Use Of Fat Grafting Research Articles

The use of autologous fat grafts in breast surgery: A literature review.

Autologous fat injection was first described roughly a century ago and has been used in surgery ever since. In addition to its use in many surgical fields, it is also frequently used for both aesthetic and reconstructive purposes in breast surgery. Since the application of fat grafting in breast surgery has steadily increased, studies investigating its reliability have simultaneously become increasingly common. Previous studies have reported that the use of fat grafting in breast surgery is reliable, but some pending questions remain about its routine use. In order to use fat grafts successfully in breast surgery, it is necessary to be familiar with the structure and content of adipose tissue, the efficacy of adipose stem cell-enriched fat grafts, the oncological safety of fat grafts, and the problems that may occur in the radiological follow-up of patients who undergo fat grafting procedures. In this literature review, we aim to discuss the use of fat grafts in breast surgery by investigating these common problems.

International Expert Panel Consensus on Fat Grafting of the Breast.

Autologous fat grafting has broad applications in reconstructive and aesthetic breast surgery as a natural filler and for its regenerative purposes. Despite the widespread use of fat grafting, there remains no shared consensus on what constitutes the optimal fat grafting technique and its oncological safety. For this reason, the authors of this study have organized a Survey and an International Consensus Conference that was held at the Aesthetic Breast Meeting in Milan (December 15, 2018). All studies on fat grafting, both for breast aesthetic and reconstructive purposes, were electronically screened. The literature review led to 17 "key questions" that were used for the Survey. The authors prepared a set of 10 "key statements" that have been discussed in a dedicated face-to-face session during the meeting. The 10 key statements addressed all the most debated topics on fat grafting of the breast. Levels of evidence for the key statements ranged from III to IV with 2 statements (20%) supported by a level of evidence III and 6 statements (60%) by level of evidence IV. Overall consensus was reached for 2 statements (20%) with >75% agreement reached for 7 statements. The survey demonstrated a diversity of opinion and attitude among the panelists with regard to technique. Clear recommendations for evidence-based clinical practice for fat grafting use both in aesthetic and reconstructive breast surgery could not be defined due to the scarcity of level 1 or 2 studies.

Fat Grafting and the Palpable Breast Mass in Implant-Based Breast Reconstruction: Incidence and Implications

Background: Fat grafting is a powerful and increasingly used technique in breast reconstruction. However, fat necrosis can lead to palpable postoperative changes that can induce anxiety and lead to unplanned diagnostic studies. The authors’ aim in this study was to evaluate the incidence, type, and timing of these unanticipated studies; the specialty of the ordering provider; and the factors that trigger the ordering process. Methods: A retrospective chart review was conducted for patients from 2006 to 2015 who underwent fat grafting as part of implant-based breast cancer reconstruction and had at least 1-year follow-up after fat grafting. Results: From 2006 to 2015, 166 patients underwent fat grafting as part of implant-based breast reconstruction. Forty-four women (26.5 percent) underwent at least one imaging procedure. Thirteen women (7.8 percent) underwent 17 biopsies. For a palpable mass, the initial imaging test most commonly ordered was ultrasound, followed by mammography/ultrasound. The percentage of patients with a diagnosis of fat necrosis on mammography, ultrasound, and biopsy was 4.2, 12.7, and 5.4 percent, respectively. Seven patients (4.2 percent) had distant metastases. Tissue diagnosis of local recurrence was never identified. Mean follow-up was 2.4 years. Conclusions: Fat-grafting sequelae may lead to early unplanned invasive and noninvasive procedures initiated by a variety of providers. In this study, fat grafting had no impact on local recurrence rate. As use of fat grafting grows, communication among breast cancer care providers and enhanced patient and caregiver education will be increasingly important in optimizing the multidisciplinary evaluation and monitoring of palpable breast lesions. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

The Study of Adipose Derived Mesenchymal Stem Cells Mixed with Platelet Rich Fibrin Matrix in Augmentation and Rejuvenation of The Lower Leg: A Comparative Study

