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Seabra Robalo Gomes Jorge AC, Feng YS, Santos Stahl A, Grözinger G, Nikolaou K, Glanemann M, Daigeler A, Stahl S. Danger Zones of the Gluteal Anatomy: Improving the Safety Profile of the Gluteal Fat Grafting. Aesthetic Plast Surg 2024; 48:1597-1605. [PMID: 38302712 PMCID: PMC11058931 DOI: 10.1007/s00266-023-03824-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/14/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Knowledge of the vascular anatomy is critical to performing safe gluteal surgery. To date, only the course of the main blood vessels within the muscles has been outlined. These findings are based on MRI and CTA images that do not conform to a topographically standardized and normalized probability distribution. OBJECTIVES The aim of this study was to develop a three-dimensional mapping of the gluteal zones of high vascular density in relation to anatomical landmarks. MATERIALS AND METHODS This single-center retrospective cohort analysis comprised all consecutive patients who underwent cone-beam computed tomography (CBCT) scans between January 2016 and October 2021. The location of blood vessels in the gluteal region was allometrically normalized in relation to anatomical landmarks. Moreover, the caliber and area of the blood vessels were assessed. RESULTS CBCT scans of 32 patients with an average age of 64 ± 12 years (range 34-87 years) were included. Fifty-three percent were female. The median [IQR] caliber of the intramuscular gluteal vessels was 1.47 [1.15-1.88] mm, significantly greater than that of the subcutaneous vessels 1.09 [0.72-1.44] mm (p < 0.001). Vascular density was higher intramuscularly, as 4.5% of the area of the muscle was occupied by blood vessels, as opposed to 0.3% in the adipose tissue. CONCLUSION The analysis of the CBCT scans showed a higher vascular density and larger vessels intramuscularly. We, therefore, recommend the injection of autologous fat merely to the subcutaneous plane. LEVEL OF EVIDENCE II 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)
| | - You-Shan Feng
- Institute for Clinical Epidemiology and Applied Biometrics, Medical University of Tübingen, Tübingen, Germany
| | | | - Gerd Grözinger
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | - Matthias Glanemann
- Department of General, Visceral, Vascular, and Pediatric Surgery, Saarland University Hospital, Kirrberger Straße, 66421, Homburg, Saarland, Germany
| | - Adrien Daigeler
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Clinic Tübingen, Tübingen, Germany
| | - Stéphane Stahl
- CenterPlast private practice, Bahnhofstraße 36, 66111, Saarbrücken, Germany
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Alessandri Bonetti M, Arellano JA, Scarabosio A, Liu HY, Giorgino R, Ejaz A, Rubin JP, Egro FM. The Effect of Fat Grafting on Scars Hyperpigmentation: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2024; 48:989-998. [PMID: 38286897 DOI: 10.1007/s00266-023-03828-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/18/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Hyperpigmented scars, particularly in exposed body areas, can be difficult to conceal and may evoke psychological distress. While the precise causes of scar dyschromia are not fully understood, alterations in melanogenic activity appear to hold more significance than changes in melanocyte quantity. Current treatments encompass laser interventions. However, it is essential to consider their costs and potential complications in relation to their limited proven effectiveness. Fat grafting has gained interest as a scar modulation technique due to its regenerative properties, and its efficacy in reducing scar hyperpigmentation is currently under investigation. METHODS A systematic review and meta-analysis was reported according to PRISMA guidelines. PubMed, Embase, and Cochrane Library databases were accessed. PROSPERO registration number is CRD42023457778. The primary outcome was a change in scar pigmentation after fat grafting. Pigmentation changes after fat grafting were calculated using the standardized mean difference (SMD) between baseline and postoperative scores according to POSAS and VSS scales. Bias assessment was conducted according to the National Institute for Health and Clinical Excellence quality assessment tool. RESULTS A total of 8 articles meeting inclusion and exclusion criteria were identified, involving 323 patients with hyperpigmented scars treated with fat grafting. A significant difference in scar pigmentation was noted after treatment with fat grafting according to observers' ratings, with a SMD of - 1.09 [95% CI: - 1.32; - 0.85], p<0.01. The SMD for patient-reported scar pigmentation after treatment with fat grafting was - 0.99 [96% CI: - 1.31; - 0.66], p<0.01. Four studies provided objective measurements of melanin changes after fat grafting and revealed inconsistent findings compared to subjective observations. CONCLUSIONS Fat grafting shows promise in ameliorating hyperpigmented scars based on subjective assessments, but further corroborating evidence from objective measures is required. 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)
- Mario Alessandri Bonetti
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - Jose Antonio Arellano
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - Anna Scarabosio
- Department of Plastic Surgery, Ospedale Santa Maria della Misericordia, 33100, Udine, Italy
| | - Hilary Y Liu
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, 20141, Milan, Italy
| | - Asim Ejaz
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - J Peter Rubin
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA.
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Brenac C, Fieux M, Giroudon C, Gautherot Tournay N, Henry G, Person H, Ospital C, Mojallal A. Use of autologous adipose tissue in acute burn wound management: A systematic review. ANN CHIR PLAST ESTH 2024; 69:70-78. [PMID: 37770323 DOI: 10.1016/j.anplas.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 09/30/2023]
Abstract
Fat transfer is increasingly used as part of our reconstructive armamentarium to address the challenges encountered in burn wounds and reconstructive surgery. The present systematic review aimed to evaluate the effectiveness of autologous fat transfer for acute burn wound management. A systematic review of the US National Library of Medicine, Cochrane Library, Web of Science, and Embase was conducted on October 15, 2022 (registration number CDR42022369726). A database watch was performed until submission of the manuscript. The review focused on wound healing. All studies reporting fat transfer in adult patients (at least 5 patients reported) with deep 2nd degree burn wounds were included. The database search yielded a total of 720 records and 367 patients were included from 3 studies. A statistically significant improvement in scar texture, scar appearance, and time to healing was reported in one study in the fat transfer group versus control (P<0.001). Similarly, scores for scar color, scar thickness, scar stiffness, and scar regularity increased significantly. The small number of included studies and their heterogeneity did not allow a meta-regression to be performed. This systematic review emphasizes the limited evidence currently available regarding the use of autologous fat transfer to improve burn wound healing in adult patients, even though it seems promising. Future search should focus on randomized controlled trials with a larger number of participants.
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Affiliation(s)
- C Brenac
- Department of Plastic, Reconstructive and Aesthetic Surgery, hospices civils de Lyon, Croix-Rousse Hospital, 69004 Lyon, France
| | - M Fieux
- Service d'ORL, d'otoneurochirurgie et de chirurgie cervicofaciale, centre hospitalier Lyon Sud, hospices civils de Lyon, 69310 Pierre-Bénite cedex, France; Université de Lyon, université Lyon 1, 69003 Lyon, France
| | - C Giroudon
- Service de la documentation centrale, hospices civils de Lyon, 69424 Lyon cedex, France
| | - N Gautherot Tournay
- Department of Plastic, Reconstructive and Aesthetic Surgery, hospices civils de Lyon, Croix-Rousse Hospital, 69004 Lyon, France
| | - G Henry
- Department of Plastic, Reconstructive and Aesthetic Surgery, hospices civils de Lyon, Croix-Rousse Hospital, 69004 Lyon, France
| | - H Person
- Service de chirurgie des brûlés, plastique, reconstructrice et esthétique, hospices civils de Lyon, hôpital Édouard-Herriot, 69003 Lyon, France
| | - C Ospital
- Department of Plastic, Reconstructive and Aesthetic Surgery, hospices civils de Lyon, Croix-Rousse Hospital, 69004 Lyon, France
| | - A Mojallal
- Department of Plastic, Reconstructive and Aesthetic Surgery, hospices civils de Lyon, Croix-Rousse Hospital, 69004 Lyon, France; Université de Lyon, université Lyon 1, 69003 Lyon, France; Service de chirurgie des brûlés, plastique, reconstructrice et esthétique, hospices civils de Lyon, hôpital Édouard-Herriot, 69003 Lyon, France.
