as well as reduced incidence of cellulitis, although with poor cosmetic results; 87.5% of these reports recommended postoperative compression garments. The overall complication rates were 1% for LVA, 13% for VLNT, 11% for SAL, and 46% for extirpative procedures. Altogether, only one paper lacked some kind of improvement.Primary lymphedema is amenable to surgical treatment; the currently performed procedures have effectively improved symptoms and QoL in this population. Complication rates are related to the invasiveness of the chosen procedure.

Arm Contouring and Beautification Without Incision: Application of Arm Net Suture.

Arm contouring has been a challenging issue for many years. Patients request contouring of their arms without incisions and with a shorter recovery time. Making an incision on the arm does not always lead to a nice scar, and in case of complications, it may be catastrophic. The use of "arm net suture" can replace the incision during the arm contour surgery. The author has developed a simple technique of arm contouring with arm net suture that leads to eliminating the need for making an incision, preventing of sagging in the proximal part of the arm, and a shorter recovery time. A retrospective study was conducted on 157 patients who underwent arm contouring surgery. Through a small 5 mm incision in the medial elbow, normal saline solution containing Xylocaine (Fresenius Kabi, Bad Homburg, Germany) and adrenaline was infiltrated. After 20 min, liposuction was started from the most superficial layer with a 3 mm cannula, and then, deeper layers superficial to the fascia were suctioned with a 4 mm cannula. The author usually utilizes traditional suction-assisted lipectomy or power-assisted lipectomy. After completing liposuction, the laxity of the skin along the arm was checked. Most of the laxity of the skin occurred in the proximal third of the arm; while the assistant pulled the skin of the proximal part lateral and downward, the net sutures were inserted. On the third or fourth day (based on the severity of laxity of the skin), the sutures start to be removed from the distal rows, with all sutures removed by the fifth to sixth day. The follow-up times were between 3 and 12 months. All patients were female, and their age range was from 19 to 62 years (mean, 40.45 years). The volume of liposuction was from a minimum of 1200 cc to a maximum of 2500 cc (mean, 1645 cc), and the reduction of the arm diameter was occurred in the range of 6 to 14 cm. No immediate postoperative problems were observed in the patients. Revision was not needed for any patients. Arm net suture is a simple and safe method to replace the incision during arm contour surgery.

Optimizing Outcomes in Lymphedema Reconstruction.

After studying this article, the participant should be able to: 1. Describe current surgical techniques for treating primary and secondary lymphedema. 2. Optimize the surgical care of patients with lymphedema. Over the past decade, significant advances have been made in the surgical treatment of lymphedema. The most notable changes have been the reintroduction and evolution of physiologic techniques, including lymphovenous bypass-sometimes referred to as lymphovenous anastomosis in the literature-and vascularized lymph node transplant. These surgical modalities are now often used as first-line surgical options or may be combined with nonphysiologic approaches, including direct excision and suction-assisted lipectomy. Surgeons continue to debate the most appropriate sequence and combination of surgical treatment, particularly for patients at both extremes of the severity spectrum. Furthermore, debate remains around the need to apply different treatment approaches for patients with upper versus lower extremity involvement and primary versus secondary cause. In this article, we provide a summary of the surgical techniques currently used for both primary and secondary lymphedema and provide our recommendations for optimizing the surgical care of patients with lymphedema.

Outcome Analysis of Combined Surgical Approaches in Advanced-stage Upper Extremity Breast Cancer-related Lymphedema.

This study aimed to discuss several surgical approaches for advanced-stage breast cancer-related lymphedema and compared their treatment outcomes. The patients who underwent surgery with International Society of Lymphology stage III lymphedema were included in this study. The three surgical methods used here were (1) suction-assisted lipectomy with lymphovenous anastomosis, (2) autologous breast reconstruction with muscle-sparing transverse rectus abdominis muscle flap combined with inguinal lymph node transfer, and (3) vascularized lymph node transfer with free omental flap. Analysis of the postoperative outcomes in the patients was based on the difference in volume between patients pre- and postoperatively, LYMPH-Q questionnaire, and bioelectrical impedance analysis. Eighty-seven patients with stage IIb or higher disease underwent surgery. 38 patients underwent suction-assisted lipectomy + lymphovenous anastomosis, 23 underwent autologous breast reconstruction with vascularized lymph node transfer + lymphovenous anastomosis, and 26 underwent right gastroepiploic omental vascularized lymph node transfer with lymphovenous anastomosis. The LYMPH-Q questionnaire, which evaluates patients' subjective satisfaction, showed that the autologous breast reconstruction group showed the greatest improvement, whereas in bioimpedance analysis, the omental flap group demonstrated the greatest postoperative improvement compared with preoperative values. However, suction-assisted lipectomy was considered the most effective surgical method for reducing limb volume in patients with high-stage lymphedema accompanied by fibrosis and volume increase. We observed slightly different clinical effects for each surgical method; however, all surgical methods demonstrated a reduction in the degree of edema and an increase in patient satisfaction.

