Treatment of intractable orbital implant exposure with a large conjunctival defect by secondary insertion of the implant after preceding dermis fat graft

AIM: To report a procedure and results of a two-stage operation to manage intractable extensive orbital implant exposure with a large conjunctival defect which was difficult to treat with dermis fat grafts due to repeated graft necrosis. METHODS: A retrospective chart review of four patients who had extensive orbital implant exposures with large conjunctival defects and had past histories of repeated autologous or preserved dermis graft failures was done. As a first-stage operation, the problematic pre-existing orbital implants were removed and autologous dermis fat grafts alone were performed on the defect area. Four months later, new orbital implants were secondarily inserted after confirmation of graft survival. The size of the conjunctival defects and state of the extraocular muscles were checked preoperatively. Success of the operations and complications were investigated.RESULTS: The mean size of the conjuctival defects was 17.3mm×16.0mm, and the mean time from the initial diagnosis of orbital implant exposure to implant removal and autologous dermis fat graft was 20.8 months. After implant removal and autologous dermis fat graft, no graft necrosis was observed in any patients. Also, implant exposure or fornix shortening was not observed in any patients after new orbital implant insertion. CONCLUSION: The secondary insertion of a new orbital implant after pre-existing implant removal and preceding dermis fat graft is thought to be an another selective management of intractable orbital implant exposure in which dermis fat grafts persistently fail.

Effects of radiation and chemotherapy on adipose stem cells: Implications for use in fat grafting in cancer patients

Autologous fat transplantation is a versatile tool in reconstructive surgery.Adipose-derived stem cells(ASCs)increase survival of fat grafts and thus are increasingly used for breast reconstruction in breast cancer patients.However,radiation and/or chemotherapy have been proposed to inhibit soft tissue regeneration in wound healing thus suggesting alteration in stem cell pathways.Therefore,elucidating effects of radiation and chemotherapy on ASCs is critical if one desires to enhance the survival of fat grafts in patients.This review outlines our work evaluating the function and recoverability of ASCs from radiation or chemotherapy patients,focusing specifically on their availability as a source of autologous stem cells for fat grafting and breast reconstruction in cancer patients.Even though evidence suggests radiation and chemotherapy negatively influence ASCs at the cellular level,the efficiency of the isolation and differentiation capacity did not appear influenced in patients after receiving chemotherapy treatment,although fat from radiated patients exhibited significantly altered ASC differentiation into endothelial-like cells.Further,the in vitro growth rates of patient’s ASCs do not differ significantly before or after treatment.Taken together,these studies suggest ASCs as an important new tool for grafting and reconstruction even when radiation and chemotherapy treatment are involved.

Augmentation mammoplasty with autologous fat grafting

Considering the issues that can accompany prosthetic breast implants,augmentation mammoplasty(AM)with autologous fat grafting(AFG)has attracted growing interest globally,especially in the last two decades,as breast implant-associated anaplastic large cell lymphoma has been increasing in incidence over time.Here,we review the detailed processes of AFG to the breast and the pertinent complications associated with this procedure.This study aims to elucidate the critical points and technique improvements in AM with AFG in recent years,as well as discuss how to decrease complications related to this procedure.Attention was focused on the specific AFG steps,clinical outcomes,and complications to highlight the advantages and disadvantages of the available protocols.

Current state and exploration of fat grafting

Fat grafting has become one of the most frequently used techniques in plastic and reconstructive surgery.Many studies have focused on optimizing procedures,such as donor site selection,harvesting,processing,and grafting.Representative basic techniques include Coleman’s and“3L3M”techniques.A new technique called compartment-based targeted fat grafting(CTFG)has gradually been established based on anatomical findings of the facial and hand compartments.CTFG achieved precise restoration of the fat volume in the anatomical state.Cell-based fat grafting has introduced new fields involving tissue repair and regeneration,including facial rejuvenation and scar improvement,among others.In this review,we summarize the timeline for the development of fat grafting.

Fat Grafting for Rejuvenation and Regeneration with Stromal Vascular Fraction Gel

Lipotransfer has become a powerful regenerative tool,largely because of its cellular components,the stromal vascular fraction(SVF).However,the clinical separation of cells with collagenase is strictly legislated.In 2017,Yao et al.postulated a novel fat-derived product mechanically concentrating SVF cells and an extracellular matrix(ECM)and named it stromal vascular fraction gel(SVF-gel).This review discussed the protocol of SVF-gel and its component as well as its inner structure.The histologic examination and the retention rate after the transplantation of SVF-gel were also rendered.Moreover,we summed up the rejuvenating and regenerative use of SVF-gel and introduced its possible mechanism.