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Demichelis MDRE, Barrera A, Campero A, Sufianov A, Ramírez MDJE, Nurmukhametov R, Montemurro N, Castillo-Rangel C, Rosario AR, Baldoncini M. Lipotranferences in post neurosurgical esthetic defects. Surg Neurol Int 2023; 14:443. [PMID: 38213453 PMCID: PMC10783699 DOI: 10.25259/sni_783_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/28/2023] [Indexed: 01/13/2024] Open
Abstract
Background There are numerous procedures in which, beyond adequate manipulation of the temporalis muscle and cranial closure, patients may present bone and muscle defects due to atrophy and consequent facial asymmetry, causing psychological discomfort and functional deterioration. The objective of our work is to combine the knowledge of plastic surgery and apply it to cranial reconstructions with fat transfers in post-neurosurgical patients, analyzing its results. Methods During the year 2022, 45 fat transfer procedures were performed for the correction of craniofacial defects, of which 29 were female and 16 were male. All had a surgical history of pterional craniotomies and their variants, orbitozygomatic and transzygomatic approaches, with the consequent volume deficit. Results The procedure was performed on an outpatient basis, with local anesthesia, and in an average time of 30-40 min. The lower hemiabdominal region was used as the donor area, processing the fat using the decantation technique and injecting it into the receptor area at the craniofacial level. The patients tolerated the procedure adequately without intraoperative complications or superadded events. Conclusion Fat transfer is a minimally invasive, effective, and cost-effective technique that plastic surgery offers us to implement in post-neurosurgical patients, as it achieves natural results that stand the test of time.
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Affiliation(s)
| | - Augusto Barrera
- Plastic Surgery Service, Churruca-Visca Medical Complex, Buenos Aires, Argentina
| | - Alvaro Campero
- Neurosurgery Service, Padilla Hospital, Faculty of Medicine, National University of Tucumán, Tucuman, Argentina
| | - Albert Sufianov
- Department of Educational and Scientific Institute of Neurosurgery, Peoples’ Friendship University of Russia, Moscow, Russian Federation
- Department of Neurosurgery, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | | | - Renat Nurmukhametov
- Department of Neurosurgery, Russian People’s Friendship University, Ulitsa Miklukho-Maklaya, Moscow, Russian Federation
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), University of Pisa, Pisa, Italy
| | - Carlos Castillo-Rangel
- Neurosurgery Service, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Regional Hospital October 1, Mexico City, Mexico
| | | | - Matias Baldoncini
- Laboratory of Microsurgical Neuroanatomy, Second Chair of Gross Anatomy, School of Medicine, University of Buenos Aires, San Fernando, Argentina
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Pazmiño P, Del Vecchio D. Safety in Gluteal Augmentation. Clin Plast Surg 2023; 50:521-523. [PMID: 37704319 DOI: 10.1016/j.cps.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Gluteal fat grafting is the fastest growing surgery in body contouring because of the powerful results that no other procedure can achieve. Efforts made to improve the safety of this procedure are reviewed.
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Affiliation(s)
- Pat Pazmiño
- Division of Plastic Surgery, University of Miami.
| | - Daniel Del Vecchio
- Department of Plastic Surgery, Massachusetts General Hospital, Boston, MA, USA
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Molière S, Boutet G, Azuar AS, Boisserie-Lacroix M, Brousse S, Golfier F, Kermarrec É, Lavoué V, Seror JY, Uzan C, Vaysse C, Lodi M, Mathelin C. [Lipofilling in the management of breast cancer: An update based on a literature review and national and international guidelines]. Gynecol Obstet Fertil Senol 2023; 51:471-480. [PMID: 37419415 DOI: 10.1016/j.gofs.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 07/01/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Lipomodelling (LM) is an increasingly used technique to reconstruct or correct an aesthetic defect linked to a loss of substance. In France, the Haute Autorité de santé (HAS) published recommendations in 2015 and 2020 concerning the conditions of use of LM on the treated and contralateral breast. These appear to be inconsistently followed. METHODS Twelve members of the Senology Commission of the Collège national des gynécologues-obstétriciens français (French College of Gynecologists and Obstetricians) reviewed the carcinological safety of LM and the clinical and radiological follow-up of patients after breast cancer surgery, based on French and international recommendations and a review of the literature. The bibliographic search was conducted via Medline from 2015 to 2022, selecting articles in French and English and applying PRISMA guidelines. RESULTS A total of 14 studies on the oncological safety of LM, 5 studies on follow-up and 7 guidelines were retained. The 14 studies (6 retrospective, 2 prospective and 6 meta-analyses) had heterogeneous inclusion criteria and variable follow-up, ranging from 38 to 120 months. Most have shown no increased risk of locoregional or distant recurrence after LM. A retrospective case-control study (464 LMs and 3100 controls) showed, in patients who had no recurrence at 80 months, a subsequent reduction in recurrence-free survival after LM in cases of luminal A cancer, highlighting the number of lost to follow-up (more than 2/3 of luminal A cancers). About follow-up after LM, the 5 series showed the high frequency after LM of clinical mass and radiological images (in ¼ of cases), most often corresponding to cytosteatonecrosis. Most of the guidelines highlighted the uncertainties concerning oncological safety of LM, due to the lack of prospective data and long-term follow-up. DISCUSSION AND PERSPECTIVES The members of the Senology Commission agree with the conclusions of the HAS working group, in particular by advising against LM "without cautionary periods", excessively, or in cases of high risk of relapse, and recommend clear, detailed information to patients before undergoing LM, and the need for postoperative follow-up. The creation of a national registry could address most questions regarding both the oncological safety of this procedure and the modalities of patient follow-up.
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Affiliation(s)
- S Molière
- Imagerie du Sein, CHRU, avenue Molière, 67200 Strasbourg, France.
| | - G Boutet
- AGREGA, service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU de Bordeaux, groupe hospitalier Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - A-S Azuar
- Centre hospilalier Clavary, chemin de Clavary, 06130 Grasse, France.
| | - M Boisserie-Lacroix
- Unité de radiologie-sénologie, institut Bergonié, 229, cours de l'Argonne, 33000 Bordeaux, France.
| | - S Brousse
- Service d'oncologie chirurgicale, centre Eugène-Marquis, Unicancer, Rennes, France.
| | - F Golfier
- Service de chirurgie gynécologique et cancérologique - obstétrique, hospices civils de Lyon, CHU de Lyon Sud, Lyon, France.
| | - É Kermarrec
- Service de radiologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France.
| | - V Lavoué
- Service de gynécologie, CHU, 16, boulevard de Bulgarie, 35200 Rennes, France.
| | - J-Y Seror
- 9, terrasse boulevard Montparnasse, 75006 Paris, France.
| | - C Uzan
- Hôpital Pitié-Salpetrière, 47, boulevard de l'Hôpital, 75013 Paris, France.
| | - C Vaysse
- Service de chirurgie oncologique, institut universitaire du cancer de Toulouse-Oncopole, CHU de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France.
| | - M Lodi
- CHRU, avenue Molière, 67200 Strasbourg, France.
| | - C Mathelin
- CHRU, avenue Molière, 67200 Strasbourg, France; ICANS, 17, rue Albert-Calmette, 67033 Strasbourg cedex, France.
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Tomita K, Taminato M, Kubo T. Total breast reconstruction with a fat-augmented latissimus dorsi flap: A comparative study between muscle and myocutaneous flaps. J Plast Reconstr Aesthet Surg 2023; 83:250-257. [PMID: 37279635 DOI: 10.1016/j.bjps.2023.04.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/26/2023] [Indexed: 06/08/2023]
Abstract
The fat-augmented latissimus dorsi myocutaneous flap can overcome the volume insufficiency of latissimus dorsi flaps by immediate fat grafting into the flap. When breast skin supplementation is unnecessary, latissimus dorsi flaps can be harvested as a muscle flap to avoid an additional back incision. Here, we compared the efficacy of fat-augmented latissimus dorsi myocutaneous and muscle flaps in total breast reconstruction. We retrospectively reviewed 94 cases of unilateral total breast reconstruction using fat-augmented latissimus dorsi flaps (muscle: 40, myocutaneous: 54) at our hospital from September 2017 to March 2022. The muscle flap group had a significantly shorter operative time than the myocutaneous flap group (p < 0.0001). Mastectomy specimen weight did not differ between the 2 groups, but total flap weight in the muscle flap group was significantly lower (p < 0.0001). Conversely, total fat graft volume, fat graft volume to the latissimus dorsi flap, and fat graft volume to the pectoralis major muscle were significantly greater in the muscle flap group (p < 0.0001, p < 0.0001, and p = 0.02, respectively). The percentage of cases requiring additional fat grafting was significantly higher in the muscle flap group, but postoperative esthetic evaluation did not significantly differ between the 2 groups. Both groups scored high on each BREAST-Q item, but the muscle flap group scored significantly higher for "Satisfaction with Back." Although the frequency of additional fat grafting was higher than with fat-augmented latissimus dorsi myocutaneous flaps, total breast reconstruction with fat-augmented latissimus dorsi muscle flaps is a viable technique with a short operative time and high patient satisfaction.