Lymphatic Improvement after Suction-assisted Lipectomy in a Lipedema Patient

Summary: Lipedema is a chronic and progressive disease that may compromise lymphatic function. Although suction-assisted lipectomy (SAL) is considered a safe treatment for lipedema patients, the lymphatic repercussions of this surgical procedure are not fully understood. There is not enough evidence to support the role of SAL in lymphatic function treatment in lipedema. Here, we report a case of lymphatic drainage improvement after lipedema treatment with SAL. Tumescent SAL was performed in the deep subcutaneous layer, preserving the superficial and muscular lymphatic vessels. Pre- and postsurgical lymphoscintigraphy was equally documented under the Genoa protocol. A 34-year-old female patient presented with painful enlargement of the arms and lower limbs caused by lipedema. The patient had undergone conservative treatment with mild improvement in pain and heaviness. Lymphoscintigraphy showed slowed radiotracer progression on the left lower limb, collateral and tortuous lymphatic vessels on the right lower limb, and exuberant radiopharmaceutical concentration on the inguinal chain. Nine months after SAL was performed, the patient underwent another lymphoscintigraphy, which exhibited normalized radiopharmaceutical progression time and normal and symmetrical lymphatic vessel patterns. Collateral lymphatic paths and tortuosity vessels were no longer identified. Furthermore, the patient reported significant improvement in pain and the limb’s appearance. Tumescent SAL is not only efficient and safe in treating lipedema, but may also be responsible for improvement in lymphatic drainage in lipedema patients. Additional prospective studies are fundamental to reinforce the current evidence and possibly yield predicting information about the tumescent liposuction eligibility in the improvement of lymphatic drainage.

Masculinizing chest wall gender-affirming surgery: Clinical outcomes of 73 subcutaneous mastectomies using the double-incision and semicircular incision techniques

Masculinizing chest wall gender-affirming surgery is an important element in the treatment of gender dysphoria. In this study, we report an institutional series of subcutaneous mastectomies and aim to identify the risk factors for major complications and revision surgery. A retrospective review of consecutive patients who underwent primary masculinizing top surgery via subcutaneous mastectomy at our institution through July 2021 was performed. Demographics and clinical characteristics were recorded as well as major complications and revision surgeries. Time-to-event analyses were performed to assess predictors of major complications and revision surgery. Seventy-three consecutive patients (146 breasts) were included. The mean age and the mean body mass index were 25.2±7 years and 27.6±6.5kg/m2, respectively. The mean follow-up time was 7.9±7.5 months. None of the patients had a history of chest wall radiation or breast surgery. Double incision with free nipple grafting was the most common technique (n=130, 89%), followed by periareolar semicircular incision (n=16, 11%). The mean resection weight was 524.7±377.7g. Concomitant suction-assisted lipectomy was performed in 48 (32.9%) cases. The rate of major complications was 2.7%. Revision surgery was performed in 8 (5.4%) cases. Concomitant liposuction was significantly associated with a lower rate of revision surgery (p=0.026). Masculinizing chest wall gender-affirming surgery is a safe procedure with a low rate of revision. Concomitant liposuction significantly reduced the need of revision surgery. Future studies utilizing patient-reported outcomes are still required to better assess the success of this procedure.

Liposuction for Advanced Lymphedema in a Multidisciplinary Team Setting in Australia: 5-Year Follow-Up.

