A Classification of Clinical Fat Grafting

Vecchio, Daniel Del; Rohrich, Rod J.

doi:10.1097/prs.0b013e31825dbf8a

Cited by 108 publications

(28 citation statements)

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“…39,40 Multiple studies report negative correlation between fat graft particle width and retention percentage. 8,15,25,41 Long-term fat graft retention requires small volumes of fat to be diffusely distributed into a well-vascularized recipient site through well-separated tunnels. 1,4,8,41–43 If the microinjections are not diffusely distributed in the recipient site, they will coalesce, forming particles too wide to survive.…”

Section: Resultsmentioning

confidence: 99%

“…Fat grafting can be considered in 4 phases: harvesting, processing, reinjecting, and managing the recipient site. 15 To determine the optimal surgical methods for harvesting, processing, and reinjecting, Gir et al 6 completed an extensive literature review. Their results show the variability of current surgical techniques with current literature only supporting general principles and not any specific technique.…”

mentioning

confidence: 99%

“…Attempts to improve graft retention have largely been based on the “cell survival theory,” which states that long-term graft volume consists primarily of grafted adipocytes that have survived the entire procedure. 15 This theory has generally been accepted 18,19 and has directed most efforts to maintaining adipocytes viability through improved harvesting, processing, and reinjecting techniques. 19–21 Studies supporting the cell survival theory claim that the “viable zone” (40% adipocyte survival) reaches as far down as 0.2 cm from the periphery of the grafted tissue.…”

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confidence: 99%

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Diffusion and Perfusion

Khouri¹,

Khouri²,

Lujan-Hernandez

et al. 2014

Plastic and Reconstructive Surgery Global Open

137

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Background:Fat grafting is now widely used in plastic surgery. Long-term graft retention can be unpredictable. Fat grafts must obtain oxygen via diffusion until neovascularization occurs, so oxygen delivery may be the overarching variable in graft retention.Methods:We studied the peer-reviewed literature to determine which aspects of a fat graft and the microenvironment surrounding a fat graft affect oxygen delivery and created 3 models relating distinct variables to oxygen delivery and graft retention.Results:Our models confirm that thin microribbons of fat maximize oxygen transport when injected into a large, compliant, well-vascularized recipient site. The “Microribbon Model” predicts that, in a typical human, fat injections larger than 0.16 cm in radius will have a region of central necrosis. Our “Fluid Accommodation Model” predicts that once grafted tissues approach a critical interstitial fluid pressure of 9 mm Hg, any additional fluid will drastically increase interstitial fluid pressure and reduce capillary perfusion and oxygen delivery. Our “External Volume Expansion Effect Model” predicts the effect of vascular changes induced by preoperative external volume expansion that allow for greater volumes of fat to be successfully grafted.Conclusions:These models confirm that initial fat grafting survival is limited by oxygen diffusion. Preoperative expansion increases oxygen diffusion capacity allowing for additional graft retention. These models provide a scientific framework for testing the current fat grafting theories.

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Diffusion and Perfusion

Khouri¹,

Khouri²,

Lujan-Hernandez

et al. 2014

Plastic and Reconstructive Surgery Global Open

137

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“…Del Vecchio and Rohrich find that after sedimentation and discarding unwanted crystalloid, there is still 20% to 30% of additional crystalloid in the fat. Ignoring the step of condensation reduces long-term volume maintenance, there is a “percentage yield” by 20% to 30% before the procedure is finished than condensation method 23. Thus, through the process of gauze filtering, cool saline washing, and cotton pad concentrating, the desired pure semisolid fat was achieved for further injection (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Time efficiency (optimization) versus effectiveness of technique (maximization) is a critical workflow concept in fat transplantation 23. The method we used is associated with a Chinese traditional philosophy—the “Golden mean,” which means we must achieve the best balance between minimal injury and less ischemic time of the fat before it is transplanted into the breast.…”

Section: Discussionmentioning

confidence: 99%

Breast Augmentation With Autologous Fat Injection

Chen

Cheng

2014

Annals of Plastic Surgery

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IntroductionAutologous fat transplantation has attracted great interest in breast augmentation for cosmetic purpose. In the present study, we reported our experience in fat grafting in breast in 105 cases, and some detailed procedure concerning efficacy and safety of grafting was evaluated.MethodsFat was harvested using 20-mL syringe attached to a 3-hole blunt cannula in a diameter not beyond 3 mm. After washing with cool normal saline to remove blood, the fat was managed with open method using cotton towel as a platform for concentration fat tissue and separating them from fluids, oil, and debris. A 14-gauge, 1-hole blunt cannula was used to place the fat through 3-mm incision on inframammary fold. The fat was infiltrated into the breast from deep to superficial subcutaneous plane.ResultsBetween July 2002 and August 2010, 105 patients have undergone this procedure. The age distribution of the patients ranged from 18 to 45 years, with a mean of 31.3 years. Grafted fat volume has ranged from 120 to 250 mL (average, 205 mL) per breast per session. All women had a significant improvement in their breast size and shape postoperatively, and the breasts were soft and natural in appearance.ConclusionsLiposuction and autologous fat transplantation is a suitable approach for augmentation mammaplasty.

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Injectable Mussel‐Inspired Immobilization of Platelet‐Rich Plasma on Microspheres Bridging Adipose Micro‐Tissues to Improve Autologous Fat Transplantation by Controlling Release of PDGF and VEGF, Angiogenesis, Stem Cell Migration

Zhou

Chang

et al. 2017

Adv Healthcare Materials

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Platelets-rich plasma (PRP) can produce growth factors (GFs) to improve angiogenesis. However, direct injection of PRP does not lead to highly localized GFs. The current study employs a mussel-inspired polydopamine to immobilize PRP on gelatin microspheres (GMs) with the purpose of bridging adipose micro-tissues to help implanted fat survive (GM-pDA-PRP). Enhanced PRP adhesion leads to a prolonged and localized production of GFs, which is verified by platelet counting and by ELISA of vascular endothelial growth factors (VEGFs) and of platelet derived growth factors (PDGFs). The GM-pDA-PRP "hatches" a microenvironment for the proliferation of adipose-derived stem cells. After the adipose micro-tissue has bridged with GM-pDA-PRP after 16 weeks, triple-fluorescence staining reveals that the mature adipocytes, blood vessels, and capillaries are arranged like in normal adipose tissue. The survival fat increases significantly compared to that in control, PRP, and GM-PRP groups (84.8 ± 11.4% versus 47.8 ± 8.9%, 56.9 ± 9.7%, and 60.2 ± 10.5%, respectively). Both histological assessments and CD31 immunofluorescence indicate that the improvement of angiogenesis in GM-pDA-PRP is higher than in the fat graft group (6.4-fold in quantitative CD31 positive cells). The CD34 positive cells in the GM-pDA-PRP group are around 3.5-fold the amount in the fat graft group, which suggests that more stem cells migrate to the implant area. Cell proliferation staining shows that the number of Ki67 positive cells is around five times as high as that in the fat graft group.

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A Classification of Clinical Fat Grafting

Cited by 108 publications

References 0 publications

Diffusion and Perfusion

Diffusion and Perfusion

Breast Augmentation With Autologous Fat Injection

Injectable Mussel‐Inspired Immobilization of Platelet‐Rich Plasma on Microspheres Bridging Adipose Micro‐Tissues to Improve Autologous Fat Transplantation by Controlling Release of PDGF and VEGF, Angiogenesis, Stem Cell Migration

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