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Affiliation(s)
- Koichi Tomita
- Department of Plastic and Reconstructive Surgery, Kindai University Faculty of Medicine, Osaka, Japan; Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
| | - Mifue Taminato
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tateki Kubo
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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Saelmans AG, Rijkx M, Hommes J, van der Hulst R, Piatkowski A. Bilateral breast infection following total breast reconstruction with autologous fat transfer (AFT): A case report. Int J Surg Case Rep 2023; 104:107917. [PMID: 36812827 PMCID: PMC9958470 DOI: 10.1016/j.ijscr.2023.107917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/24/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Total breast reconstruction with autologous fat transfer (AFT) has a low complication rate. Fat necrosis, infection, skin necrosis and hematoma are the most common complications. Infections are usually mild and manifested by a unilateral red painful breast and treated with oral antibiotics with or without superficial irrigation of the wound. CASE PRESENTATION One of our patients reported an ill-fitting pre-expansion device several days after surgery. This was due to a severe bilateral breast infection following a session of total breast reconstruction with AFT despite perioperative and postoperative antibiotic prophylaxis. Surgical evacuation was performed in combination with both systemic and oral antibiotic treatment. CLINICAL DISCUSSION Most infections can be prevented in the early post-operative period with antibiotic prophylaxis. If an infection does occur, it is treated with antibiotics or superficial irrigation of the wound. A delay in identification of an alarming course could be reduced by monitoring the fit to the EVEBRA device, implementing video consultations on indication, limiting the means of communication and better informing the patient on what complications to monitor. The recognition of an alarming course following a subsequent session of AFT is not guaranteed after a session without complication. CONCLUSION Besides temperature and redness of the breast, a pre-expansion device that doesn't fit can be an alarming sign. Patient communication should be adapted as severe infections can be insufficiently recognized by phone. Evacuation should be considered when an infection does occur.
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Affiliation(s)
- Alexander Gabriël Saelmans
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, 6229 HX Maastricht, the Netherlands.
| | - Maud Rijkx
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, 6229 HX Maastricht, the Netherlands.
| | - Juliette Hommes
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, 6229 HX Maastricht, the Netherlands.
| | - René van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, 6229 HX Maastricht, the Netherlands.
| | - Andrzej Piatkowski
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, 6229 HX Maastricht, the Netherlands.
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Abstract
Just as priceless procedure of art and science needs the visual frame to bring out the subtle proportion to your face and bring out the best frame for the smile. Lip augmentation procedures with hyaluronic acid dermal fillers have become increasingly popular worldwide because full lips are often considered beautiful and youthful. The objective of a lip augmentation procedure is to create smooth lips with adequate volume and a natural appearance and not to be over corrected. Various techniques for lip augmentation have been used and described.
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Affiliation(s)
- Shohreh Ghasemi
- OMFS Department, Augusta University, 1120,15 th Street, Augusta, GA 30912, USA.
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Mecott GA, Gonzalez-Cantu CM, Moreno-Peña PJ, Flores PP, Castro-Govea Y, de Oca-Luna RM, Perez-Trujillo JJ, Garcia-Perez MM. Effect of Diameter and Fenestration Area of the Liposuction Cannula on the Viability of the Adipocytes. Aesthetic Plast Surg 2022; 46:912-9. [PMID: 35133462 DOI: 10.1007/s00266-021-02712-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/29/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Loss of volume is perhaps the most frustrating problem of fat grafting. The process of fat grafting depends on different variables such as harvesting, processing, and injection techniques. Results between studies that evaluate the effect of the cannula size on fat graft survival have been controversial. However, the role of the fenestration area of the cannula has not been described. METHODS Four custom-made cannulas with a single fenestration were used for this study. Cannulas vary in diameter and area of the fenestration. Healthy patients seeking primary liposuction of the abdomen for aesthetic reasons were included. Lipoaspiration was performed in a clockwise pattern, and the order of the cannulas was rotated. Negative pressure was maintained at 0.8 atm at all times. Ten ml of fat, obtained from the suction tube, was poured into 20-ml conical centrifugal tubes for further processing. One gram of lipoaspirate was extracted from each sample, and acridine orange stain was added. Adipocytes were extracted, extended in a frotis, and observed by a histologist (masked fashion) under fluorescence microscopy. Viability was reported in percentages per sample. RESULTS The overall viability was 64.75% ± 18.58. The viability of the obtained samples ranged from 66.51± 20.66 % to 62.83 ± 18.1. In further analysis, comparing the viability according to the shaft diameter and fenestration area, there was no significant difference among groups. CONCLUSIONS Neither the diameter of the cannula nor the size of the fenestrations are determining factors to affect the viability of the adipocytes. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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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11
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Dembinski D, Moore MG, Effendi M, Ovalle F, Gobble R. Assessing the quality and reliability of patient information regarding aesthetic fat grafting on YouTube. J Plast Reconstr Aesthet Surg 2022; 75:2343-2345. [PMID: 35272959 DOI: 10.1016/j.bjps.2022.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/13/2021] [Accepted: 01/18/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Patients increasingly consult social media regarding aesthetic surgery. Given the popularity of fat transfer operations, this study assesses the quality and reliability of patient information available on YouTube regarding aesthetic fat grafting. METHODS The terms "fat grafting" and "fat transfer" were searched on YouTube with respect to the terms "face", "breast", "buttock", and "Brazilian butt lift". Filtered by view count, the top 20 unique, English language, aesthetic surgery-related videos for each search combination were reviewed by three independent reviewers for demographic and descriptive characteristics. Videos were rated for information reliability and quality using the modified DISCERN (MD) tool (1 = low, 5 = high) and global quality scale (GQS) (1 = poor, 5 = excellent). RESULTS Out of 80 total videos, 76% were authored by physicians and 24% by laypersons. The overall mean MD score was 1.5 and the mean GQS was 2.6. Videos authored by physicians outscored those by non-medical authors (MD: 1.6 vs. 1.3; GQS 2.7 vs. 2.2). Board-certified plastic surgeon videos (N = 30) scored higher on both the MD (1.7 vs 1.3) and GQS (3.1 vs 2.2) than those of non-medical authors. On the contrary, videos by laypersons and non-plastic surgeons had 40% more views, twice as many "likes" and nearly double as many subscribers. CONCLUSION The overall quality of information presented in aesthetic fat grafting procedures videos on YouTube is low and from unreliable sources. Surgeons should educate patients regarding potentially inaccurate information, and professional societies should disseminate high-quality media.
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Affiliation(s)
- Doug Dembinski
- University of Cincinnati Medical Center, Division of Plastic and Reconstructive Surgery, Cincinnati, OH USA
| | - Meredith G Moore
- University of Cincinnati Medical Center, Division of Plastic and Reconstructive Surgery, Cincinnati, OH USA
| | - Maleeh Effendi
- University of Cincinnati Medical Center, Division of Plastic and Reconstructive Surgery, Cincinnati, OH USA
| | - Fernando Ovalle
- University of Cincinnati Medical Center, Division of Plastic and Reconstructive Surgery, Cincinnati, OH USA
| | - Ryan Gobble
- University of Cincinnati Medical Center, Division of Plastic and Reconstructive Surgery, Cincinnati, OH USA.