Background: Adipose tissue is an abundant source ofmesenchymal stem cells. The use of transplantation of preadipocytesand adipocytes to restore the volume of tissueshas added a lot to the value of fat transplantation strategies.These cells are more advantageous as a cell source than matureadipocytes. They are capable of both proliferating to obtainlarger cell numbers and of differentiating to obtain the tissueof interest. This study aims to compare the results of traditionalfat injection and activated adipose derived mesenchymal stemcells injection enriched with platelet rich fibrin matrix inaugmentation and rejuvenation of the distal leg.Patients and Methods: The study was conducted on 14patients who had fat injection of the leg. They were dividedinto 2 groups: 7 cases by traditional fat injection and 7 casesby injection of (PRFM) with the adipose derived mesenchymalstem cells. Post-operative assessment at 3, 6, 18 months weredone subjectively. Patients in group 11 were subjected tomonthly injection of platelet rich plasma. The final results ineach patient were evaluated according to the comparison ofpre-and post-operative photos and measurements of circumferencefor the degree of improvement by the patients. Threepopulations including the patient herself, a surgeon not involvedin the procedure and nurse were subjected to standardizedquestionnaire.Results: All patients were treated bilaterally, they knoticedthat the use of fat grafting not only provided a volumetriceffect but also improved the quality of skin. They felt theirskin is thicker, firmer with less wrinkles and pigmentationand less need for moisturizers.Conclusion: Mixing fat containing activated mesenchymalstem cells with platelet rich fibrin matrix gave better longlasting results than traditional fat injection as regarding bothvolume and skin quality.

Approach to Feminization Surgery and Facial Masculinization Surgery: Aesthetic Goals and Principles of Management.

The 1960s and 1970s were an important time for craniofacial surgery because of the work of Paul Tessier and Hugo Obwegeser, both mentored by Sir Harold Gillies, along with many other important monumental minds. During this era, the birth of craniofacial surgery occurred and represented a new discrete specialty within plastic surgery. In the 1980s distraction of the facial skeleton became an indispensable tool in the arsenal of the craniofacial surgeon, based on initial cases in Italy, and rigorous research by McCarthy, Grayson, and others. In more recent times, from 2000 onward, craniofacial surgery has benefitted from the advent and refinement of techniques using computer-aided planning for procedures, spring distraction, as well as the widespread use of fat grafting as part of facial reconstruction. In the last decade, innovations based on the fusion of microsurgical procedures with craniofacial procedures for face allotransplantation and improvements in safety regarding separation of craniopagus infants have been observed. The author thinks it is worth mentioning and conferring praise upon the anesthesia colleagues for improvements in anesthesia which have led to vastly decreased mortality in the infant population undergoing complex procedures.The common theme among these achievements is that they were quickly adopted by the subspecialty community. However, in the hindsight of history, the author thinks it is now understood that during this time another great achievement, long overlooked, occurred in craniofacial surgery. In the 1980s the author's associate and mentor, Douglas Ousterhout, adapted techniques of craniofacial surgery to change the lives of transgender patients. This new and powerful surgery had the potential to change the course of someone's life just as profoundly as the correction of congenital craniofacial anomalies. This quality of life improvement for trans patients undergoing facial feminization has been evaluated and found to be quite significant. However, it was essentially ignored by the specialty community, and the author and his colleagues were slow to adopt this surgery. In this study, the author will give an overview of the procedures required to feminize or masculinize a face. The history of surgery is fascinating, and the author hopes that the origins of facial gender confirmation surgery (facial feminization and masculinization), which may be found in the forward to this journal, are fascinating to the readers as well.

Abdominal Etching: Past and Present.

