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Fat Grafting: Basic Science, Techniques, and Patient Management. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e3987. [PMID: 35317456 PMCID: PMC8932485 DOI: 10.1097/gox.0000000000003987] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/22/2021] [Indexed: 11/25/2022]
Abstract
In this review, a summary of the rich history of autologous fat grafting is provided, and a comprehensive summary of the science and theory behind autologous adipocyte transplantation, as well as the techniques commonly used is described. These include recipient site preparation, harvesting, processing, and engraftment. In addition, important considerations for preoperative and postoperative management are discussed to maximize graft retention. Special considerations in grafting to the breast, face, and buttocks are also summarized.
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Wurzer P, Branski LK, Kamolz LP, Herndon DN, Finnerty CC. Fat and Adipose-Derived Stem Cell Grafts in Acute Burns. J Burn Care Res 2018; 37:e302. [PMID: 25798806 DOI: 10.1097/bcr.0000000000000234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Paul Wurzer
- Shriners Hospitals for Children, University of Texas Medical Branch, Galveston, Texas Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University Graz, Graz, Austria Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University Graz, Graz, Austria Shriners Hospitals for Children, University of Texas Medical Branch, Galveston, Texas
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Gargano F, Schmidt S, Evangelista P, Robinson-Bostom L, Harrington DT, Rossi K, Guo Y, Liu P. Burn scar regeneration with the "SUFA" (Subcision and Fat Grafting) technique. A prospective clinical study. JPRAS Open 2018; 17:5-8. [PMID: 32158824 PMCID: PMC7061675 DOI: 10.1016/j.jpra.2018.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/11/2018] [Accepted: 05/09/2018] [Indexed: 11/24/2022] Open
Abstract
Background Treatment of burn scars with traditional surgical techniques is challenging due to recurrent contractures. Fat grafting has been previously used in small clinical series and results are often biased by lack of scientific validating methods. Fat grafting in clinical practice is often evaluated for its filler properties and rarely scientifically validated for its potential in dermal regeneration. Animal studies have shown dermal regeneration with new deposition and reorientation of the collagen fiber. Our study aims to apply the validity of in vitro studies to clinical practice. Methods Our study prospectively evaluated outcomes in 12 patients treated with the “SUFA” technique (Subcision and Fat Grafting) for debilitating contracted burns scars limiting range of motion. Results were evaluated clinically with the Vancouver scale and by range of motion at 1, 3, 6 and 12 months. Dermal regeneration was evaluated by looking at dermis thickening using high definition ultrasound and scar remodeling looking at reorientation and new deposition of collagen fibers with hematoxylin-eosin histology and monoclonal antibodies against collagen type 1 and 3. Results Statistically significant clinical improvements in range of motion of the affected joints was observed (P<0.05). Fat reabsorption occurred with a mean of 40%. Thickening of dermis and redistribution and reorientation of the collagen fibers within the dermis was also demonstrated. Conclusions Our results present the first clinical scientific evidence of dermal regeneration in fat grafting. Using monoclonal antibodies and high definition ultrasounds, we demonstrate the first evidence of dermis regeneration in a clinical scenario.
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Affiliation(s)
- Francesco Gargano
- The Institute for Advanced Reconstruction at The Plastic Surgery Center, Sycamore Ave., Shrewsbury, NJ, United States
| | - Scott Schmidt
- Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, Richmond St., Providence, RI, United States
| | - Peter Evangelista
- Department of Radiology, The Warren Alpert Medical School of Brown University, Richmond St., Providence, RI, United States
| | - Leslie Robinson-Bostom
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Richmond St., Providence, RI, United States
| | - David T Harrington
- Department of Surgery, The Warren Alpert Medical School of Brown University, Richmond St., Providence, RI, United States
| | - Kristie Rossi
- The Institute for Advanced Reconstruction at The Plastic Surgery Center, Sycamore Ave., Shrewsbury, NJ, United States
| | - Yfan Guo
- Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, Richmond St., Providence, RI, United States
| | - Paul Liu
- Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, Richmond St., Providence, RI, United States
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Johns N, Fairbairn N, Trail M, Ewing A, Yong L, Raine C, Dixon JM. Autologous breast reconstruction using the immediately lipofilled extended latissimus dorsi flap. J Plast Reconstr Aesthet Surg 2017; 71:201-208. [PMID: 29239797 DOI: 10.1016/j.bjps.2017.10.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 08/23/2017] [Accepted: 10/13/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The latissimus dorsi flap is a popular choice for autologous breast reconstruction. To dramatically improve volume, we report our experience of using the immediately lipofilled extended latissimus dorsi (ELD) flap and show it as a valid option for autologous breast reconstruction. METHODS Patients undergoing the procedure between December 2013 and June 2016 were included. Demographic, clinical and operative factors were analysed, together with in-hospital morbidity and duration of postoperative hospital stay. RESULTS A total of 71 ELD flaps with immediate lipofilling were performed. Forty-five reconstructions were immediate and the remaining 26 delayed. Median (range) volume of autologous fat injected immediately was 171 ml (40-630 ml). Contralateral reductions were performed in 25 patients with the median reduction volume 185 g (89-683 g). Median duration of admission was 6.5 (3-18) days and patients were followed up for 12 months (1-37). Three total flap failures occurred and had to be excised (4%). One haematoma occurred requiring drainage (1%). Signs of infection requiring intravenous antibiotics occurred in five patients (7%). In 5 patients wound dehiscence occurred, and only two of these required resuturing (3%). In total, 7 patients developed a seroma requiring repeated drainage (10%). Three reconstructions experienced mild mastectomy flap necrosis with no needing reoperation (4%). CONCLUSIONS Our experience represents the largest series to date and shows that in carefully selected patients the technique is safe, can avoid the requirement for implants, and has the potential to streamline the reconstructive journey.