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12
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Ibrahiem SMS. Investigating the Safety of Multiple Body Contouring Procedures in Massive Weight Loss Patients. Aesthetic Plast Surg 2022; 46:2891-2902. [PMID: 35650300 PMCID: PMC9729125 DOI: 10.1007/s00266-022-02941-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/08/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Deformities after massive weight loss are usually severe and affect many parts of the body, negatively impacting patients' social and intimate lives. A common request of patients after massive weight loss is to treat more than one anatomical area in one surgical procedure. Advantages include a single recovery period, lower surgical costs, and faster patient satisfaction. Disadvantages may include increased need for blood transfusions, longer hospital stay, and increased risk of common complications. OBJECTIVE The main objective of the study is to compare operative risk, hospital length of stay, complication rate, and patient satisfaction in MWLP according to the number of surgical procedures performed in the same surgical setting. PATIENTS AND METHODS This is a retrospective case-control study of 653 MWLP who underwent multiple contouring procedures simultaneously in a single surgical procedure. All patients underwent surgery between 2016 and 2020. The patients studied were divided into 4 groups according to the number of anatomical areas operated on. RESULTS A total of 1254 body contouring procedures were included in the study. Follow-up time ranged from 13 to 41 months, with a mean of 17 months. The mean age in the study was 33 years old. Women accounted for 78% of the studied population and men accounted for 22%. The overall complication rate (major and minor) was 105 cases (16.07%) in all groups CONCLUSION: Patient satisfaction was highest in patients who underwent 2-3 procedures within the same surgical setting compared to patients who underwent +3 procedures. Nevertheless, this is clinically insignificant. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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)
- Saad Mohamed Saad Ibrahiem
- grid.7155.60000 0001 2260 6941Department of Plastic Surgery, Reconstructive Surgery, and Burn Management, Faculty of Medicine, Alexandria University, Champollion Street, El-Khartoum Square, Azarita Medical Campus, Alexandria, 21111 Egypt
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13
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Añorve Borquez IR. A New Technique for Remodelling and Increasing the Diameter of the Legs through Lipotransfer and Vertical Subcutaneous Fasciotomy of the Posterior Tibial Aponeurosis. Aesthetic Plast Surg 2021; 45:1642-1650. [PMID: 33575877 DOI: 10.1007/s00266-021-02147-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/17/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe a new technique for performing thigh and calf augmentation and remodelling through thigh lipotransfer, subcutaneous vertical fasciotomy and leg lipotransfer. METHODS Patients with thin legs due to hypotrophy or hypoplasia of the medial portion of the thighs and legs as well as a patient with a prominent tibialis anterior giving the appearance of male legs were selected. RESULTS A total of 214 surgeries were performed in 107 patients with minimal complications, and most patients reported a high rate of satisfaction. DISCUSSION Lipotransfer with fasciotomy improves the standard results of liposculpture in body contour management, which allows balanced relationships among the waist, hips, thighs and legs to be achieved in many patients who are not candidates for the placement of silicone prostheses because their legs and thighs are thin and hypotrophic. 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)
- Ignacio Roberto Añorve Borquez
- , Av. Rafael Buelna 198, edificio polimédica local 616, Col. Fraccionamiento hacienda las cruces, C.P. 821010, Mazatlán Sinaloa, México.
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14
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Schreiter JS, Langer S, Klöting N, Kurow O. Leptin promotes adipocytes survival in non-vascularized fat grafting via perfusion increase. Microvasc Res 2021; 135:104131. [PMID: 33421432 DOI: 10.1016/j.mvr.2021.104131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Though autologous fat transplantation is regularly and successfully performed in plastic surgery, little is known about the factors that contribute to the rise of preadipocytes and how the viability of adipocytes is regulated. As sufficient blood supply is a key parameter for the transplant's survival, we opted to analyse the development of preadipocytes within the fat transplant via stimulation of tissue perfusion with the angiogenesis enhancing hormone leptin. METHODS In a murine (C57BL/6N) model inguinal fat was autologously transplanted into a dorsal skinfold chamber. In the intervention group the fat transplant was treated with local administration of leptin (3 μg/ml) at days 3, 7 and 10 after transplantation. Saline solution was administered respectively in the control group. On the postoperative days 3, 7, 10, and 15 intra vital microscopy was done to assess the functional vessel density, vessel diameter, adipocyte survival and preadipocyte development. The study was completed by histological tissue analysis on days 15 after transplantation. RESULTS Leptin administration leads to an increase of angiogenesis, which starts from day 7 after implantation and elevates perfusion as well as functional vessel density FVD at days 10 and 15 after transplantation. Perfusion develops first from the border zones of the transplant. Histological evaluation showed that the percentage of perilipin positive adipocytes increased markedly in the study group of mice. Moreover, fat transplants of mice of the leptin group disclosed significantly higher Pref-1 positive cells than fat transplants of the control group. The findings reported in this study indicate that the leptin can enhance the survival and the quality of grafted fat tissue, which may be due to induction of angiogenesis. CONCLUSION Leptin administration to fat transplants induced an increase in angiogenesis in the transplanted tissue and may play a role in reducing the resorption rate of lipoaspirates.
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Affiliation(s)
- Jeannine S Schreiter
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig, Germany.
| | - Stefan Langer
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig, Germany
| | - Nora Klöting
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG) of the Helmholtz Zentrum München at the University of Leipzig and University Hospital Leipzig, Leipzig, Germany
| | - Olga Kurow
- Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig, Germany
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15
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Marten T, Elyassnia D. Periorbital Fat Grafting: A New Paradigm for Rejuvenation of the Eyelids. Facial Plast Surg Clin North Am 2021; 29:243-273. [PMID: 33906759 DOI: 10.1016/j.fsc.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Fat grafting represents the most important new addition to surgical procedures to rejuvenate the orbit since the inception of the "blepharoplasty" technique. Traditional blepharoplasty procedures do not always address the changes that occur with age in the orbital area and can actually degrade the appearance of the eye. Fat grafting allows treatment of age-associated loss of periorbital volume not addressed by traditional blepharoplasty procedures. Fat grafting is an artistically powerful method to rejuvenate the periorbital orbital area that often provides a more healthy, fit, youthful, and sensual appearance than traditional blepharoplasty procedures.
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Affiliation(s)
- Timothy Marten
- Marten Clinic of Plastic Surgery, 450 Sutter St Suite 2222, San Francisco, CA 94108, USA.
| | - Dino Elyassnia
- Marten Clinic of Plastic Surgery, 450 Sutter St Suite 2222, San Francisco, CA 94108, USA
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Abstract
OBJECTIVE To describe the author's experience with the high definition lipoabdominoplasty technique for the treatment of abdominal flaccidity and lipodystrophy, with correction of muscle diastasis and definition of body contours. METHODS This is a retrospective study analyzing the results of 146 patients operated on with the high definition lipoabdominoplasty procedure. RESULTS The average age was 37.93 years (25 to 58). The average body mass index was 25.68 kg/m2 (19.6 to 29.9 kg/m2). Combined surgeries were associated in 76 cases (52%). The results obtained are demonstrated by comparing the pre and postoperative photos. DISCUSSION With the advent of high definition liposuction, the results improved significantly, reaching a higher degree of definition and giving a more athletic and aesthetically pleasing contour. However, this procedure is not free of complications, and should be performed cautiously, while following specific protocols. With proper patient selection, this technique provides excellent outcomes when combined with abdominoplasty. 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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17
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Taminato M, Tomita K, Nomori M, Maeda D, Seike S, Tashima H, Yano K, Kubo T. Fat-augmented latissimus dorsi myocutaneous flap for total breast reconstruction: A report of 54 consecutive Asian cases. J Plast Reconstr Aesthet Surg 2020; 74:1213-1222. [PMID: 33257301 DOI: 10.1016/j.bjps.2020.10.089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 10/17/2020] [Accepted: 10/22/2020] [Indexed: 11/18/2022]
Abstract
Immediate fat grafting to the latissimus dorsi myocutaneous (LD) flaps is a breakthrough that addresses the issue of insufficient volume of LD. However, the use of this procedure in Asian patients has not yet been reported. Retrospective chart reviews were conducted on 54 Japanese cases of total breast reconstruction using fat-augmented LD flaps at our hospital from September 2017 to June 2019. There were 24 immediate reconstruction cases, 18 immediate two-stage reconstruction cases, nine delayed reconstruction cases, and three delayed two-stage reconstruction cases. Median age was 46 years (range, 29-69 years), and median body mass index was 21.5 (17-33.8). Median mastectomy specimen and flap weight was 225 g (123-993) and 225 g (130-796), respectively. The median volume of fat graft was 114 ml (46-305) for the LD flap and 58 ml (15-200) for the pectoralis major muscle. Of the 53 completed reconstruction cases, 38 (71.7%) achieved sufficient volume with the initial operation and six (11.3%) required additional fat grafting. The proportion of cases in the immediate reconstruction group, which achieved sufficient volume in the initial operation was significantly higher than those of the other three reconstruction groups (p = 0.007). Total breast reconstruction with fat-augmented LD flaps is a viable procedure for thin patients who have insufficient abdominal tissue, for those who wish to avoid abdominal scars, and for those in whom abdominal flaps have already been used. The procedure allows for large volume transplantation even with small skin paddles, which allows for smaller skin paddles to be designed without the need for extensive subcutaneous dissection.
