A method of harvesting fat with intact cells using a veterinary needle and a fine needle aspiration device is described. Viable fat cells are obtained in large amounts. A large subcutaneous postradiation thigh defect was reconstructed with harvested fat placed subcutaneously in various sessions. A good, but not perfect, reconstruction was obtained. This case indicates that viable fat cells can be transplanted and can survive even in the adverse environment of a postradiation defect.
Over a four year period, thirteen patients over the age of 60 (mean 69 years) underwent reconstruction of lower extremity defects with free tissue transfers. Ten latissimus dorsi, one tensor facia lata, and two rectus abdominus free flaps were used. Despite significant risk factors which included previous tobacco use, hypertension, diabetes mellitus, and angiographic vessel abnormalities, ten of thirteen cases had successful outcomes. There was one acute flap failure secondary to arterial thrombosis. Four flaps had delayed healing, with one patient eventually requiring amputation secondary to persistent pain and wound drainage. This experience demonstrates that free flap reconstruction of lower extremity defects in the elderly patient is a reasonable alternative to amputation when other options are limited.
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