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Affiliation(s)
- N Johns
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK
| | - N Fairbairn
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK
| | - M Trail
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK
| | - A Ewing
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK
| | - L Yong
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK
| | - C Raine
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK
| | - J M Dixon
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK.
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Abstract
Fat grafting provides a reliable modality with expanding usefulness in reconstructive plastic surgery. Owing to its mechanical and theorized regenerative properties, adipose tissue can improve scar qualities and scar related symptoms when grafted adjacent to or within a scar. In this article, the literature describing the effect of fat grafting on various types of scars, current scientific understanding of fat grafting for scars, and our current approach to the management of problematic burn scars are reviewed.
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Affiliation(s)
- Rafi Fredman
- Division of Plastic and Reconstructive Surgery, University of North Carolina at Chapel Hill, 7038 Burnett-Womack, CB7195, Chapel Hill, NC 27599, USA.
| | - Adam J Katz
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Florida, 4037 Northwest 86 Terrace, 3rd Floor, Gainesville, FL 32606, USA
| | - Charles Scott Hultman
- Division of Plastic and Reconstructive Surgery, University of North Carolina at Chapel Hill, 7038 Burnett-Womack, CB7195, Chapel Hill, NC 27599, USA
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Abstract
Peripheral neuropathy and nerve compression syndromes lead to substantial morbidity following burn injury. Patients present with pain, paresthesias, or weakness along a specific nerve distribution or experience generalized peripheral neuropathy. The symptoms manifest at various times from within one week of hospitalization to many months after wound closure. Peripheral neuropathy may be caused by vascular occlusion of vasa nervorum, inflammation, neurotoxin production leading to apoptosis, and direct destruction of nerves from the burn injury. This article discusses the natural history, diagnosis, current treatments, and future directions for potential interventions for peripheral neuropathy and nerve compression syndromes related to burn injury.
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El-Sabbagh AH. Modern trends in lipomodeling. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2017; 6:Doc06. [PMID: 28401032 PMCID: PMC5378998 DOI: 10.3205/iprs000108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Lipomodeling is the process of relocating autologous fat to change the shape, volume, consistency, and profile of tissues, with the aim of reconstructing, rejuvenating, and regenerating body features. There have been several important advancements in lipomodeling procedures during the last thirty years. Four clinical steps are important for the success of engraftment: fat harvesting, fat processing, fat reinjection, and preconditioning of the recipient site. With the discovery of adipose derived stem cells and dedifferentiated cells, fat cells become a major tool of regenerative medicine. This article reviews recent trends in lipomodeling trying to understand most of the issues in this field.