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Affiliation(s)
- Mifue Taminato
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka Suita, Osaka 5650871, Japan
| | - Koichi Tomita
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka Suita, Osaka 5650871, Japan.
| | - Michiko Nomori
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka Suita, Osaka 5650871, Japan
| | - Daisuke Maeda
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka Suita, Osaka 5650871, Japan
| | - Shien Seike
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka Suita, Osaka 5650871, Japan
| | - Hiroki Tashima
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka Suita, Osaka 5650871, Japan
| | | | - Tateki Kubo
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka Suita, Osaka 5650871, Japan
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18
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Bonomi R, Johnson M, Toussoun G. Refining aesthetic approaches to tuberous breast using combined minimally invasive approaches to treat moderate asymmetric tuberous breast. J Surg Case Rep 2020; 2020:rjaa373. [PMID: 33005327 PMCID: PMC7515514 DOI: 10.1093/jscr/rjaa373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/17/2020] [Indexed: 11/29/2022] Open
Abstract
Tuberous breast deformity refers to a deformity of the breast that is characterized by varying degree of herniation of the breast parenchyma, widened nipple areolar complex, constriction of the breast base and may involve some degree of hypoplasia. Tuberous breast deformity is most often seen in young women who commonly presents due to dissatisfaction with breast symmetry, as this can be a source of significant psychosocial distress. Principles of reconstruction are focused on recreating an aesthetically pleasing breast shape and achieving symmetrization. Traditionally, reconstruction commonly involved utilization of breast implants or local flap to achieve these goals. The introduction of fat transfer has led to a paradigm shift in aesthetic breast surgery. Fat grafting is safe and can reliably achieve satisfactory aesthetic results in selected cases and reduces the need for implants or local flaps. Concepts that reduce scar burden allows for even more satisfactory aesthetic outcomes.
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Affiliation(s)
- Riccardo Bonomi
- Division of Oncoplastic and Cosmetic Breast Surgery, BMI Goring Hall Hospital, Worthing, UK
| | - Miguel Johnson
- Department of Plastic Reconstructive & Aesthetic Surgery, Queen Victoria Hospital NHS Trust, East Grinstead, UK
| | - Gilles Toussoun
- Division of Oncoplastic and Cosmetic Breast Surgery, BMI Goring Hall Hospital, Worthing, UK
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19
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Bonetti MA, Rovere G, Fulchignoni C, De Santis V, Ziranu A, Maccauro G, Pataia E. Autologous fat transplantation for the treatment of trapeziometacarpal joint osteoarthritis. Orthop Rev (Pavia) 2020; 12:8666. [PMID: 32913600 PMCID: PMC7459373 DOI: 10.4081/or.2020.8666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 11/23/2022] Open
Abstract
Rhizarthrosis is a progressive and disabling pathology affecting the carpometacarpal joint. It’s very common in elderly patients and typically affects postmenopausal women. The diagnosis of rhizarthrosis is mainly made by using different physical examination tests and by evaluating the type of pain and it’s then confirmed by imaging. Over the last few years increasing attention has been devoted to the assessment of new treatment techniques for rhizarthrosis. In this context intra-articular injection of autologous fat grafting for cartilage regeneration has demonstrated promising results in experimental settings as an alternative to open surgery procedures. The aim of this study was therefore to sum up the evidences available so far on autologous fat grafting as an emerging treatment for patients affected by carpometacarpal rizarthrosis. An electronic literature research was carried out on Pubmed, Google Scholars and Cochrane Library using “fat grafting”, “fat graft”, “adipose”, “fat transfer” and “lipoaspirate” as search terms. Authors believe autologous fat grafting is an interesting technique, that hand surgeon should keep in mind especially in early stages of rhizarthrosis were pain has not been solved with non-surgical treatment.
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Affiliation(s)
- Mario Alessandri Bonetti
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Giuseppe Rovere
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Camillo Fulchignoni
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Vincenzo De Santis
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Antonio Ziranu
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Giulio Maccauro
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Elisabetta Pataia
- Department of Orthopedics and Traumatology Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome; Università Cattolica Del Sacro Cuore, Rome, Italy
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20
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Bertrand B, Eraud J, Velier M, Cauvin C, Macagno N, Boucekine M, Philandrianos C, Casanova D, Magalon J, Sabatier F. Supportive use of platelet-rich plasma and stromal vascular fraction for cell-assisted fat transfer of skin radiation-induced lesions in nude mice. Burns 2020; 46:1641-1652. [PMID: 32475796 DOI: 10.1016/j.burns.2020.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/15/2019] [Accepted: 04/15/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND External radiotherapy has become indispensable in oncological therapies. Unfortunately, radiation is responsible for serious side effects, such as radiodermatitis. The skin is weakened and ulcerated. Our study aimed to evaluate the subcutaneous transfer of microfat (MF) alone and two mixes: MF+Platelet-rich plasma (PRP) and MF+stromal vascular fraction (SVF) to treat radiation-induced skin lesions. METHOD We defined randomly five experimental groups of nine mice: 1 healthy control group and 4 irradiated (60 Grey) and treated groups. The skin lesions were treated 3 months after irradiation by MF, MF+PRP (50%-50%), MF+SVF (90%-10%) or Ringer-lactate subcutaneous injections. Wound healing was evaluated at 1, 2 and 3 months post-injection and histological wound analysis at 3 months, after euthanasia. RESULTS All the irradiated mice presented with wounds. After sham-injection, the wound area increased by 91.1±71.1% versus a decrease of 15.9±23.1% after MF alone (NS), 27.3±23.8% after MF+SVF (NS) and 76.4±7.7% after MF+PRP (P=0.032). A significative reduction of skin thickness in wound periphery was measured for the three treated groups compared to sham-injection (P<0.05) but not in the healed wounds (NS). The most important subcutaneous neo-vessel density was shown after MF+SVF injection. CONCLUSION The MF+PRP mix was the most efficient product to increase healing. The MF+SVF mix showed the highest rate of neo-angiogenesis but was disappointing in terms of healing. LEVEL OF EVIDENCE Not gradable.
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Affiliation(s)
- Baptiste Bertrand
- Department of Plastic Surgery, La Conception Hospital, Assistance Publique - Hôpitaux de Marseille, France; Aix-Marseille Univ, C2VN, INSERM, INRA, France.
| | - Julia Eraud
- Department of Plastic Surgery, La Conception Hospital, Assistance Publique - Hôpitaux de Marseille, France.
| | - Mélanie Velier
- Aix-Marseille Univ, C2VN, INSERM, INRA, France; Culture and Cell Therapy Laboratory, INSERM CICBT-1409, La Conception Hospital, Assistance Publique - Hôpitaux de Marseille, France.
| | - Cécile Cauvin
- Department of Radiotherapy, Hopital Privé Clairval, Marseille, France.
| | - Nicolas Macagno
- Department of Pathology, la Timone Hospital, Assistance Publique - Hôpitaux de Marseille, France.
| | - Mohamed Boucekine
- Aix-Marseille Univ, EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, France.
| | - Cécile Philandrianos
- Department of Plastic Surgery, La Conception Hospital, Assistance Publique - Hôpitaux de Marseille, France.
| | - Dominique Casanova
- Department of Plastic Surgery, La Conception Hospital, Assistance Publique - Hôpitaux de Marseille, France.
| | - Jeremy Magalon
- Aix-Marseille Univ, C2VN, INSERM, INRA, France; Culture and Cell Therapy Laboratory, INSERM CICBT-1409, La Conception Hospital, Assistance Publique - Hôpitaux de Marseille, France.
| | - Florence Sabatier
- Aix-Marseille Univ, C2VN, INSERM, INRA, France; Culture and Cell Therapy Laboratory, INSERM CICBT-1409, La Conception Hospital, Assistance Publique - Hôpitaux de Marseille, France.