Liposuction for International Society of Lymphology late stage 2 or 3 limb lymphedema is an established surgical option to remove excessive adipose tissue deposition and has been performed in Australia since 2012 at the Australian Lymphoedema Education, Research, and Treatment (ALERT) Program of Macquarie University. Between May of 2012 and May of 2017, 72 patients with unilateral primary or secondary lymphedema of the arm or leg underwent suction-assisted lipectomy using the Brorson protocol. This prospective study presents 59 of these patients who had consented to research with a 5-year follow-up. Of the 59 patients, 54 (92%) were women, 30 (51%) had leg lymphedema, and 29 (49%) had arm lymphedema. For patients with arm lymphedema, the median preoperative volume difference between the lymphedematous and the contralateral arm was 1061 mL, which was reduced to 79 mL 1 year after surgery and to 22 mL 5 years after surgery. For patients with leg lymphedema, the median preoperative volume difference was 3447 mL, which was reduced to 263 mL 1 year after surgery but increased to 669 mL 5 years after surgery. Suction-assisted lipectomy is a long-term option for the management of selected patients with International Society of Lymphology late stage 2 or 3 limb lymphedema when conservative management can offer no further improvement. Therapeutic, IV.

Suction-assisted lipectomy and lymphatic procedures for lymphedema in the ambulatory surgery setting from 2016 to 2019

Suction-assisted lipectomy and lymphatic procedures for lymphedema in the ambulatory surgery setting from 2016 to 2019

Surgical Correction of Massive Gynecomastia Using Power-Assisted Liposuction and Direct Gland Resection

Introduction: The surgical treatments of mild to moderate gynecomastia has evolved towards less invasive techniques, such as power-assisted liposuction, suction-assisted lipectomy or ultrasound-assisted liposuction. Excisional techniques are still indicated for the most severe cases characterized by skin excess and ptosis. The aim of this study was to present a method of using power-assisted liposuction combined with gland resection to treat gynecomastia with severe hypertrophy. Materials and Methods: We conducted a chart review of 27 consecutive patients treated for massive gynecomastia between 2014 and 2018. Power-assisted liposuction was performed to remove the fatty breast tissue. Incisions for liposuction were placed at lateral inframammary fold and upper anterior axillary pillar. An inferior hemiperiareolar incision was then performed to allow direct resection of fibroglaundular breast tissue. A final liposuction in all directions was performed again to recontour the breast. No skin was resected and drains were always inserted in each breast. Compression vest was worn for 6 weeks after surgery. Results: In average, 749 mg of fat and fibroglandular tissue were removed from each breast. No complications were reported. At 1 year follow-up, ideal aesthetic results, with minimal scars, adequate virilization of the chest contour and full satisfaction of surgeon and patient were observed in 24 patients, while 3 patients presented residual skin excess. Conclusion: In average, 749 mg of fat and fibroglandular tissue were removed from each breast. No complications were reported. At 1 year follow-up, ideal aesthetic results, with minimal scars, adequate virilization of the chest contour and full satisfaction of surgeon and patient were observed in 24 patients, while 3 patients presented residual skin excess.

Single-Stage Suction-Assisted Lipectomy with Dermal Mastopexy: An Alternative Procedure in Repeated Reduction Mammaplasty with Questionable Nipple-Areola Complex Vascularity.

Financial Disclosure: None Corresponding Author: Lawrence Gray, MD Atlantic Plastic Surgery Portsmouth, New Hampshire UNITED STATES [email protected]

Single-Stage Suction-Assisted Lipectomy with Dermal Mastopexy: An Alternative Procedure in Repeated Reduction Mammaplasty with Questionable Nipple-Areola Complex Vascularity.