Abstract Since its inception in the 1980s, liposuction has undergone a tremendous paradigm shift from the simple removal of excess subcutaneous fat to a procedure of extreme sophistication and elegance where we as surgeons are able to mold and shape a patient’s figure. Plastic surgeons have modified this procedure with the overall goal of improving the aesthetic results while focusing on maximizing safety and minimizing complications. These modifications include advanced liposuction technology and techniques, the increasing use of subdermal superficial liposuction, differential liposuction, the advent and introduction of a wide range of cannulas, and the use of fat grafting simultaneously with liposuction for targeted contour and fat repositioning. In this article, the authors discuss in detail the introduction and progression of abdominal etching, a procedure first introduced by the senior author (H.A.M.) in the early 1990s. The authors also present their experience over the past 4 years. In this procedure, the technique of differential liposuction is employed to enhance the detail of abdominal musculature. The literature on abdominal etching is fairly scarce. Thus, the authors hope that this review will not only give the provider a thorough review and understanding of liposuction and its evolution over the years but will also provide an overview of the indications, patient selection, technique, expectations, and complications of abdominal etching as well. Level of Evidence: 4

Autologous Fat Grafting in Cleft Lip and Palate.

Structural fat grafting is a technically simple procedure that has revolutionized the field of plastic surgery, with applications ranging from tissue regeneration to scar modulation to volume restoration. This technique has found applications in the treatment of cleft lip and palate, where it can be used to fill deficient midfacial volume and treat velopharyngeal insufficiency. In this article, the authors summarize the current literature supporting the use of fat grafting in patients with clefts. Evidence as to the safety, efficacy, longevity, and potential complications of the technique are discussed.

The use of fat grafting and platelet-rich plasma for wound healing: A review of the current evidence.

Fat grafting is becoming a common procedure in regenerative medicine because of its high content of growth factors and adipose derived stem cells (ADSCs) and the ease of harvest, safety, and low cost. The high concentration of ADSCs found in fat has the potential to differentiate into a wide range of wound-healing cells including fibroblasts and keratinocytes as well as demonstrating proangiogenic qualities. This suggests that fat could play an important role in wound healing. However retention rates of fat grafts are highly variable due in part to inconsistent vascularisation of the transplanted fat. Furthermore, conditions such as diabetes, which have a high prevalence of chronic wounds, reduce the potency and regenerative potential of ADSCs. Platelet-rich plasma (PRP) is an autologous blood product rich in growth factors, cell adhesion molecules, and cytokines. It has been hypothesised that PRP may have a positive effect on the survival and retention of fat grafts because of improved proliferation and differentiations of ADSCs, reduced inflammation, and improved vascularisation. There is also increasing interest in a possible synergistic effect that PRP may have on the healing potential of fat, although the evidence for this is very limited. In this review, we evaluate the evidence in both in vitro and animal studies on the mechanistic relationship between fat and PRP and how this translates to a benefit in wound healing. We also discuss future directions for both research and clinical practice on how to enhance the regenerative potential of the combination of PRP and fat.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters

BACKGROUND CONTEXT Lumbar discectomy is one of the most common procedures in spine surgery. Variability exists in pre-, intra- and postoperative management strategies. We undertook a survey of Canadian neurosurgeons at two points in time one decade apart (2007 and 2017) to assess these practice patterns. PURPOSE To ascertain and compare practice patterns over time in the surgical management of one-level lumbar discectomies in the Canadian adult population. The results will be compared with the known evidence-based literature. STUDY DESIGN/SETTING Observational, descriptive study – 17 question national survey. OUTCOME MEASURES Questionnaire asking 17 questions regarding the pre-, intra- and postoperative management of one-level lumbar discectomy, that is preoperative antibiotic use, preferred choice of magnification, use of MIS, use of fibrin glue for dural tear, preferred time of discharge and return to work, etc. METHODS One-page questionnaire faxed and/or emailed to Canadian Neurosurgeons with questions relating to their practice of this common spine procedure. Data was analyzed using Chi-square statistics. RESULTS A total of 112 completed surveys were returned in 2007 – 64% response rate and 104 in 2017 – 42% response rate. Statistically significant differences between the two points in time were noted with: more spine fellowship trained 25 (33%) 2017 versus 15 (15%) 2007 (p=.006), use of pre-op MRI 64 (84%) 2017 versus 27 (28%) 2007 (p=.001), use of intramuscular injection 56 (75%) 2017 versus 43 (44%) 2007 (p=.001), more used both microscope and loups 19 (25%) 2017 versus 3 (3%) 2007 (p=.001), more use of tubular retraction 25 (33%) 2017 versus 12 (16%) 2007 (p=.001), greater use of fibrin glue for a dural tear 70 (92%) 2017 versus 75 (77%) 2007 (p=.007), increased rate of same-day discharge 45 (59%) 2017 versus 18 (18%) 2007 (p=.001), a quicker return to work in 2017 in less than 6 weeks (p=.002). No statistical differences were noted with pre-incision localization, preoperative antibiotics, preincision local anesthetic use, use of fat graft or epidural steroids. In either survey, the majority would not operate on a primary complaint of back pain with lumbar discectomy. CONCLUSIONS Our survey has shown significant changes in practice aspects in the management of one-level lumbar disc herniation. These changes include usage of MRI over CT preoperatively, more frequent use of microscope, increasing use of tubular retraction and the tendency toward earlier discharge from hospital and return to work. These results could form the basis for the design of randomized control trials in the evaluation of the best management approach for this common spine procedure.