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Blackshear CP, Longaker MT, Wan DC. Commentary on: The Effects of Fat Harvesting and Preparation, Air Exposure, Obesity, and Stem Cell Enrichment on Adipocyte Viability Prior to Graft Transplantation. Aesthet Surg J 2016; 36:1174-1175. [PMID: 27474768 DOI: 10.1093/asj/sjw118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Charles P Blackshear
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Institute for Stem Cell Biology and Regenerative Medicine, Stanford University Medical Center, Stanford, CA
| | - Michael T Longaker
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Institute for Stem Cell Biology and Regenerative Medicine, Stanford University Medical Center, Stanford, CA
| | - Derrick C Wan
- From the Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Institute for Stem Cell Biology and Regenerative Medicine, Stanford University Medical Center, Stanford, CA
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The Current State of Fat Grafting: A Review of Harvesting, Processing, and Injection Techniques. Plast Reconstr Surg 2016; 136:897-912. [PMID: 26086386 DOI: 10.1097/prs.0000000000001590] [Citation(s) in RCA: 266] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Interest in and acceptance of autologous fat grafting for use in contour abnormalities, breast reconstruction, and cosmetic procedures have increased. However, there are many procedural variations that alter the effectiveness of the procedure and may account for the unpredictable resorption rates observed. METHODS The authors highlighted studies investigating the effects of harvesting procedures, processing techniques, and reinjection methods on the survival of fat grafts. This review focused on the impact different techniques have on outcomes observed in the following: in vitro analyses, in vivo animal experiments, and human studies. RESULTS This systemic review revealed the current state of the literature. There was no significant difference in the outcomes of grafted fat obtained from different donor sites, different donor-site preparations, harvest technique, fat harvesting cannula size, or centrifugation speed, when tumescent solution was used. Gauze rolling was found to enhance the volume of grafted fat, and no significant difference in retention was observed following centrifugation, filtration, or sedimentation in animal experiments. In contrast, clinical studies in patients found more favorable outcomes with fat processed by centrifugation compared with sedimentation. In addition, higher retention was observed with slower reinjection speed and when introduced into less mobile areas. CONCLUSIONS There has been a substantial increase in research interest to identify methodologies for optimizing fat graft survival. Despite some differences in harvest and implantation technique in the laboratory, these findings have not translated into a universal protocol for fat grafting. Therefore, additional human studies are necessary to aid in the development of a universal protocol for clinical practice.
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Wound healing after thermal injury is improved by fat and adipose-derived stem cell isografts. J Burn Care Res 2015; 36:70-6. [PMID: 25185931 DOI: 10.1097/bcr.0000000000000160] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Patients with severe burns suffer functional, structural, and esthetic complications. It is important to explore reconstructive options given that no ideal treatment exists. Transfer of adipose and adipose-derived stem cells (ASCs) has been shown to improve healing in various models. The authors hypothesize that use of fat isografts and/or ASCs will improve healing in a mouse model of burn injury. Twenty 6 to 8 week old C57BL/6 male mice received a 30% surface area partial-thickness scald burn. Adipose tissue and ASCs from inguinal fat pads were harvested from a second group of C57BL/6 mice. Burned mice received 500 μl subcutaneous injection at burn site of 1) processed adipose, 2) ASCs, 3) mixed adipose (adipose and ASCs), or 4) sham (saline) injection (n = 5/group) on the first day postinjury. Mice were followed by serial photography until being killed at days 5 and 14. Wounds were assessed for burn depth and healing by hematoxylin and eosin (H&E) and immunohistochemistry. All treated groups showed improved healing over controls defined by decreased wound depth, area, and apoptotic activity. After 5 days, mice receiving ASCs or mixed adipose displayed a non-significant improvement in vascularization. No significant changes in proliferation were noted at 5 days. Adipose isografts improve some early markers of healing postburn injury. The authors demonstrate that addition of these grafts improves specific structural markers of healing. This improvement may be because of an increase in early wound vascularity postgraft. Further studies are needed to optimize use of fat or ASC grafts in acute and reconstructive surgery.
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Studies in fat grafting: Part III. Fat grafting irradiated tissue--improved skin quality and decreased fat graft retention. Plast Reconstr Surg 2014; 134:249-257. [PMID: 25068325 DOI: 10.1097/prs.0000000000000326] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Following radiation therapy, skin becomes fibrotic and can present a difficult problem for reconstructive surgeons. There is an increasing belief that fat grafting under irradiated skin can reverse the damage caused by radiation. The present study evaluated the effect of fat grafting on irradiated skin, along with fat graft quality and retention rates in irradiated tissue. METHODS Nine adult Crl:NU-Foxn1 CD-1 mice underwent 30-Gy external beam irradiation of the scalp. Four weeks after irradiation, scalp skin from irradiated and nonirradiated mice was harvested and compared histologically for dermal thickness, collagen content, and vascular density. Human fat grafts were then injected in the subcutaneous plane of the scalp. Skin assessment was performed in the irradiated group at 2 and 8 weeks after grafting, and fat graft retention was measured at baseline and every 2 weeks up to 8 weeks after grafting using micro-computed tomography. Finally, fat graft samples were explanted at 8 weeks, and quality scoring was performed. RESULTS Fat grafting resulted in decreased dermal thickness, decreased collagen content, and increased vascular density in irradiated skin. Computed tomographic analysis revealed significantly decreased fat graft survival in the irradiated group compared with the nonirradiated group. Histologic scoring of explanted fat grafts demonstrated no difference in quality between the irradiated and nonirradiated groups. CONCLUSIONS Fat grafting attenuates dermal collagen deposition and vessel depletion characteristic of radiation fibrosis. Although fat graft retention rates are significantly lower in irradiated than in nonirradiated tissue, the quality of retained fat between the groups is similar.