A majority of malpractice claims in plastic surgery involve complications following breast surgery.1 Nipple-areola complex necrosis is a devastating complication in reduction mammaplasty secondary to compromised vascular supply. The risk of nipple-areola complex necrosis increases in repeated reduction mammaplasty, particularly when the previously used technique is unknown and operative reports are unobtainable. The appropriate technique for repeated reduction mammaplasty remains controversial, as several approaches have been advocated in the literature.2 Many of these techniques involve full-thickness incisions and wide tissue excision for volume reduction, and thus carry the intrinsic risk of nipple-areola complex necrosis due to violation of the underlying vasculature. Suction-assisted lipectomy with dermal mastopexy is a novel technique for repeated reduction mammaplasties to preserve nipple-areola complex vasculature and sensation. An inverted-T de-epithelialization is marked preoperatively (Fig. 1). Each breast is instilled with 1 liter of tumescent solution consisting of 1 liter of Ringer’s lactate with 1:1,000,000 epinephrine and 50 cc of 1% lidocaine. De-epithelialization is undertaken while the breast is tumesced, and the raw surface provides access points for suction-assisted lipectomy. Liposuction is accomplished using a MedGyn Rigid Currette size 7 (MedGyn Products, Addison, Ill.). After suction-assisted lipectomy, dermal mastopexy is completed with interrupted sutures, imbricating the dermal surface.Fig. 1.: Intraoperative views of suction-assisted lipectomy with dermal mastopexy. The midline axis, inframammary fold, nipple-areola complex, distance from sternal notch to nipple, and incision lines were marked along the breast (left). There was much less excess skin in repeated reduction mammaplasties than in primary reductions, and the nipple-areola complex rarely had to be moved more than a couple of centimeters. De-epithelialization of the breast then provides access for suction-assisted lipectomy (right).Eleven suction-assisted lipectomy with dermal mastopexy procedures were performed from 2008 to 2019. The median patient age was 43 years (±9.9 years) and the median time between reductions was 14.5 years (±5.9 years). Average total volume reduction per breast was 800 cc (±200 cc). There were no intraoperative complications in the cohort. Two patients had postoperative complications of wound dehiscence requiring eventual return to the operating room for hypertrophic scar revision. After a follow-up period of 6 months, all patients reported intact nipple-areola complex sensation, and nipple-areola complex vasculature was preserved in all cases. All patients reported decreased symptoms associated with macromastia, such as rashes and back pain. All patients reported satisfaction with their final breast size and symmetry. Aside from aesthetic considerations, any breast reduction must also take oncologic considerations into account. Preoperative imaging was performed in most of our patients to identify malignancies and serve as a comparative baseline for future mammograms. Reduction mammaplasty with liposuction has been shown to trigger deep intraparenchymal calcification development.3 Most of these changes are macrocalcifications, however, and are rarely confused with malignant-appearing microcalcifications when reviewed by experienced radiologists.3 The evidence suggests that liposuction with dermal mastopexy does not interfere with detection of malignancies any more than traditional techniques.4 In this small review, we show that repeated reduction mammaplasty can be as complication-free as the initial reduction with nipple-areola complex preservation. Furthermore, this approach can be critically useful in the setting of unknown prior surgical techniques. Limitations to our study include our small sample size and lack of a standardized comparison group. Furthermore, while suction-assisted lipectomy is a favorable approach for breasts composed largely of fatty tissue, this technique is not appropriate for breasts composed of mostly glandular tissue.5 Therefore, suction-assisted lipectomy with dermal mastopexy may offer a significant advantage for older patients due to the progressive fatty involution of breast tissue with age. DISCLOSURE The authors have no commercial associations or financial disclosures that might pose or create a conflict of interest with information presented in this article. No funding was received for this work.

Stem Cell Harvest From Adipose Tissue

Background: Differentiation, self-renewal, immunomodulation, and angiogenesis are all capabilities of stem cells that can help improve tissue structure (Bacakova et al, 2018). In adipose tissue, there is a stromal vascular fraction (SVF) that contains a variety of cell types that can transdifferentiate between endothelial and adipogenic cell lineages. (Schreml et al., 2009). The procedure used to harvest adipose tissue, such as liposuction or excision, has an impact on the quality of SVF and ADSC recovered from it. Barzelay et al., 2015). Literature review: The two most common locations for stem cell harvest are bone marrow and fat tissue. Taking stem cells can be done in a variety of ways, depending on the source of the cells. Isolating stem cells from preimplantation embryos is how embryonic stem cell retrieval is done. Liposuction is the removal of subcutaneous tissue with the help of a suction pump and an aspiration cannula introduced through a skin incision. Suction-assisted lipectomy, suction lipoplasty, and liposculpture are other synonyms for liposuction. The advantage of liposuction over resection for obtaining stem cells is that it is less intrusive and can preserve neurovascular structures. In addition, liposuction preserves fluid balance and reduces patient discomfort. A high-speed cannula is used in liposuction to disrupt adipocytes. This procedure has the potential to cause cellular harm. Adipocyte viability and transplant survival will be improved by using less stressful adipose tissue extraction procedures. (Simonacci et al., 2017). Under general anaesthesia, the resected tissue was removed whole. In order to separate ADSC, fibrous tissue and visible blood vessels were removed from the retrieved adipose tissue. Resection of adipose tissue produced more SVF and ADSC cells than liposuction, according to Iyyanki et al and Faustini et al. This differs from the findings of a prior study by Schreml et al. Conclusion: Liposuction and resection both have advantages and downsides when it comes to extracting stem cells from fat tissue. There was no discernible difference in the removal of stem cells from adipose tissue by liposuction versus excision.