Percutaneous Autologous Fat Injection Following 2-Layer Flap Lower Blepharoplasty for the Correction of Tear Trough Deformity.

Tear trough deformity has been an area that has received much attention in terms of esthetic improvements. Fat transposition has been commonly used for the treatment of tear trough deformity. As some patients have had minimal improvement by that method, we propose the use of fat grafting combined with open blepharoplasty to complement the sunken area, including some of anterior maxilla region, and evaluate and precisely remove the excessive tissue.Lower blepharoplasty was performed by separating the skin and muscle flap. The excessive or laxed tissue was evaluated during the procedure and resected in each flap. Fat grafting was performed after completing a lower blepharoplasty, to ensure accurate placement on the spot where the surgeon originally intended. Overcorrection is not recommended.No serious complications were reported during a period of 10 years. Only 4 patients required a secondary fat injection.Patients who require structural correction of the lower eyelid area (eg, aggressive herniated fat, excessive skin laxity, or bulky orbicularis oculi muscle) and who need complementary material to fill the lower lid area (eg, deep, wide sunken area or relative exophthalmos) are good candidates for blepharoplasty with a fat grafting procedure.

Use of Fat Grafts for Stabilizing Microvascular Pedicle Geometry in Lower Limb Reconstruction.

Use of Fat Grafts for Stabilizing Microvascular Pedicle Geometry in Lower Limb Reconstruction.

Autologous Fat Grafting in the Treatment of Cleft Lip Volume Asymmetry.

The goal of cleft lip repair is a symmetrical balanced lip with minimal scar. Fat grafting is an established procedure in cosmetic and reconstructive surgery for restoration or correction of contour deformity, volume loss, and improved tissue characteristics. In this study, we evaluated the use of fat grafting in correction of cleft lip volume asymmetry. We performed a retrospective analysis of our series of patients who underwent fat grafting using the Coleman technique for cleft lip volume asymmetry. Sex, age at primary repair, age at fat grafting, perioperative data, and preoperative and postoperative photographs were reviewed. A total of 52 children underwent fat grafting as secondary revision for both unilateral and bilateral cleft lip repair. Fat was hand suctioned from the abdominal or buttock region with a mean yield of 3.0 mL (range, 2.0-5.0 mL). An average total volume of 3.0 mL (range, 2.0-4.5 mL) of fat was injected via an intraoral incision into the philtrum, vermillion, and volume deficiencies in the vertical component of the lip for volume restoration. No complications were noted with fat harvest or with fat grafting. Mean follow-up was 48 months. Postoperative assessment revealed improved volume symmetry in all patients, and all patients or families were pleased with the results. Fat grafting via an intraoral incision is a minimally invasive, safe, and reliable secondary procedure to improve volume asymmetries after cleft lip repairs.

