An Integrated Approach for Increasing the Survival of Autologous Fat Grafts in the Treatment of Contour Defects

Abstract

Autologous fat grafting as a technique to correct soft-tissue defects is a controversial subject. The high percentage of fat resorption and the resulting need for additional grafting considerably reduce the value of this method. The purpose of this study was to evaluate the clinical application of tissue-culturing methodology in the handling of the lipocyte aspirate in an endeavor to improve the survival rate and therefore the take of the grafted lipocytes. The method consists of syringe aspiration of the lipocytes from the donor site, isolation of intact lipocytes by gentle centrifugation, suspension of the aspirate in an enriched cell culture medium, and injection of the cell suspension into preformed subdermal tunnels. A number of media were tested and shown to prolong the survival of lipocytes ex vivo using fluorescent acridine orange stain. Implementing the integrated cell culture techniques increased the lipocytes' viability, as indicated in clinical evaluation in which the amount of graft take ranged between 50 and 90 percent. The results of 15 patients with varied types of cases who were operated on using this new methodology show that the tissue defect was filled and remained so in postoperative follow-ups of 6 to 24 months. A three-dimensional CAT scan-aided evaluation method was developed and used in one of four case histories presented herein.

Use of dermal-fat grafts in the post-oncological reconstructive surgery of atrophies in the zygomatic region: clinical evaluations in the patients undergone to previous radiation therapy

“…The treatment of tissue loss with grafting of autologous adipose tissue in the aesthetic areas is not a widely used technique in plastic and reconstructive surgery; [1,2] as a matter of fact, general literature reports conflicting studies on the use of this procedure for tissue replacement [8-18]. …”

“…However, other studies have achieved good results with grafting of autologous adipose tissue in areas previously exposed to radiation therapy, although they reported that resorption was slightly superior to normal tissues [1]. In order to reduce the aesthetic impact resulting from tissue resorption, it is advisable to plan a 20–50% hypercorrection of the grafted tissue [7].…”

“…The orbit has a relatively high fat content, usually in the periorbital region, and is a richly vascularized area; experimental studies have shown how grafting of adipose tissue should be performed where it is particularly present under physiological conditions [1,2,8,12,13]. Besides, it was also demonstrated that graft survival is higher in case of muscle placement [14-21].…”

“…However, some authors have reported unpredictable results about both the resorption rate of adipose tissue grafts and the quantification of the consequent surgically increased volume loss [1,2]. …”

“…Besides, many authors have studied the behavior of adipose grafts in the areas treated with radiation therapy; these studies agree in considering these areas as being unsuitable for grafting of autologous adipose tissue [1,2]. …”