Lessons Learnt from an 11-year Experience with Lymphatic Surgery and a Systematic Review of Reported Complications: Technical Considerations to Reduce Morbidity.

Complications experienced during lymphatic surgery have not been ubiquitously reported, and little has been described regarding how to prevent them. We present a review of complications reported during the surgical management of lymphedema and our experience with technical considerations to reduce morbidity from lymphatic surgery. A comprehensive search across different databases was conducted through November 2020. Based on the complications identified, we discussed the best approach for reducing the incidence of complications during lymphatic surgery based on our experience. The most common complications reported following lymphovenous anastomosis were re-exploration of the anastomosis, venous reflux, and surgical site infection. The most common complications using groin vascularized lymph node transfer (VLNT), submental VLNT, lateral thoracic VLNT, and supraclavicular VLNT included delayed wound healing, seroma and hematoma formation, lymphatic fluid leakage, iatrogenic lymphedema, soft-tissue infection, venous congestion, marginal nerve pseudoparalysis, and partial flap loss. Regarding intra-abdominal lymph node flaps, incisional hernia, hematoma, lymphatic fluid leakage, and postoperative ileus were commonly reported. Following suction-assisted lipectomy, significant blood loss and transient paresthesia were frequently reported. The reported complications of excisional procedures included soft-tissue infections, seroma and hematoma formation, skin-graft loss, significant blood loss, and minor skin flap necrosis. Evidently, lymphedema continues to represent a challenging condition; however, thorough patient selection, compliance with physiotherapy, and an experienced surgeon with adequate understanding of the lymphatic system can help maximize the safety of lymphatic surgery.

Response to: Comparison of the Effect of Suction-Assisted Lipectomy Devices on Survival of Adipose Tissue Graft

Response to: Comparison of the Effect of Suction-Assisted Lipectomy Devices on Survival of Adipose Tissue Graft

Combined lymph node transfer and suction-assisted lipectomy in lymphedema treatment: A prospective study.

Recent studies have analyzed the combination of suction-assisted lipectomy (SAL) and vascularized lymph node transfer (VLNT) in lymphedema treatment, reporting positive outcomes. However, it is difficult to draw conclusions due to the heterogeneity of the studies. Aim of this prospective study is to evaluate the effectiveness of the combination of VLNT and SAL in lymphedema treatment. Between January 2016 and May 2019, 94 patients with upper or lower limb stage IIb-III lymphedema were enrolled and treated with the gastroepiploic VLNT followed by SAL. Patients were prospectively evaluated through circumference measurement and clinical examination, including number of episodes of cellulitis. Among patients enrolled in the study 83 were affected by lower limb lymphedema (LLL) and 11 were affected by upper limb lymphedema (ULL). Average follow-up was 3 ± 0.8 years. In the LLL group, the mean circumference reduction rates (CRR) were 60.4, 56.9, 29.6, and 55.4% above and below the knee, above the ankle, and at the foot level, respectively. A statistically significant difference was noted at all the levels (p < .05), but above the ankle (p=.059). Regarding the ULL group, the mean CRR were 80.7, 60.7, 65.0 and 49.6% above and below the elbow, at wrist and at mid-hand, respectively. CRR were reported at all the levels but no statistical difference was noted. The number of episodes of cellulitis dropped significantly (p < .05). This study supports the use of VLNT+SAL in lymphedema grades IIb-III, with important implications for the clinical practice.