Use of Autologous Fat Grafts for the Endoscopic Reconstruction of Skull Base Defects: Indications, Outcomes, and Complications.

Background The use of abdominal free fat is a traditional surgical method for the repair and reconstruction of the anterior skull base. Our objective is to assess the outcomes associated with the autologous fat graft to endoscopically repair anterior skull base defects at a single tertiary care center. Methods All patients, who underwent endoscopic skull base repair utilizing abdominal free fat from September 2009 to June 2016, were included for retrospective chart review. Evaluated outcome measurements included (1) the successful closure of preoperative and intraoperative cerebrospinal fluid (CSF) leaks and (2) complications at both donor and recipient graft sites during the postoperative periods. Four representative clinical cases have additionally been selected to highlight the common indications for which the fat graft may be effective in skull base reconstruction. Results Of the 27 patients who were identified for inclusion in this review, 25 (92.6%) demonstrated successful repair of preoperative or intraoperative CSF leaks following primary skull base repair. Two patients developed recurrent CSF leaks occurring about 1 week after their primary closures, and a secondary closure rate of 96.3% was achieved with use of fat grafts. Other complications included seroma and hematoma formation at the abdominal donor sites, each occurring in 1 patient. Conclusions The use of autologous fat remains a viable option for grafting material during endoscopic skull base reconstruction. Despite the wide variety of closure techniques in skull base surgery, autologous fat provides safe and easily accessible material to repair CSF leaks.

Treatment of Temporomandibular Joint (TMJ) Reankylosis with Preservation of the TMJ Prosthesis and Use of Fat Graft: A Case Report and Review of the Literature

We report on a case of TMJ reankylosis (heterotopic bone) following total TMJ alloplastic reconstruction in a 40-year-old Black male. The heterotopic bone was excised following removal of the fossa component. The fossa component was re-inserted, and the periarticular tissue was grafted with fat procured from the abdomen. Patient was placed on an aggressive physiotherapy programme which was monitored for a period of 6 months. He returned for review one year later with a mouth opening of 27 mm. We present also a short review of the literature on heterotopic bone formation. This case is of particular interest in that despite the heterotopic bone around it; the prosthesis was preserved after the bone was removed.

Use of Fat Grafts in Facial Reconstruction on the Wounded Soldiers From the First World War (WWI) by Hippolyte Morestin (1869-1919).

During the Great War of 1914 to 1918, spectacular progress was made in the field of facial reconstruction. The sheer number and severity of facial lesions inflicted during the fighting obliged French and German surgeons to take a close interest in the treatment of patients wounded in such a manner. As head surgeon of the fifth division "blessés de la face" at the hospital of Val-de-Grace, Hippolyte Morestin was responsible for one of the largest surgical departments specializing in facial surgery and reconstruction during the war. During his time of service, he developed various surgical techniques such as autoplasties using cartilaginous and adipose grafts to reconstruct tissue defects. This study focuses primarily on the adipose graft techniques and their aesthetic outcome used by Morestin during and in the aftermath of World War I. This is a historical descriptive study. Our research is based on documents available at the museum and archives of the Val-de-Grace Army Health Service (hospital activity reports, pre- and postoperative patient photographs, newspaper clippings, documented accounts of ward nurses, wax anatomy models). Thirty-four clinical cases published by Hippolyte Morestin dealing with facial reconstruction during the World War I were studied. Fat was mainly used to fill craniofacial substance losses after carrying out often complex reconstructions. The surgical technique is well documented and subdivided into 3 succeeding procedures. Most of the time, the grafts were of autologous origin but sometimes heterologous samples were used. Although the primary objective was to increase volume, an improved quality of skin healing and better skin flexibility were observed. The fat thus allowed the filling of substance losses, and its positive effects on scarring were noticed even before the regenerative properties of the stem cells present in body fat were discovered. Hippolyte Morestin can be named one of the pioneers of facial reconstruction. A retroperspective analysis of his work with adipose grafts proves interesting because even though not being the first to apply this technique, he contributed, by means of experimentation and reproduction to proving it an innovative and useful method in facial reconstruction. It was not until the 1990s that adipose grafts were again applied under the name of lipostructure. Nowadays, they are commonly used in cosmetic and restorative surgery.