Current Status of ADSCs-Enriched Fat Grafts in Plastic Surgery

Autologous fat grafting is an increasingly popular technique in plastic surgery for volume augmentation and rejuvenation.However,the unpredictability of long-term volume retention limits its clinical application.Various animal studies have documented the positive effects of adipose tissue-derived stem cells(ADSCs)on the acceleration of lipofilling.However,the results have been inconsistent,and there is an insufficient number of high-quality clinical studies to formulate evidence-based recommendations for ADSC-enriched fat grafts.Moreover,related technical standards,such as the final count of harvested ADSCs and the enrichment ratio,have not yet been established.This systematic review included all clinical trials on ADSC-enriched fat grafts in plastic surgery from PubMed in the past 10 years,as well as all registered clinical trials on ClinicalTrials.Gov.To examine the current landscape of ADSCs harvest,we summarize the current applications of ADSCs in the field of plastic surgery and discuss the current barriers to universal clinical use.

Treatment of Temporomandibular Joint (TMJ) Reankylosis with Preservation of the TMJ Prosthesis and Use of Fat Graft: A Case Report and Review of the Literature

We report on a case of TMJ reankylosis (heterotopic bone) following total TMJ alloplastic reconstruction in a 40-year-old Black male. The heterotopic bone was excised following removal of the fossa component. The fossa component was re-inserted, and the periarticular tissue was grafted with fat procured from the abdomen. Patient was placed on an aggressive physiotherapy programme which was monitored for a period of 6 months. He returned for review one year later with a mouth opening of 27 mm. We present also a short review of the literature on heterotopic bone formation. This case is of particular interest in that despite the heterotopic bone around it;the prosthesis was preserved after the bone was removed.

Initial Experience of Face Augmentation Using Fat Graft-Platlet Rich Plasma Mix

Plastic surgeons accustomed to use autologous fat grafs for augmentation of soft tissues in the last two decades. The main drawback of fat grafting is unpredictable graft resorption. Several studies have searched for new ways of increasing the viability of the transplanted tissue to overcome this disadvantage. The most recent and promising approach is to mix the fat graft with Platelet-Rich Plasma (PRP) before transplantation. The purpose of this article is to present the initial experience using the autologous fat injection with platlet rich plasma as a method for fascial augmentation.

Treatment of Steroid Induced Lipoatrophy with Structural Fat Grafting

Background: Systemic corticosteroid injections are used to treat a variety of medical conditions. Inaccurate placement of intramuscular injections of corticosteroid can result in local lipoatrophy, and a resultant cosmetic deformity. Objective: Describe the condition, and a simple, reproducible method of correcting the volume deficiency and skin changes associated with steroid induced lipoatrophy Methods: A retrospective chart review was undertaken of all patients treated by the author for steroid induced lipoatrophy between June of 2005 and March of 2011. Results: Structural fat grafting was used to treat 11 patients with steroid induced lipoatrophy during this time period. 10 patients were female and one was male. 9 of the patients had atrophy of the buttock or hip, and 2 had atrophy of the upper extremity. All patients had satisfactory correction of their deformities, and only one of the patients required a second grafting session to achieve an adequate volume for complete correction. Conclusions: Structural fat grafting can eliminate the volume deficiency and skin changes associated with steroid induced lipoatrophy. It is a straightforward, well tolerated method for correcting a problem which can be quite cosmetically deforming.

Dermis-fat graft for contracted socket reconstruction in an indigenous black population, Southwestern Nigeria

The purpose of this case series is to report the indications for dermis-fat grafting and the outcome of treatment in orbital soft tissue contraction among patients in a tertiary center. It is a retrospective, consecutive, interventional case series where all patients with orbital soft tissue contraction who had dermis-fat grafting were studied. All nine patients in our series underwent secondary dermis-fat grafting for orbital soft tissue reconstruction. The major cause for contracted socket was surgical eye removal following trauma. Eight of nine patients had no orbital implants inserted at the time of primary eye removal and eight patients have had failed orbital reconstructive procedures. Satisfactory cosmetic results were reported in all patients post-operatively. Dermis-fat grafting for contracted socket reconstruction was found to give satisfactory cosmetic results in our studied population.