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Garcia B, Francois-Vaughan H, Onikoyi O, Kostadinov S, De Paepe ME, Gruppuso PA, Sanders JA. Xenotransplantation of human fetal adipose tissue: a model of in vivo adipose tissue expansion and adipogenesis. J Lipid Res 2014; 55:2685-91. [PMID: 25193996 DOI: 10.1194/jlr.d052787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Obesity during childhood and beyond may have its origins during fetal or early postnatal life. At present, there are no suitable in vivo experimental models to study factors that modulate or perturb human fetal white adipose tissue (WAT) expansion, remodeling, development, adipogenesis, angiogenesis, or epigenetics. We have developed such a model. It involves the xenotransplantation of midgestation human WAT into the renal subcapsular space of immunocompromised SCID-beige mice. After an initial latency period of approximately 2 weeks, the tissue begins expanding. The xenografts are healthy and show robust expansion and angiogenesis for at least 2 months following transplantation. Data and cell size and gene expression are consistent with active angiogenesis. The xenografts maintain the expression of genes associated with differentiated adipocyte function. In contrast to the fetal tissue, adult human WAT does not engraft. The long-term viability and phenotypic maintenance of fetal adipose tissue following xenotransplantation may be a function of its autonomous high rates of adipogenesis and angiogenesis. Through the manipulation of the host mice, this model system offers the opportunity to study the mechanisms by which nutrients and other environmental factors affect human adipose tissue development and biology.
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Affiliation(s)
- Briana Garcia
- Division of Pediatric Endocrinology, Rhode Island Hospital and Brown University, Providence, RI 02903
| | - Heather Francois-Vaughan
- Division of Pediatric Endocrinology, Rhode Island Hospital and Brown University, Providence, RI 02903
| | - Omobola Onikoyi
- Division of Pediatric Endocrinology, Rhode Island Hospital and Brown University, Providence, RI 02903
| | - Stefan Kostadinov
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital and Brown University, Providence, RI 02903
| | - Monique E De Paepe
- Department of Pathology and Laboratory Medicine, Women and Infants Hospital and Brown University, Providence, RI 02903
| | - Philip A Gruppuso
- Division of Pediatric Endocrinology, Rhode Island Hospital and Brown University, Providence, RI 02903
| | - Jennifer A Sanders
- Division of Pediatric Endocrinology, Rhode Island Hospital and Brown University, Providence, RI 02903
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Jet-assisted fat transfer to the female breast: preliminary experiences. EUROPEAN JOURNAL OF PLASTIC SURGERY 2014. [DOI: 10.1007/s00238-014-0934-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Pfaff M, Wu W, Zellner E, Steinbacher DM. Processing technique for lipofilling influences adipose-derived stem cell concentration and cell viability in lipoaspirate. Aesthetic Plast Surg 2014; 38:224-229. [PMID: 24399146 DOI: 10.1007/s00266-013-0261-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 12/09/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Autologous fat grafting is a highly used technique in plastic and reconstructive surgery. Several fat-processing techniques have been described, with centrifugation frequently touted as the optimal method. Processing is one factor important for maximizing cell viability and adipose-derived mesenchymal stem cell (ADSC) concentrations. This study compared two methods of fat preparation (centrifugation vs Telfa-rolling) to determine which technique results in the greatest degree of cell viability and ADSC concentration. METHODS Abdominal fat was harvested from five patients. Equal aliquots were divided and processed by both centrifugation and Telfa-rolling. Samples were analyzed for ADSC proportions via flow cytometry and cell viability using methylene blue-based cell counting. Paired t tests were performed on all samples, and a P value lower than 0.05 was considered statistically significant. RESULTS Telfa-rolling processing resulted in a higher percentage of isolated ADSCs (P < 0.5 for 3 of 4 parameters) and a significantly higher number of viable cells (P < 0.05). CONCLUSION Telfa-rolling results in a higher proportion of ADSCs and greater cell viability than centrifugation for donor adipose graft preparation. Further studies are necessary to confirm whether optimal preparation translates to improved augmentation and cell take at the recipient site. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Miles Pfaff
- Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, CT, 06520, USA
| | - Wei Wu
- Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, CT, 06520, USA
| | - Elizabeth Zellner
- Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, CT, 06520, USA
| | - Derek M Steinbacher
- Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, CT, 06520, USA.
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Experimental Study of Free Fat Grafts in Temporomandibular Joint Disc Anchor. J Craniofac Surg 2014; 25:253-7. [DOI: 10.1097/scs.0000000000000419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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