Analysis of Fat Grafts for Stabilizing Microvascular Pedicle Geometry in Head and Neck Reconstruction

Background Even after careful microanastomosis, microsurgeons sometimes encounter unexpected twisting, kinking, and destabilizing mechanical forces. In these cases, a small fat graft is a useful technique for stabilizing the pedicle geometry in free flap transfer. However, few reports have provided the details with an analysis of fat graft use. The use of fat grafts for free flap transfer in head and neck reconstruction was reviewed. Materials and Methods This was a retrospective review of 157 patients (116 men, 41 women; average ± SD age: 64 ± 13.1 years) who had undergone head and neck reconstruction with free flap transfer between 2010 and 2016. We used a fat graft to stabilize pedicle geometry to prevent kinking and other problems. Postoperative thrombosis formation and the use of a fat graft at the pedicle depending on recipient vessel selection and reconstructed site were examined. Results In 23 patients (14.6%), fat grafting was performed to correct pedicle geometry. A fat graft was used at the arterial anastomosis in 13 patients and at the venous anastomosis in 10. There were no significant differences in postoperative thrombosis formation depending on the use of a fat graft. However, fat grafts were more likely to be performed with the superior thyroid artery as a recipient artery and in tongue and/or oral cavity reconstruction. Conclusion A fat graft is a reliable and easy procedure to correct pedicle geometry. However, reconstructive surgeons should consider the use of a fat graft based on the selection of the recipient vessels and the recipient site.

Protocol for a systematic review of the efficacy of fat grafting and platelet-rich plasma for wound healing

BackgroundThe use of fat grafting as a reconstructive surgical option is becoming much more common. Adipose-derived stem cells found in fat grafts are believed to facilitate wound healing via differentiation into fibroblasts and keratinocytes and the release of pro-healing growth factors. Several small studies have shown a positive effect of fat grafting in healing of wounds of a variety of aetiologies. When fat is combined with autologous platelet-rich plasma (PRP), there may be enhanced healing effects. This may be due to the pro-angiogenic and anti-inflammatory effects of PRP. We aim to synthesise the current evidence on combination fat grafting and PRP for wound healing to establish the efficacy of this technique.Methods/designWe will conduct a comprehensive literature search in the MEDLINE, EMBASE, CENTRAL, Science Citation Index, and Google Scholar databases (up to July 2017) to identify studies on fat grafting and PRP for wound healing. All primary studies and systematic reviews of these studies will be included, except case reports and case series with fewer than three patients, to evaluate the outcome of fat grafting and PRP on wound healing either on its own or when compared to other studies. Primary outcome measures are expected to be the proportion of total wounds healed at 12 weeks and the average wound healing time (time for 100% re-epithelialisation). Expected secondary outcome measures are the proportion of wounds achieving 50% wound healing, the type of wound benefitting most from fat grafting, economic evaluation, health-related quality of life, and adverse events. Subgroup analysis will be performed for the proportions of wounds healed based on wound aetiology.DiscussionThis review will provide robust evidence of the efficacy of fat grafting and PRP for wound healing. This is an emerging technique, and this review is expected to guide clinical practice and ongoing research aimed at improving wound care.Systematic review registrationPROSPERO CRD42016049881

Autologous fat grafting in keloids and hypertrophic scars: a review.