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Abstract
One of the greatest challenges in the progression of aesthetic medicine lies in providing treatments with long-term results that are also minimally invasive and safe. Keeping up with this demand are developments in autologous therapies such as adipose-derived stem cells, stromal vascular fraction, microfat, nanofat, and platelet therapies, which are being shown to deliver satisfactory results. Innovations in more traditional cosmetic therapies, such as botulinum toxin, fillers, and thread lifts, are even more at the forefront of the advancement in aesthetics. Combining autologous therapies with traditional noninvasive methods can ultimately provide patients with more effective rejuvenation options.
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Affiliation(s)
- Aunna Pourang
- Department of Dermatology, University of California, Davis, 3301 C Street, Suite 1400, Sacramento, CA 95816, USA
| | - Helena Rockwell
- University of California, San Diego, School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Kian Karimi
- Rejuva Medical Aesthetics, 11645 Wilshire Boulevard #605, Los Angeles, CA 90025, USA.
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22
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Abstract
Fat grafting is effectively used in the lower eyelid and periorbital area for rejuvenation of the aging face. Several complications may occur with fat grafting, including volume undercorrection or overcorrection, contour irregularities, prolonged bruising and swelling, infection, granulomas and inflammation, and vascular embolization with visual loss or stroke. In many cases, complications can be effectively treated, although permanent and serious injury can occur. Appropriate surgical techniques help to prevent most of these complications. An understanding of how and why complications of fat grafting of the lower eyelid occur aids in the avoidance and treatment of these complications.
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Affiliation(s)
- Robi N Maamari
- John F. Hardesty, MD Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8096, St. Louis, MO 63110, USA.
| | - Guy G Massry
- Ophthalmic Plastic and Reconstructive Surgery, 150 N. Robertson Boulevard, Suite 314, Beverly Hills, CA 90211, USA
| | - John Bryan Holds
- Ophthalmic Plastic and Cosmetic Surgery, Inc.,12990 Manchester Road, Suite 102, Des Peres, MO 63131-1860, USA
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23
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Abstract
Best practices in fat transfer to the face focus on tissue harvest and processing techniques. This article discusses the role of adipose-derived mesenchymal stem cells (MSCs) in mitigating tissue loss in grafting. Discrepancies among common practice and recent study results have propagated uncertainty with long-term results. Fortunately, recent increases in the understanding of these MSCs are leading providers to identify statistically more favorable tissue donor sites, harvest technique, and preparation methods to increase their concentration in transferred tissue. Future studies are needed to support or confound the long-term effects of MSC transfer on facial fat grafting.
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Affiliation(s)
- Christian H Barnes
- Facial Plastic and Reconstructive Surgery, The Maas Clinic, 2400 Clay Street, San Francisco, CA 94115, USA
| | - Corey S Maas
- Facial Plastic and Reconstructive Surgery, The Maas Clinic, 2400 Clay Street, San Francisco, CA 94115, USA.
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24
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Abstract
After massive weight loss, deflation of the tissues and loss of skin elasticity in the face and neck can result in the appearance of accelerated facial aging. Surgical facial rejuvenation can be successfully performed with several modifications. Proper preoperative counseling and expectation management regarding staged or ancillary procedures is recommended. Wide undermining of the face and neck, and extended postauricular incisions are required to allow for mobilization of excess skin and access to the mobile superficial musculoaponeurotic system (SMAS). Fat transfer into the deep malar compartment for midface volumizing is helpful. Treatment of the SMAS and platysma are universally necessary.
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Affiliation(s)
- Joshua T Waltzman
- Private Practice, Waltzman Plastic and Reconstructive Surgery, 3828 Schaufele Avenue, #360, Long Beach, CA 90808, USA.
| | - James E Zins
- Department of Plastic Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A60, Cleveland, OH 44195, USA
| | - Rafael A Couto
- Department of Plastic Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, A60, Cleveland, OH 44195, USA
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25
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Schiavone Panni A, Vasso M, Braile A, Toro G, De Cicco A, Viggiano D, Lepore F. Preliminary results of autologous adipose-derived stem cells in early knee osteoarthritis: identification of a subpopulation with greater response. Int Orthop 2018; 43:7-13. [PMID: 30280218 DOI: 10.1007/s00264-018-4182-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 09/21/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to report the clinical and functional results of a series of patients with early knee osteoarthritis (KOA) treated with the intra-articular injection of autologous adipose-derived stem cells (aASCs) plus arthroscopic debridement. The hypothesis was that protocol would significantly improve the clinical and functional outcomes in patients with early KOA. METHODS Fifty-two patients with early KOA, who received arthroscopic debridement followed by percutaneous injection of aASCs, were enrolled into the study and retrospectively analyzed with an average follow-up of 15.3 (range, 6 to 24) months. Patients were assessed through the IKS knee and function scores and VAS pain scale. RESULTS The mean IKS knee score improved from 37.4 (range, 14 to 79) points pre-operatively to 62.6 (range, 27 to 95) points at the latest follow-up (p < < 0.01). The mean IKS function score improved from 57.2 (range, 25 to 100) points pre-operatively to 83.0 (range, 35 to 100) points at the latest follow-up (p < < 0.01). The mean VAS score decreased from 8.5 (range, 3 to 10) pre-operatively to 5.1 (range, 0 to 8) at the latest follow-up (p < < 0.01). Additionally, patients with a pre-operative VAS score greater than 8 were found to show greater clinical and functional benefits compared with patients with VAS score lower than 8. CONCLUSIONS The knee injection of aASCs associated to arthroscopic debridement increased significantly the clinical and functional scores in patients with early KOA at a mid-term follow-up, especially those with higher pre-operative VAS scores.
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Affiliation(s)
- Alfredo Schiavone Panni
- Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, University of the Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
| | - Michele Vasso
- Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, University of the Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
| | - Adriano Braile
- Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, University of the Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
| | - Giuseppe Toro
- Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, University of the Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy.
| | - Annalisa De Cicco
- Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, University of the Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
| | - Davide Viggiano
- Department of Medical, Surgical, Neurological, Metabolic and Geriatrics Sciences, University of the Campania "Luigi Vanvitelli", Naples, Italy
| | - Federica Lepore
- Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, University of the Campania "Luigi Vanvitelli", Via L. De Crecchio 4, 80138, Naples, Italy
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Abstract
Gluteal augmentation with autologous fat transfer is an increasingly popular procedure that has the ability to transform a patient's entire body silhouette and gluteal appearance. Proper patient selection, preoperative evaluation, and planning are critical to the success of the procedure. Using the preoperative planning, surgical technique, and postoperative care described, the procedure can be performed safely with powerful and consistent results and avoidance of complications associated with gluteal fat transfer.
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Affiliation(s)
- Ashkan Ghavami
- Division of Plastic and Reconstructive Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Suite 465, Los Angeles, CA 90095, USA; Private Practice, Ghavami Plastic Surgery, 433 North Camden Drive, Suite 780, Beverly Hills, CA 90210, USA.