A Systemic Review of Autologous Fat Grafting Survival Rate and Related Severe Complications

Objective：Clinical application ofautologous fat grafting （AFG） is quickly expanding.Despite the widely acceptance,long-term survival rate （SR） of AFG remains a question not yet solved.Meanwhile,although rare,severe complications related to AFG including vision loss,stroke even death could be seen in the literature.Data Sources：A comprehensive research of PubMed database to June 2013 was performed according to guidelines of the American Society of Plastic Surgeons Fat Graft Task Force Assessment Methodology.Articles were screened using predetermined inclusion and exclusion criteria.Study Selection：Data collected included patient characteristics,surgical technique,donor site,recipient site,graft amount,and quantified measurement methods.Patient cohorts were pooled,and SR was calculated.All the severe complications were also summarized according to the different clinical characteristics.Results：Of 550 articles,16 clinical articles and 10 animal studies met the inclusion criteria and provided quantified measurement methods.Totally,596 patients were included.SR varied from 34％ to 82％ in breast and 30-83％ in the facial area.Nude mice were applied to investigate human fat grafting SR （38.3-52.5％ after 15 weeks）.Rabbits were commonly used to study animal AFG SR （14.00-14.56％ after 1-year）.Totally,21 severe complications were reported,including death （2）,stroke （10）,vision loss （11,8 of which accompanied with stroke）,sepsis （3）,multiple abscess （1） and giant fat necrotic cyst （2）.Ten of these complications happened within 10 years.Conclusions：There is no unified measurement method to evaluate fat graft SR until now and no clinical evidence to show better SR according to different donor and recipient cite.Body mass index change between pre-and postoperation may be the bias factor in evaluating fat SR.Fat embolisms of the ophthalmic artery and the middle cerebral artery are the most severe complication of AFG and still lack of effective treatment.

Comparison of adipose particle size on autologous fat graft retention in a rodent model

Aim:Unpredictable retention outcomes remain a significant issue in autologous fat grafting procedures.Liposuction cannula variation leads to variability in fat particle size.Recent data suggest that the size of fat particles is closely related to graft healing outcomes;however,this remains a point of contention due to potential confounding variables such as tissue trauma with harvest.The aim of this study was to compare autologous fat grafting outcomes with variable fat particle sizes in an animal model which isolated fat particle size as the primary experimental variable.The overall goal of this work was to determine if reducing fat particle size is an effective method for enhancing graft retention in autologous fat grafting.Methods:The range of fat particle diameter harvested by four common liposuction cannulas was quantified to define relevant small and large particle target diameters.To determine if particle size impacted nutrient and oxygen permeability,small and large particles were incubated in vitro in a spinner flask with an abundance of culture media and vascular endothelial growth factor secretion was measured with enzyme-linked immunosorbent assay.Finally,small and large fat grafts were prepared from subcutaneous mouse fat pads and grafted in syngeneic Balb/CJ mice.Weight and volume retention were evaluated at 1,4,8,and 12 weeks.Histological analysis with Masson's trichrome and perilipin immunofluorescent staining was performed.Real-time quantitative polymerase chain reaction was performed foradipogenic,inflammatory and apoptotic genes.Results:The range of fat particle diameters harvested with four commonly used cannulas was 2-7 mm.In vitro studies showed that 5-7-mm particles had significantly increased VEGF secretion normalized to weight,indicating increased tissue hypoxia in these particles compared to 2-4-mm particles.Surprisingly,in vivo comparison in two unique studies showed 2-4-mm and 5-7-mm fat particles had comparable graft retention(P=0.5329).Masson's trichrome staining revealed increased extracellular matrix and fibrosis in the 5-7-mm particle group(P=0.0115).Adipocyte survival with perilipin demonstrated comparable viability.Gene expression showed large particles experienced increased inflammation and apoptosis at one week after grafting,but overall there were no significant differences between groups.Conclusion:The ideal fat particle size should be large enough to contain adequate mesenchyme while not so thick as to preclude imbibition.This study suggests that,despite changes in hypoxia and VEGF levels,differing fat particles(2-4-mm and 5-7-mm)can achieve similar graft retention.

A promising tool for surgical lipotransfer: a constant pressure and quantity injection device in facial fat grafting

Background: The purpose of this study was to preliminarily assess a constant pressure and quantity fat granule injection device for minimal invasive properties in clinic.Methods: A retrospective controlled study was carried out, from October 2013 to January 2015, on 76 female healthy patients aged between 26 and 53 years at the General Hospital of Lanzhou Military Command, China. To achieve small volume, high thrust, and precision requirements of facial fat grafting, an integrated handheld controller and motor design was adopted, reducing the volume and weight of the fat transplantation injection device. The 76 patients underwent 90 procedures each side of the face;each patient was treated with the aforementioned device on the face's left side, while a conventional hand-push injection device was used on the right side as control. The outcome was assessed on pre- and postoperative images, with 6-24 months follow-up.Results: The current device consistently allowed deposition of fat threads at about 55 μL/cm after cannula withdrawal;the volume of fat injected could be precisely adjusted to 0.04 mL/s. This device had the advantages of small-volume injection and convenient operation. The patients exhibited a good, stable shape and a smooth contour line in both sides. The long term satisfaction was higher for the left side than for the right one. Nodules and unevenness occurred only on the right side. Ecchymosis occurred significantly less frequent on the left side than the right one. Intraoperative pain was significantly lower for the left side than the right one.Conclusions: This device offered superior control compared with the conventional one and constitutes a promising tool for surgeons practicing lipotransfer.