Keloid and hypertrophic scars are unique human dermal fibroproliferative disorders of the injured skin and are associated with pain, itch and can cause functional limitations. A number of genetic, systemic and local factors have been identified in the formation of keloids and hypertrophic scars. Studies have shown that adipose-derived stem cells have angiogenic and antiapoptotic properties which has effects on wound healing, soft-tissue restoration and scar remodelling, and thus may have a role in managing keloid scaring. However, this role is not well described in the literature. A systemic review of available literature was thus undertaken, regarding the use of fat grafting in treatment of keloids and hypertrophic scarring. In total, 858 articles were identified, with ten studies ultimately fulfilling inclusion criteria. There were no studies specifically isolating the keloids and hypertrophic group of patients, and thus quantitative data were completely lacking from the literature. There were, however, individual cases described, and qualitatively encouraging clinical results were reported for the use of fat grafting on keloids and hypertrophic scars. Combined with the current theoretical and immunohistochemical understanding through other laboratory and animal studies, fat grafting may play a role in the treatment of keloids and hypertrophic scaring; however, specific evidence is currently lacking. The role for further research is clear.

Autologous Fat Grafting for Pedal Fat Pad Atrophy: A Prospective Randomized Clinical Trial.

Pedal fat pad atrophy is associated with pain, decreased tissue thickness, and increased foot pressures. To date, no objective studies investigating the use of fat grafting to the forefoot have been performed. The authors hypothesize that pedal fat grafting can reduce pain, increase tissue thickness, and decrease pedal pressures. A prospective randomized study was performed to assess tissue thickness, pain, and foot pressures. Group 1 underwent fat grafting immediately with 1-year follow-up, and group 2 underwent conservative management for 1 year. Thirteen patients (two men and 11 women) constituted group 1 and 12 patients (four men and eight women) constituted group 2. Ten patients in group 1 underwent bilateral injections with a mean volume of 4.8 cc per foot. Mean follow-up time was 11.1 ± 5.4 months for group 1 and 13.8 ± 4.2 months for group 2. At 1 year, group 1 demonstrated improved foot function (p = 0.022), pain (p = 0.022), and work/leisure activities (p = 0.021). Group 1 had no change in tissue thickness, whereas in group 2, the right third metatarsal tissue thickness decreased significantly (p = 0.036). Foot pressures in group 1 did not improve; however, group 2 had a significant increase in left foot pressure (p = 0.011). When comparing the groups at 1 year, group 2 had significantly higher foot pressures and forces than group 1 (p < 0.05). Pedal fat grafting significantly improves pain and disability outcomes, and prevents against worsening foot pressures. Future analysis will reveal whether fat grafting has lasting efficacy. Therapeutic, II.

The Effect of Lipoaspirates on Human Keratinocytes.

One increasingly important trend in plastic, reconstructive, and aesthetic surgery is the use of fat grafts to improve cutaneous wound healing. In clinical practice, lipoaspirates (adipose tissue harvested by liposuction) are re-injected in a procedure called lipofilling. Previous studies, however, mainly evaluated the regenerative effect of isolated adipocytes, adipose-derived stem cells, and excised en bloc adipose tissue on keratinocytes, whereas no study to date has examined the effect of lipoaspirates. The authors aimed to investigate differences in the regenerative property of en bloc adipose tissue and lipoaspirates on keratinocytes. Human keratinocytes, lipoaspirates, and en bloc adipose tissue from 36 healthy donors were isolated. In vitro proliferation, differentiation, migration, stratification, and wound healing of keratinocyte monolayers were measured. Furthermore, secreted levels of VEGF, bFGF, IGF-1, MMP-9, and MIF were detected by ELISA. Migration, proliferation, and wound healing of keratinocytes were increased by lipoaspirates. Interestingly, the effect of lipoaspirates on keratinocyte proliferation was significantly higher than by en bloc adipose tissue after 5 days. The differentiation of keratinocytes was equally attenuated by lipoaspirates and en bloc adipose tissue. Stratification of keratinocyte layers was enhanced by lipoaspirates and en bloc fat when compared to controls. Lipoaspirates secrete higher levels of bFGF, whereas higher levels of VEGF and IGF-1 are released by en bloc adipose tissue. We show that lipoaspirates and en bloc adipose tissue have a regenerative effect on keratinocytes. One reason for the higher effect of lipoaspirates on keratinocyte proliferation may be the secretion of different cytokines.