| | - Nathaniel L Villanueva
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390, USA
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Pantelides NM, Srinivasan JR. Rippling Following Breast Augmentation or Reconstruction: Aetiology, Emerging Treatment Options and a Novel Classification of Severity. Aesthetic Plast Surg 2018; 42:980-5. [PMID: 29546437 DOI: 10.1007/s00266-018-1117-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/04/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Implant rippling is a frequent complication following breast augmentation or implant-based reconstruction and results in significant patient dissatisfaction. Traditionally, the treatment has been to replace the implant, often placing it in a subpectoral pocket to reduce the risk of recurrence. Other techniques, such as increasing the implant size or tightening the capsule, can also be used. Recently, however, there has been much interest in alternative treatments, including fat grafting or insertion of an acellular dermal matrix. METHODS We review the evidence base for emerging treatments and propose a classification to grade severity, based on the typical clinical presentation of rippling: Grade 1-MILD-rippling is palpable but not visible: (1a) palpable in the lower outer quadrant, (1b) palpable in the upper inner quadrant (cleavage area); Grade 2-MODERATE-rippling is visible only when the patient bends forward; Grade 3-SEVERE-rippling is visible with the patient upright. CONCLUSION Our proposed classification aims to standardise the clinical description of rippling, which will be valuable in determining the efficacy of new treatments and better characterising long-term complications from breast augmentations or reconstructions. LEVEL OF EVIDENCE V 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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Clauser L, Lucchi A, Tocco-Tussardi I, Gardin C, Zavan B. Autologous Fat Transfer for Facial Augmentation and Regeneration: Role of Mesenchymal Stem Cells. Atlas Oral Maxillofac Surg Clin North Am 2018; 26:25-32. [PMID: 29362068 DOI: 10.1016/j.cxom.2017.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Danilla S. Rectus Abdominis Fat Transfer (RAFT) in Lipoabdominoplasty: A New Technique to Achieve Fitness Body Contour in Patients that Require Tummy Tuck. Aesthetic Plast Surg 2017; 41:1389-99. [PMID: 28634702 DOI: 10.1007/s00266-017-0909-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe a new technique to achieve a fit-look in lipoabdominoplasty patients through liposculpture and rectus abdominis fat transfer (RAFT). METHODS Patients with a body mass index under 26 and of both genders scheduled for abdominoplasty or body lift were selected for this procedure. Fat was transferred directly to the rectus abdominis muscle after flap elevation during lipoabdominoplasty. RESULTS A total of 26 patients were operated on with this technique. No complications attributable to the fat grafting were noticed. All patients had a high satisfaction level with the procedure. Demonstrative cases are shown. DISCUSSION The RAFT technique is a useful and effective technique to improve results in standard lipoabdominoplasty. Its main limitation is the adequate selection of the patient. The RAFT technique can be incorporated easily to common day practice. 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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Picard F, Hersant B, La Padula S, Meningaud JP. Platelet-rich plasma-enriched autologous fat graft in regenerative and aesthetic facial surgery: Technical note. J Stomatol Oral Maxillofac Surg 2017; 118:228-231. [PMID: 28576462 DOI: 10.1016/j.jormas.2017.05.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/22/2017] [Indexed: 11/19/2022]
Abstract
The goal of adding platelet-rich plasma (PRP) to autologous fat graft is to increase the survival rate of the graft. After their activation, platelets release some important growth factors. As a result, PRP may increase the proliferation and differentiation of Adipose-derived stem cells (ASCs) into adipocytes, improve fat graft vascularisation, and may block the apoptosis of grafted adipocytes. The other benefit expected from the addition of PRP to fat graft is the improvement of cutaneous trophicity above the grafted areas. An exhaustive review of the literature retrieved 11 clinical studies on humans and 7 on animals. A statistically significant increase of the survival rate of fat grafts has been found in 9 comparative studies. Our synthesis allowed us to set up the following protocol: addition of 20% of PRP activated with calcium hydrochloride to fat grafts. It may enhance the results of autologous facial fat graft in regenerative and aesthetic facial surgery.
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Affiliation(s)
- F Picard
- Department of plastic, reconstructive and maxillofacial surgery, Henri-Mondor hospital, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - B Hersant
- Department of plastic, reconstructive and maxillofacial surgery, Henri-Mondor hospital, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - S La Padula
- Department of plastic, reconstructive and maxillofacial surgery, Henri-Mondor hospital, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
| | - J-P Meningaud
- Department of plastic, reconstructive and maxillofacial surgery, Henri-Mondor hospital, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
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Debald M, Pech T, Kaiser C, Keyver-Paik MD, Walgenbach-Bruenagel G, Kalff JC, Kuhn W, Walgenbach KJ. Lipofilling effects after breast cancer surgery in post-radiation patients: an analysis of results and algorithm proposal. Eur J Plast Surg 2017; 40:447-454. [PMID: 28989237 PMCID: PMC5610213 DOI: 10.1007/s00238-017-1311-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/09/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lipofilling or autologous fat transfer is an established technique in plastic surgery. Herein, we describe the lipofilling effects after implant-based breast reconstruction in post-radiation patients and propose an algorithm for indication of lipofilling. METHODS Forty patients with a history of breast cancer were included in this retrospective analysis. Patients had undergone either breast conserving therapy or mastectomy. Twenty-six patients underwent additional radiation therapy. Patients were assessed using a post-radiation skin scoring classification. RESULTS In total, 68 lipofilling procedures were analyzed. Scar release, skin softening, improved quality of life, and improvement of post-radiation findings are results of lipofilling with a closed filtration system. In all patients with post-surgical radiation, an improvement of tissue quality was observed. Staging revealed that lipofilling improved mean post-radiation skin scores of 2.40 ± 0.89 to 1.21 ± 0.76 (p ≤ 0.000). There was no recurrence of breast cancer in our study patients. CONCLUSIONS This study introduces an algorithm using lipofilling in reconstructive breast surgery and especially in post-radiation patients with low risks as well as very high acceptance in patients with various indications for this procedure. A regenerative aspect was also detectable in patients following radiation therapy and reconstruction. Lipofilling is a safe and effective procedure with a low incidence of minor complications. It is therefore a feasible method to resolve volume deficiencies and asymmetric results after oncologic breast surgery. Nevertheless, a prospective study has now been initiated focusing on the oncologic safety of lipofilling including ultrasound and radiological examinations to validate the findings of this initial study. Level of Evidence: Level IV, therapeutic study.
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Affiliation(s)
- Manuel Debald
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology, University of Bonn, Bonn, Germany
| | - Thomas Pech
- Division of Plastic and Aesthetic Surgery, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany.,Department of Surgery, Centre for Integrated Oncology, University of Bonn, Bonn, Germany
| | - Christina Kaiser
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology, University of Bonn, Bonn, Germany
| | - Mignon-Denise Keyver-Paik
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology, University of Bonn, Bonn, Germany
| | | | - Joerg C Kalff
- Department of Surgery, Centre for Integrated Oncology, University of Bonn, Bonn, Germany
| | - Walther Kuhn
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology, University of Bonn, Bonn, Germany
| | - Klaus J Walgenbach
- Division of Plastic and Aesthetic Surgery, University of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
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Dolen U, Cohen JB, Overschmidt B, Tenenbaum MM, Myckatyn TM. Fat Grafting with Tissue Liquefaction Technology as an Adjunct to Breast Reconstruction. Aesthetic Plast Surg 2016; 40:854-862. [PMID: 27562834 PMCID: PMC5133286 DOI: 10.1007/s00266-016-0690-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/04/2016] [Indexed: 01/23/2023]
Abstract
Background Tissue liquefaction technology (TLT) delivers warmed saline from the liposuction cannula tip at low pressure pulses to disaggregate adipocytes. This technology differs significantly from that used in other liposuction devices including water jet-assisted liposuction. Here we introduce our early experience with this technology in the setting of fat transfer for revision breast reconstruction. Methods A retrospective chart review of 136 consecutive patients who underwent fat harvest with TLT and subsequent transfer into 237 breast reconstructions was conducted at a single institution. This two-surgeon series examined donor and recipient site complication rates over a median follow-up of 143 days [87–233]. Results The overall complication rate was 28.7 %, of which the majority (22.1 %) was fat necrosis at the recipient site as documented by any clinical, imaging, or pathologic evidence. The abdomen served as the donor site for half of the cases. Donor site complications were limited to widespread ecchymosis of the donor site notable in 10.4 % of cases. Twenty-five percent of patients had received postmastectomy radiotherapy prior to fat transfer. Prior to revision with fat transfer, implant-based breast reconstruction was used in 75.5 % of cases, and autologous flaps in the remainder. Fat transfer was combined with other reconstructive procedures 94.1 % of the time. Conclusions TLT can be used to harvest adipocytes for fat transfer with donor site morbidity and recipient site complications comparable to other modalities. The efficiency and quality of harvested fat makes this technology appealing for wide spread adoption during fat transfer. Level of Evidence IV This journal requires that the 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)
- Utku Dolen
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 1040 N. Mason, Ste 124, St Louis, MO, 63141, USA
| | - Justin B Cohen
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 1040 N. Mason, Ste 124, St Louis, MO, 63141, USA
| | - Bo Overschmidt
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 1040 N. Mason, Ste 124, St Louis, MO, 63141, USA
| | - Marissa M Tenenbaum
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 1040 N. Mason, Ste 124, St Louis, MO, 63141, USA
| | - Terence M Myckatyn
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 1040 N. Mason, Ste 124, St Louis, MO, 63141, USA.