A Novel Composite Skin Graft Technique with Fat Derivatives

Skin grafting,although a relatively classic and well-known technique,still has multiple disadvantages such as secondary contracture of the skin graft,sunken depression,poor elasticity,and color mismatch.Adding adipose tissues significantly improved the graft appearance compared to traditional skin grafting methods.Herein,we report two cases of modified skin graft procedures,both showing positive outcomes.In case 1,a mechanically processed fat-derived product was injected into the lower half of the skin graft area.In case 2,left upper eyelid blepharoplasty was performed,and the orbital fat strip was transferred and placed under the recipient area on the right side.Hair growth was observed only in case 1,whereas the extent of sunken depression was significantly reduced in both cases.Compared to traditional skin grafting methods,adding fat components to the skin graft recipient area improved the appearance and blood supply,together with enhancing the regenerative rate.

Fat Re-Grafting in Facial Asymmetry: A 2-Case Report

Fat redistribution through recycling of previously grafted fat hasn’t been reported. Two facial asymmetry patients are presented with history of fat grafting to the mandibular angle areas. Collected fat from these formerly fat grafted zones and swollen on subsequent extra body weight gain has been re-grafted in the temporal regions for contour enhancement and has retained volume as photographically documented up to 30 months.

Nanofat自体脂肪移植术改善面部瘢痕的疗效及护理研究

目的:通过研究自体脂肪移植技术在改善面、颈部瘢痕中的应用,探讨其改善面、颈部瘢痕外观与皮肤组织质地的临床疗效。方法:选取2016年8月-2018年2月笔者科室收治的面颈部瘢痕患者40例,进行自体纳米脂肪填充术,运用肿胀麻醉技术在患者腰腹部、大腿外侧抽取脂肪,通过清洗、静置去除多余油脂及肿胀液后进行纳米技术处理,得到的纳米脂肪填充至患者额部、面颊部、颈部瘢痕处。术前进行围手术期宣教,术中密切监测患者生命体征,术后进行创面护理、心理护理及并发症护理,纳米脂肪移植的存活率是整个手术成功与否的关键,优质的围手术期护理协助保障手术的成功。结果:40例患者纳米脂肪填充术后愈后良好,满意度高。面颈部瘢痕质地变软,3个月后瘢痕颜色变浅,且未凸出于皮肤表面,个别痤疮所致的瘢痕皮肤肤质也变得细腻有光泽,痤疮凹陷及颜色变浅,炎症减轻。所有患者术后均未发生感染、血肿等并发症,且术后填充部位均未出现团状或条索状硬结。结论:纳米脂肪填充术具有创伤小、受区形态均匀自然、可终生存活等优势,术后效果良好,能有效改善面、颈部瘢痕,患者满意度高。

Role of adipose tissue grafting and adipose-derived stem cells in peripheral nerve surgery

The application of autologous fat grafting in reconstructive surgery is commonly used to improve functional form.This review aims to provide an overview of the scientific evidence on the biology of adipose tissue,the role of adipose-derived stem cells,and the indications of adipose tissue grafting in peripheral nerve surgery.Adipose tissue is easily accessible through the lower abdomen and inner thighs.Non-vascularized adipose tissue grafting does not support oxidative and ischemic stress,resulting in variable survival of adipocytes within the first 24 hours.Enrichment of adipose tissue with a stromal vascular fraction is purported to increase the number of adipose-derived stem cells and is postulated to augment the long-term stability of adipose tissue grafts.Basic science nerve research suggests an increase in nerve regeneration and nerve revascularization,and a decrease in nerve fibrosis after the addition of adipose-derived stem cells or adipose tissue.In clinical studies,the use of autologous lipofilling is mostly applied to secondary carpal tunnel release revisions with promising results.Since the use of adipose-derived stem cells in peripheral nerve reconstruction is relatively new,more studies are needed to explore safety and long-term effects on peripheral nerve regeneration.The Food and Drug Administration stipulates that adipose-derived stem cell transplantation should be minimally manipulated,enzyme-free,and used in the same surgical procedure,e.g.adipose tissue grafts that contain native adipose-derived stem cells or stromal vascular fraction.Future research may be shifted towards the use of tissue-engineered adipose tissue to create a supportive microenvironment for autologous graft survival.Shelf-ready alternatives could be enhanced with adipose-derived stem cells or growth factors and eliminate the need for adipose tissue harvest.

