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

Correction of Post-Surgical Temporal Hollowing with Adipo-Dermal Grafts: A Case Series

Background: Surgical dissection and partial detachment of the temporalis muscle during neurosurgical procedures might result in a temporal depression known as "temporal hollowing". Reconstructive procedures to correct this condition include the implantation of synthetic materials (e.g., hydroxyapatite, methacrylate or polyethylene), injection of autologous fat or fillers as well as the use of flaps (e.g., temporo-parietal local flap and latissimus dorsi free flap). However, none of these techniques proved to be an ideal option due to a high complication rate or need for invasive and complex surgery. Adipo-dermal grafts are autologous; the resorption rate seems to be limited and the complexity of the procedure is minor. Moreover, autologous fat grafting can be performed to enhance the final outcome by correcting residual contour deformities. Methods: In this series of five patients, an institutional experience is presented using multi-layered adipo-dermal grafts harvested from the supra-pubic area for the restoration of volume and contour in post-surgical temporal hollowing. During the last follow-up, patients were asked to express their satisfaction, which was assessed by a survey. Results: this approach demonstrates a marked improvement in temporal hollowing associated with a low complication rate and good patient satisfaction. Conclusions: the aim of this consecutive case series is to emphasize the effectiveness of this surgical technique as one of the options to address temporal hollowing.

Abdominal Dermal Fat Graft Versus Nasolabial Flap in Oral Submucous Fibrosis: A Randomized Clinical Trial

Introduction

A prospective study was conducted to find out an effective alternative in the form of non-vascularized abdominal dermal fat graft (ADFG) and to compare its efficacy with the vascularised nasolabial flap (NLF) for the treatment of oral submucous fibrosis (OSMF).

Method

Comparative study comprising of 30 patients with Grade 3 and 4A OSMF, randomly divided into 2 groups: Group A (ADFG) and Group B (NLF). They were evaluated for mouth opening (MO), graft uptake, time taken for mucosalization, pain, intercommissure distance (ICD), scar, duration of surgery (DOS), patient satisfaction and thickness of masseter muscle on ultrasonography.

Findings

At 6 months, MO improved by 22.4 and 36.2 mm in Group A and Group B, respectively. There was statistically significant difference (p < 0.05) seen for the values between the groups for all the parameters except for ICD and VAS score, which was statistically insignificant (p > 0.05). Intraoral hair growth, facial scar, orocutaneous fistula and commissure tear was seen in Group B. Complete necrosis of graft followed by recurrence was seen in three cases in Group A.

Conclusion

NLF holds better as compared to ADFG in the management of OSMF. However, the cornerstone of success remains habit cessation and aggressive physiotherapy. The limitations of the study are small sample size and short duration of follow-up.

Autologous Free Dermal-Fat-Fascial Graft for Parotidectomy Defects: A Case Series

Background:

Frey’s syndrome and facial asymmetry from loss of parotid tissue are long-term sequelae of parotid surgeries causing significant morbidity. Various techniques have been used to fill the parotidectomy defect, preserve facial contour symmetry, and prevent Frey’s syndrome. Free dermal-fat-fascial graft (DFFG) is one such technique; however, its use is largely undocumented in the literature. In this case series, we investigate the efficacy of free DFFG in reconstructing parotidectomy defects at 2 tertiary care centers.

Materials and methods:

Medical records of 54 patients who underwent primary parotidectomy and immediate reconstruction with autologous abdominal free DFFG by 2 surgeons in George Washington University Hospital and McGill University Health Centre between 2007 and 2019 were collected prospectively. Patients responded to 2 questionnaires addressing postoperative outcomes.

Results:

Fifty-four patients were included; 32 superficial parotidectomies and 22 total parotidectomies were performed for 39 benign and 15 malignant tumors. Thirty-seven patients could be reached. Out of 37 patients who responded to the first questionnaire, 59% (22) reported complete facial symmetry, 27% (10) reported mild hollowness, and 14% (5) reported mild fullness. None declared noticeable hollowness or fullness. While 81% (30) did not experience Frey’s syndrome, 5.4% (2) experienced mild symptoms without disability, and 13.5% (5) experienced debilitating symptoms. Out of 37 patients, 8 patients responded to a second questionnaire addressing the outcome of the abdominal graft donor site. In regard to the donor site, 87.5% (7) were satisfied or very satisfied from its cosmetic appearance, 75% (6) were not bothered by its cosmetic appearance, and 87.5% (7) had no discomfort at the graft donor site. Patients did not report any other symptom at the graft donor site.