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Affiliation(s)
- Jacob Haiavy
- Inland Cosmetic Surgery, 8680 Monroe Ct, Rancho Cucamonga, CA 91730, USA.
| | - Husam Elias
- Southern California Center for Surgical Arts, 4910 Van Nuys Boulevard, Suite 102, Sherman Oaks, CA 91403, USA
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Harats M, Millet E, Jaeger M, Orenstein A, Haik J, Hajdu SD, Markel G, Winkler E, Tessone A. Adipocytes Viability After Suction-Assisted Lipoplasty: Does the Technique Matter? Aesthetic Plast Surg 2016; 40:578-83. [PMID: 27194429 DOI: 10.1007/s00266-016-0645-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/15/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Suction-assisted lipoplasty (SAL; liposuction) is an established aesthetic procedure in plastic surgery. The main parameters differentiating one method of lipoplasty from another are safety, consistency of results, and other more technical parameters. Due to the recent popularity of lipotransfer, the quality of extracted fat has become a relevant parameter. We compare the viability of extracted adipocytes after dry SAL, hyper-tumescent PAL (power-assisted lipoplasty), and water-assisted lipoplasty (WAL). METHODS We used fluorescent microscopy to differentiate viable from necrotic/apoptotic cells after liposuction using each of the mentioned methods. RESULTS The ratio of living cells between the three methods was significantly different with dry liposuction yielding inferior ratios (p = 0.011). When omitting extreme results, we found that the body-jet technique (WAL) yielded higher ratios of living cells than the hyper-tumescent technique (p < 0.001). The total number of cells was highest in the hyper-tumescent method (p = 0.013). CONCLUSIONS Our results indicate that the hyper-tumescent technique yields the highest number of cells, whereas the body-jet technique yields the highest living cells ratio. The dry technique is clearly inferior to both. NO LEVEL ASSIGNED 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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Gassman AA, Kao KK, Bradley JP, Lee JC. Quantification of adipose transfer viability using a novel, bioluminescent murine model. J Plast Reconstr Aesthet Surg 2016; 69:959-65. [PMID: 27017232 DOI: 10.1016/j.bjps.2016.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 01/09/2016] [Accepted: 02/10/2016] [Indexed: 11/24/2022]
Abstract
Fat grafting has highly variable long-term results. Research efforts to improve the reliability of fat grafting are limited by inefficient methods for evaluation of fat engraftment. In this work, we describe a novel animal model for the quantitative evaluation of fat grafting using in vivo bioluminescence of adipocytes from luciferase-expressing mice. Subcutaneous adipose tissue from GFP and luciferase-expressing FVB mice were obtained. The samples were homogenized, decanted, and injected into the dorsal skin folds of wild-type FVB mice. Viability of the transferred tissue was examined over a 28-day time period with quantitative bioluminescence after luciferin injection. All animals demonstrated viable adipose transfer with bioluminescence detectable on days 0, 1, 7, 14, and 28. This animal model may be used for noninvasive, longitudinal studies for quantification of the fat engraftment process.
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Affiliation(s)
- Andrew A Gassman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, UCLA David Geffen School of Medicine, CA, USA.
| | - Kenneth K Kao
- Division of Plastic and Reconstructive Surgery, Department of Surgery, UCLA David Geffen School of Medicine, CA, USA
| | - James P Bradley
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Temple University Hospital and School of Medicine, PA, USA
| | - Justine C Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, UCLA David Geffen School of Medicine, CA, USA
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Ho Quoc C, Faure C, Carrabin N, Istasse F, Rivoire M, Delay E. [Glandular posterior flap of the breast for oncoplastic surgery]. ACTA ACUST UNITED AC 2014; 44:510-5. [PMID: 25200348 DOI: 10.1016/j.jgyn.2014.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 06/28/2014] [Accepted: 07/08/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Breast conservative surgeries, associated with radiotherapy within the framework of conservatives treatments for breast malignant tumors, can occur deformation of the breast in 10 to 15% of cases. The deformity can be more or less important according to the size of the initial lesion and the glandular reshaping reconstruction. Our experience in oncologic and reconstructive surgery of the breast reflects us about difficult cases of breast conservative surgeries in a glandular reshaping to obtain the best aesthetic result. In this approach, the posterior glandular flap of the breast was used in specific indications. The study aims to estimate the efficiency and the tolerance of the posterior glandular flap in difficult cases of breast oncoplastic surgeries. MATERIAL AND METHODS We realized a consecutive serie of 24 breast oncoplastic surgeries. We noticed 15 breast conservative surgeries of superior quadrants. The posterior glandular flap was realized in 15 cases. We used the posterior part of the breast, vascularized by musculo-cutaneous intercostal arteries to give the volume lacking in the breast. We estimated efficiency and tolerance of the posterior glandular flap than one-year operating comment, as well as the oncologic follow-up long-term. RESULTS In this serie of 15 cases, we did not note acute complications like infection, hematoma or cutaneous necrosis. We listed 13 cases of malignant tumors with indication of radiotherapy, and 2 cases of benign tumors. In one year, we found two patients presenting a cyst of cytosteatonecrosis (1cm and 3cm) in the site of surgery, compared to posterior flap. The glandular total average excision was 333g (30-1200). An oncologic surgical resumption was necessary in 2 cases (a case of preventive mastectomy for BRCA1, and a case of insufficient margins). We realized 12 cases of controlateral surgery at the same time for symmetry. The aesthetic result was judged at one year post-operatory: good or very good in 74% of the cases, correct in 20% of the cases, and insufficient in 6% of the cases. The oncologic follow-up did not find locoregional recurrence. CONCLUSION The posterior glandular flap is an interesting contribution in oncoplastic surgery of superior quadrants of the breast to replace harmoniously the missing volume. This flap, reliable and reproductible, offers an alternative to bring of the custom-made volume without residual deformation of the breast. The aesthetic results allowed, in spite of the radiotherapy, to decrease the aftereffects of breast conservative surgery treatments, and this interesting approach deserves a wider distribution.
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Affiliation(s)
- C Ho Quoc
- Cabinet privé : clinique du Val d'Ouest, 39, chemin de la Vernique, 69130 Ecully, France; Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France.
| | - C Faure
- Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France
| | - N Carrabin
- Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France
| | - F Istasse
- Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France
| | - M Rivoire
- Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France
| | - E Delay
- Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France
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Krumboeck A, Giovanoli P, Plock JA. Fat grafting and stem cell enhanced fat grafting to the breast under oncological aspects--recommendations for patient selection. Breast 2013; 22:579-84. [PMID: 23769661 DOI: 10.1016/j.breast.2013.05.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 05/05/2013] [Indexed: 11/29/2022] Open
Abstract
Reconstructive and aesthetic fat grafting has been introduced to the breast level over the last years. The safety of such procedures has so far not been completely clarified. The concept has now been refined to stem cell enhanced fat grafting. However beside the promise of using adult stem cells in terms of tissue rejuvenation and augmentation, scar treatment and reconstruction, the variance of adipose stem cell function--including angiogenetic, antiapoptotic, immunomodulatory, chemotactic and anti-scarring potential--raises new scepsis about oncological safety. Herein we reviewed experimental and clinical data on fat grafting and stem cell enhanced fat grafting addressing surgical promise and oncological concerns. Based on these data we suggest clinical criteria for patient selection undergoing fat grafting for aesthetic or reconstructive reasons based on their individual breast cancer risk.
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Affiliation(s)
- Anna Krumboeck
- Division of Plastic and Hand Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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Abstract
Lupus erythematosus profundus, a form of chronic cutaneous lupus erythematosus, is a rare inflammatory disease involving in the lower dermis and subcutaneous tissues. It primarily affects the head, proximal upper arms, trunk, thighs, and presents as firm nodules, 1 to 3 cm in diameter. The overlying skin often becomes attached to the subcutaneous nodules and is drawn inward to produce deep, saucerized depressions. We present a rare case of lupus erythematosus profundus treated with autologous fat transfer.
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Affiliation(s)
- Jimi Yoon
- Department of Dermatology and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Jinju, Korea
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