Autogenous fat grafting for mild-to-moderate postoperative temporal hollowing after decompressive craniectomy: One-year follow-up

Abstract

BackgroundTemporal hollowing is inevitable after decompressive craniectomy. This complication affects self-perception and quality of life, and various techniques and materials have therefore been used to restore patients’ confidence. Autologous fat grafting in postoperative scar tissue has been considered challenging because of the hostile tissue environment. However, in this study, we demonstrate that autologous fat grafting can be a simple and safe treatment of choice, even for postoperative depressed temporal scar tissue.MethodsAutologous fat grafting was performed in 13 patients from 2011 to 2016. Fat was harvested according to Coleman’s strategy, using a tumescent technique. Patient-reported outcomes were collected preoperatively and at 1-month and 1-year follow-ups. Photographs were taken at each visit.ResultsThe thighs were the donor site in all cases for the first procedure. The median final volume of harvested fat was 29.4 mL (interquartile range [IQR], 24.0–32.8 mL). The median final volume of fat transferred into the temporal area was 4.9 mL on the right side (IQR, 2.5–7.1 mL) and 4.6 mL on the left side (IQR, 3.7–5.9 mL). There were no major complications. The patient-reported outcomes showed significantly improved self-perceptions at 1 month and at 1 year.ConclusionsDespite concerns about the survival of grafted fat in scar tissue, we advise autologous fat grafting for patients with temporal hollowing resulting from a previous craniectomy.

Temporal hollowing causes, classifications, and treatment options: A systematic review

“…Studies of Baek et al (2009) 13 and McNichols et al (2012) 14 met most of the inclusion criteria, but their full texts were unavailable. The majority (67%) of studies included in our systematic review were original articles, 3,10,15‐27 25% were case reports or series, 28‐33 one was a technical note, 34 and one was a featured operative technique 35 . The countries of origin included the United States (25%), China (25%), South Korea (21%), and Norway (8%), and one study each from the United Kingdom, Sweden, Japan, Canada, and Thailand.…”

Cranioplasty and temporal hollowing correction with a three-dimensional printed bioresorbable mesh and double vertical suture anchor muscle sling: a case report

“…Temporal hollowing is a common complication of craniectomy that worsens aesthetic outcomes. Multiple treatment plans have been implemented, including a 3D implant to make up for the loss in tissue, repositioning of the temporalis muscle, and microfat graft [ 12 , 13 ]. Soft tissue fixation to bone itself is a basic technique especially in orthopedic surgeries, and suture anchors have been developed for this purpose [ 14 ].…”

Correction of Temporal Hollowing Deformity Using Serratus Anterior Muscle Flap

“…Autologous fat grafts and filler injections are most commonly used for correction of THD [ 21 , 22 ]; they are technically simple, have minimal or no donor site morbidity, and can be performed under local anesthesia in the outpatient clinic. However, they show unpredictable resorption, as the temporal region has decreased vascularity due to previous surgical procedures; therefore, repeated procedures may be required [ 6 , 23 ].…”