Conclusion:

In this large series of total parotidectomies including malignant pathologies, autologous abdominal free DFFG effectively prevented Frey’s syndrome and preserved facial cosmesis in most patients.

The bone-mimicking effect of calcium phosphate on composite chitosan scaffolds in maxillofacial bone tissue engineering

This research explored a new trend in biomaterials science. The bone-mimicking effect of calcium phosphate on chitosan composite scaffolds was evaluated. Chitosan with 2% calcium phosphate was found to have suitable bone-mimicking performance for maxillofacial bone tissue engineering.

Free Dermal Fat Graft for Reconstruction of Soft Tissue Defects in the Maxillofacial Region

Study Design

Facial contour deformities are a very challenging issue for aesthetic and reconstructive surgeons. Free dermal fat graft is a composite graft used for the reconstruction of soft tissue defects in the maxillofacial region. The free dermal fat graft is easily adapted and contoured intraoperatively and provides a soft, natural, and favorable appearance after augmentation of the soft tissue defects.

Objective

To assess the use of free dermal fat graft for reconstruction of soft tissue defects in the maxillofacial region in regard to graft success, percentage of overcorrection, any associated complications, and cone beam computed tomography scan linear measurements for defect's depth.

Methods

This is a prospective study that included a patients were grafted with free dermal fat graft for correction of facial soft tissue defects from November 2017 to July 2019. All patients possess a depression defect and facial asymmetry due to congenital facial deformities, post-traumatic deformities, and post-ablative surgical deformities.

Results

Eleven patients (8 males and 3 females) with a mean age of 33.7 years were enrolled in this study. Five regions in the maxillofacial area were grafted in 11 patients. The mean of the postoperative follow-up was 6 months. The percentage of graft overcorrection was 15%. The mean for graft survival was 94.4% with no serious complications reported.

Conclusions

The autologous FDFG is a versatile and less invasive method in the reconstruction of facial soft tissue defects with a very good survival rate.

Dermal-Fat Graft for Facial Contouring in Patients With Craniofacial Microsomia

Craniofacial microsomia (CFM) is a variable craniofacial malformation, related to the development of the structures originated from the first and second brachial arches, affecting skeletal tissue, soft tissue, and neuromuscular components. In the situation of subcutaneous tissue and chewing muscles hypoplasia, free tissue transfer is a treatment option. Dermal-fat graft allows easy modeling during surgery, volumetric gain and improvement of asymmetry. The aim of this study was to evaluate the facial contour and the percentage of symmetry after the use of dermal-fat graft in patients with CFM, who had already submitted to osteotomies, attended at the Associate Center for Cleft Lip and Palate (CAIF) during 2001 to 2018. For analysis, the authors selected 17 patients who fulfilled the above prerequisites. The symmetry study was done by the analysis of preoperative and postoperative photographs in the Image J software. Two standard points were used: nasal base and upper lip limit. On the nasal base, the preoperative analysis showed a hypoplastic side with a median of 93.00% of the normal side size, rising to 97.78% in the postoperative period. On the upper lip limit, the preoperative analysis showed a median of 87.80% and, in the postoperative period, 98.15%. Analysis of the interaction between the operative moments and the modified Pruzansky classification showed that there were no significant differences between grades. Long-term evaluation demonstrated that the use of a dermal-fat graft for correction of facial symmetry was effective and close to 100%, regardless of the degree of hypoplasia of the patient.

Corrective Strategies for a Complex Deformity Caused by "European-Style Double Eyelid" Blepharoplasty in Asians

BACKGROUND

"European-style double eyelid" blepharoplasty often leads to a complex deformity, which includes one or more of the following features: a high fold, upper eyelid depression, multiple folds, an obvious scar, blepharoptosis, and lower flap tumidness. However, there is still a lack of comprehensive research on evaluation and treatment strategies for this complex deformity.

