Craniofacial Microsomia Soft-Tissue Reconstruction Comparison: Inframammary Extended Circumflex Scapular Flap versus Serial Fat Grafting:

Fat grafts supplemented with adipose-derived stromal cells in the rehabilitation of patients with craniofacial microsomia

BACKGROUND

Although first reports of the clinical use of adipose-derived stromal cells suggest that this approach may be feasible and effective for soft-tissue augmentation, there is a lack of randomized, controlled clinical trials in the literature. Thus, this study aimed to investigate whether a faster protocol for isolation of adipose-derived stromal cells and their use in combination with fat tissue improve the long-term retention of the grafts in patients with craniofacial microsomia.

METHODS

Patients with craniofacial microsomia (n = 14) were grafted either with supplementation of adipose-derived stromal cells (experimental group) or without supplementation of adipose-derived stromal cells (control group). The number of viable cells isolated before and after the supplementation of the grafts was calculated, and these cells were examined for mesenchymal cell surface markers using flow cytometry. Computed tomography was performed to assess both hemifaces preoperatively and at 6 months postoperatively.

RESULTS

The average number of viable cells isolated before and after the supplementation of the grafts was 5.6 × 10 and 9.9 × 10 cells/ml of fat tissue (p = 0.015). Flow cytometric analysis revealed that the adipose-derived stromal cells were positive for mesenchymal cell markers (>95 percent for CD73 and CD105). Surviving fat volume at 6 months was 88 percent for the experimental group and 54 percent for the control group (p = 0.003).

CONCLUSION

These results suggest that this strategy for isolation and supplementation of adipose-derived stromal cells is effective, safe, and superior to conventional lipoinjection for facial recontouring in patients with craniofacial microsomia.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, II.

Autologous microtia reconstruction combined with ancillary procedures: a comprehensive reconstructive approach

INTRODUCTION

Autologous microtia reconstruction is generally performed in two stages. The second stage presents a unique opportunity to carry out other complementary procedures. The present study describes our approach to microtia reconstruction, wherein the second stage of reconstruction is combined with final refinements to the ear construct and/or additional procedures to enhance facial contour and symmetry.

METHODS

Retrospective analysis of patients who underwent two-stage microtia reconstruction by a single surgeon (NWB) was conducted in order to ascertain those that had ancillary procedures at the time of the second stage. Patient and operative details were collected.

RESULTS

Thirty-four patients (male, 15, median age and age range at second stage, 11 and 10-18 years, respectively) who had complementary procedures executed during the second stage of auricular reconstruction were identified. Collectively, these included centralizing genioplasty (n = 1), fat transfer (n = 22), ear piercing (n = 7), and contralateral prominauris correction (n = 7). Six patients had correction for unilateral isolated microtia and in the remaining 28 patients, auricular reconstruction for microtia associated with a named syndrome. All patients reported a high rate of satisfaction with the result achieved and the majority (85%) reported no perceived need for additional surgical refinements to the ear or procedure(s) to achieve further facial symmetry. No peri- or post-operative complications were noted.

CONCLUSION

Combining the final stage of autologous microtia reconstruction with other ancillary procedures affords a superior aesthetic outcome and decreased patient morbidity.

The effect of hyaluronan hydrogel on fat graft survival

BACKGROUND

Autologous fat transplantation is a common technique for soft tissue augmentation in aesthetic and reconstructive surgery; however, the degree of fat graft take can be unpredictable. Hyaluronan has been shown to be a promising cell carrier in adipose tissue engineering.

OBJECTIVES

The authors investigate the effect of a hyaluronan hydrogel on fat graft survival, angiogenesis, and volume maintenance in a rat model.

METHODS

Fat was harvested from the groins of 27 rats, processed, and injected beneath the animals' dorsums to form 2 grafts: 1 containing fat alone and 1 containing fat and hyaluronan hydrogel in a 1:1 mix (fat-HA). The grafts were scanned in vivo under high-resolution computed tomography at baseline and prior to euthanasia at 4, 12, and 20 weeks to measure total fat-HA graft volume as well as the volume of the fat component alone. Histological studies were performed after sacrifice to evaluate fat necrosis and blood vessel density.

RESULTS

All grafts were clinically viable. Overall, fat necrosis was significantly reduced in the fat-HA grafts compared with the grafts containing fat alone (P < .001). This difference was most profound at 4 weeks (P = .008) but did not reach statistical significance at 12 and 20 weeks. At 12 weeks, blood vessel density in the fat-HA grafts was significantly greater than in the grafts containing fat alone (P = .016), but this did not reach statistical significance at 4 or 20 weeks. At 20 weeks, the fat component of the fat-HA graft had significantly less volume loss than the fat-alone graft (P = .008).

CONCLUSIONS

When mixed with fat, hyaluronan hydrogel can improve early fat graft survival and may enhance vascularity and prolong volume maintenance.

Fat grafting versus adipose-derived stem cell therapy: distinguishing indications, techniques, and outcomes

With adipose-derived stem cells (ASCs) at the forefront of research and potential clinical applications, it is important that clinicians be able to distinguish them from the fat grafting currently used clinically and to understand how the two approaches relate to one another. At times, there has been confusion in clinically considering the two therapies to be the same. This report is aimed at distinguishing clearly between fat grafting and ASC therapy with regard to the indications, harvesting, processing, application techniques, outcomes, and complications. Findings have shown that autologous fat transfer, a widely used procedure for soft tissue augmentation, is beneficial for reconstructive and cosmetic procedures used to treat patients with volume loss due to disease, trauma, congenital defects, or the natural process of aging. On the other hand, ASCs have been identified as an ideal source of cells for regenerative medicine, with the potential to serve as soft tissue therapy for irradiated, scarred, or chronic wounds. Recent advances in tissue engineering suggest that the supplementation of fat grafts with ASCs isolated in the stromal vascular fraction may increase the longevity and quality of the fat graft. Research suggests that ASC supplementation may be a great clinical tool in the future, but more data should be acquired before clinical applications.

Free dermal fat graft for restoration of soft tissue defects in maxillofacial surgery

Various local flaps have been used for reconstruction of developmental and post surgical soft tissue defects of maxillofacial region. They include nasolabial flap, palatal pedicled flap, buccal fat pad, temporalis muscle and fascia flap. An ideal flap for all indications is yet to be found. Our experience with free dermal fat graft in the correction of deformities associated with Parry Romberg syndrome and oral submucous fibrosis is presented.