ХАРАКТЕРИСТИКА ЖИЗНЕСПОСОБНОСТИ КЛЕТОК ЛИПОГРАФТА ПРИ РАЗЛИЧНЫХ МЕТОДИКАХ ЕГО ПОЛУЧЕНИЯ И ПОДГОТОВКИ

Objective. To determine the predictors of adipocytes and fibroblast-like cells survival in the lithographt using various techniques of lipoaspiration and adipose tissue preparation to autotraslantation. Methods. Cellular viability was analyzed in 57 adipose tissue samples prepared by various techniques of lipoaspiration, and analysis of damage to adipocytes and fibroblast-like cells - in 73 smears after passing of adipose tissue through filters of different diameters. Results. The average adipocyte viability in untreated lipoaspirate was 59%. Using water-jet technique, it was 65% (median 61%), syringe technique - 65% (median 74%), suction-assisted lipectomy - 55% (median 44%), p=0.18. The number of viable adipocytes depending on donor sites: thighs - 76%, waist - 67%, abdomen - 57%, buttocks - 50%, shoulders - 38%, knees - 35%. The number of intact adipocytes after 1.4 mm filter processing was 62-68%, fibroblast-like cells - 24-28%. The number of viable cells reduced with each passage. The number of intact adipocytes after 1.2 mm filter was 42-52%; of non-damaged fibroblast-like cells were 24-26% which located among connective tissue. The number of intact cells after emulsifying filter elevated up to 4-16% of adipocytes and 6-16% of fibroblast-like cells with a reduction of viable cells number with increasing of each passage. Single connective tissue fibers were determined, most content of the smear was represented by homogeneous fat. Conclusion. The viability of adipocytes is higher when using the syringe lipoaspiration technique with sampling from the inner and outer surfaces of the thighs and lower back. For regenerative purposes, it is preferable to use emulsified fat, characterized by the destruction of adipocytes and the elimination of connective tissue fibers, keeping intact up to 16% of fibroblast-like cells. The defects of soft tissue is better to fill with washed «macro-fat» without filtration, or use a 1.4 mm cell filter. For a combination of regenerative and volumizing purposes, it is advisable to use anaerobic cell filters. What this paper adds For the first time the viability of adipocytes using different lipoaspiration techniques and taken from different anatomical areas has been analyzed. An original technique for analyzing the viability of lipograft has been firstly applied. A reliable difference in the cellular composition of the lipograft when using different cell filters has been found. A reliable significant negative relationship between the number of viable cells and the number of passages through cell filters (D-1.4, 0.5 mm.) has been established. Recommendations for the preparation of various types of lipograft to obtain the maximum ratio of viable cells were substantiated.

Fate of Fat Grafting In Vivo and In Vitro: Does the Suction-Assisted Lipectomy Device Matter?

Recently, there has been increasing research interest in identifying the effect of liposuction procedures on fat graft survival in order to clarify whether different harvest techniques affect the quality of fat grafts. The aim of this study was to investigate the effect of 2 liposuction methods on the survival and regeneration potential of grafted fat tissue. The proliferation and differentiation potentials of adipose-derived stem cells (ASCs) isolated by both methods was also investigated. Fat grafts were collected from patients who underwent liposuction procedures by 2 different methods: traditional suction-assisted liposuction (TSAL) and vibration amplification of sound energy at resonance (VASER). One portion of the lipoaspirates was implanted into the subcutaneous layer of nu mice for 4 and 12 weeks. ASCs were isolated from the other portion of the lipoaspirate and subjected to proliferation and differentiation assays. Although in vivo fat grafting presented similar adipose tissue survival for the 2 different liposuction methods, more angiogenesis and less fibrosis was observed in the VASER group based on histologic evaluation. Furthermore, VASER-derived ASCs presented better quality in terms of cell differentiation capacity. The in vivo study confirmed better graft angiogenesis with less inflammation, apoptosis, and scar formation in the VASER group. ASCs harvested with VASER exhibited increased differentiation capacity compared with those obtained by TSAL, and represent an excellent source for fat grafting and regenerative medicine.

Primary Lymphedema: Update on Genetic Basis and Management.

Significance: Primary lymphedema is a chronic condition without a cure. The lower extremities are more commonly affected than the arms or genitalia. The disease can be syndromic. Morbidity includes decreased self-esteem, infections, and reduced function of the area. Recent Advances: Several mutations can cause lymphedema, and new variants continue to be elucidated. A critical determinant that predicts the natural history and morbidity of lymphedema is the patient's body mass index (BMI). Individuals who maintain an active lifestyle with a normal BMI generally have less severe disease compared to subjects who are obese. Because other causes of lower extremity enlargement can be confused with lymphedema, definitive diagnosis requires lymphoscintigraphy. Critical Issues: Most patients with primary lymphedema are satisfactorily managed with compression regimens, exercise, and maintenance of a normal body weight. Suction-assisted lipectomy is our preferred operative intervention for symptomatic patients who have failed conservative therapy. Suction-assisted lipectomy effectively removes excess subcutaneous fibro-adipose tissue and can improve underlying lymphatic function. Future Directions: Many patients with primary lymphedema do not have an identifiable mutation and thus novel variants will be identified. The mechanisms by which mutations cause lymphedema continue to be studied. In the future, drug therapy for the disease may be developed.