METHODS

During a 6-year period, 65 patients (106 eyes) with a high fold and upper eyelid depression underwent corrective blepharoplasty. The authors classified this complex deformity as mild, moderate, or severe based on the extent of adhesion and tissue insufficiency, and we performed preaponeurotic fat flap transfer in 47 eyes (44.3%), free fat graft in 35 eyes (33%), and free dermis-fat graft in 24 eyes (22.6%), respectively.

RESULTS

The outcomes in 87 eyelids were judged as excellent; and the grading was excellent in 41 eyes (87.2%) that underwent preaponeurotic fat flap transfer, 30 eyes (85.7%) that received a free fat graft, and 16 eyes (66.7%) that received a free dermis-fat graft. The outcomes in only 3 eyes (2.8%) were evaluated as unsatisfactory.

CONCLUSIONS

The fundamental reasons behind this deformity were adhesion and tissue insufficiency above the supratarsal crease. The purpose of correction was to reconstruct the gliding system and restore the volume. The authors performed preaponeurotic fat flap transfer, free fat graft, and free dermis-fat graft and achieved satisfactory results. Great improvement in ptosis was achieved by releasing the adhesion and lowering the fold in patients with normal levator muscle function.

LEVEL OF EVIDENCE IV

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Evaluation of Use of Adipose Cells in Various Procedures of Plastic Surgery and its Volumetric Quantification using High Resolution Ultrasound

INTRODUCTION

Autologous fat transfer is based on one of the principles of plastic surgery, replace like with like. It is used in wide variety of aesthetic procedures such as lip, facial augmentation and reconstructive procedures such as involutional disorders, post traumatic defects etc.

AIM

This prospective study was on the use of adipose cells in various procedures of plastic surgery, the role of high resolution ultrasound in estimating the volume of the grafted fat, comparison of the results based on the different donor sites of the harvested fat and comparison of the effectiveness of grafted fat in extremities and craniofacial region.

MATERIALS AND METHODS

In this prospective study a total of 34 patients underwent fat grafting procedure at various sites of the body from May 2012 till November 2013. After noting the details of the patient, details of the defect, laboratory and radiological investigations, the consent for the fat grafting procedure was taken. Clinical photographs and High Resolution Ultrasound (HRUS) volume estimation was done on a regular basis as per the protocol.

RESULTS

Out of 34 patients, 29 patients underwent free fat grafting and five patients underwent derma fat grafting. HRUS at six months revealed a mean 73.5% and 63.5% of the injected fat remained in contour deformity in extremities and craniofacial region respectively. HRUS at one year revealed a mean 57.4% and 41.4% of the injected fat remained in contour deformity in extremities and craniofacial region respectively.

CONCLUSION

HRUS is an excellent handy modality for serial volume estimation, cost-effective, non-invasive, multi planar modality, does not require any preparation, and easily done outdoor procedure. Follow up is a practical proposition. Autologous fat grafting is a safe procedure with no significant complications other than fat reabsorption and it can be done under local anaesthesia in contour deformity of smaller areas. Disadvantage of autologous fat grafting is the fat reabsorption needing multiple sittings.

Abdominoplasty-derived dermal-fat graft augmentation gluteoplasty

BACKGROUND

Plastic surgeons are exploring novel techniques for augmentation gluteoplasty as the demand for this procedure increases annually in the United States.

OBJECTIVES

The authors retrospectively reviewed a series of lower abdominal dermal-fat graft augmentation gluteoplasties to validate the procedure.

METHODS

Nine consecutive patients underwent abdominoplasty or torsoplasty in which 2 oval dermal-fat grafts were excised, de-epithelialized, and then implanted into subfascial gluteal pockets for augmentation. All operations were independently conducted by 1 of 2 surgeons at facilities in Maryland and New Jersey.

RESULTS

The mean age of the 9 female patients was 46 years. The mean dermal-graft size was 188 cm(2), and the mean graft weight was 288 g. One graft became infected and required excision 39 days after the procedure. There were no other complications. All surviving grafts provided a substantial increase in posterior projection and long-lasting gluteal volume.

CONCLUSIONS

Dermal-fat graft augmentation gluteoplasty provides a voluminous, natural-feeling, and durable aesthetic result. The procedure should be considered a viable option for patients undergoing abdominoplasty or torsoplasty, especially as more experience is gained.

LEVEL OF EVIDENCE

4.