黄芪联合川芎嗪减少游离真皮脂肪瓣体积损失的作用及机制研究

目的:研究中药黄芪联合川芎嗪在减少游离真皮脂肪瓣体积损失中的作用及其机理,探索最佳的辅助用药方案。方法:将80只雌性SD大鼠腹部的游离真皮脂肪瓣移植到胸部,成功建模。随后将大鼠分成4组(每组20只):对照组,每天腹腔注射生理盐水;黄芪注射液组,每天腹腔注射黄芪注射液(2 g/mL);川芎嗪注射液组,每天腹腔注射川芎嗪注射液(2.4 mg/mL);黄芪+川芎嗪组,每天腹腔注射含有黄芪注射液和川芎嗪注射液1:1的混合液,持续4周。每组在术后即刻、1周、2周和4周取出移植物,测定各时间点真皮脂肪瓣的重量和厚度、氧化损伤程度,并测定血管内皮细胞生长因子(VEGF)和高度糖基化的I型跨膜糖蛋白(CD34)的表达。结果:所有给药组都能增加游离真皮脂肪瓣的重量和厚度(P<0.001),提高超氧化物歧化酶(SOD)和谷胱甘肽过氧化物酶(GSH-Px)的活性,并降低真皮脂肪中丙二醛(MDA)的含量(P<0.05);所有给药组在第4周都显著增加了游离真皮脂肪瓣组织VEGF的表达,其中黄芪注射液联合川芎嗪注射液显著增加了CD34的表达(P<0.05)。结论:黄芪注射液和川芎嗪注射液有助于促使新生血管的形成,减少皮瓣缺血再灌注损伤,有助于延缓真皮游离脂肪萎缩。在体积维持上,黄芪注射液和川芎嗪注射液联合应用效果最佳。

自体脂肪颗粒与透明质酸填充鼻唇沟皱纹的疗效比较观察

目的对比自体脂肪颗粒移植与透明质酸注射在填充鼻唇沟皱纹患者中的临床疗效。方法收集2018年2月至2023年2月于我院行鼻唇沟皱纹注射填充治疗的患者,经纳入排除标准筛选后,最终A组(自体脂肪颗粒)和B组(透明质酸)各纳入20例患者,术后进行12个月的随访,比较两组患者术后疗效、满意率及并发症发生情况。结果分别于术后1、3、6、12月各时间点对两组患者进行随访,两组WSRS评分较治疗前均呈现先下降后回升的趋势,B组WSRS评分在随访结束后回归治疗前基线水平。两组WSRS评分在各时间点进行组间差异性比较,治疗前及治疗后1、3月差异无统计学意义(P>0.05),治疗后6、12月差异有统计学意义(P<0.05)。随访期间两组患者同时行GAIS评分,统计各时间点患者满意率,治疗后12月A组患者满意率高于B组,差异有统计学意义(P<0.05)。统计注射后出现的并发症(疼痛、肿胀、淤青、结节),B组出现疼痛的概率明显高于A组(P<0.05),其余均无统计学差异。结论自体脂肪颗粒移植与透明质酸注射治疗鼻唇沟皱纹均具有良好的治疗效果,前者的效果持续时间更久、并发症发生率低并且通常可以获得更高的满意度。

不同伤口负压治疗模式联合自体脂肪微粒移植在糖尿病足足部创面修复中的应用效果

目的 探讨不同伤口负压治疗模式联合自体脂肪微粒移植在糖尿病足足部创面修复中的应用效果。方法 选取72例糖尿病足患者,将患者随机分为观察组和对照组,每组36例。常规手术清创后,两组患者均行自体脂肪微粒移植,在此基础上,对照组行负压封闭引流治疗,观察组行负压辅助闭合治疗,均持续治疗至出院,并于治疗结束后随访3个月。比较两组患者的临床疗效、换药次数、创面愈合时间和住院时间。结果 观察组的治疗总有效率高于对照组(P<0.05)。观察组的换药次数少于对照组,创面愈合时间和住院时间均短于对照组(均P<0.05)。结论 负压辅助闭合联合自体脂肪微粒移植在糖尿病足足部创面修复中的疗效确切,可缩短患者住院时间,减少换药次数,有利于创面的快速愈合,并促进患者恢复。